NFI INDUSTRIES, ZURICH AMERICAN INS. CO. c/o GALLAGHER BASSETT SERVICES JOAQUIN GONZALEZ WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAJOAQUIN GONZALEZ, Applicant,vs.NFI INDUSTRIES, ZURICH AMERICAN INS. CO. c/o GALLAGHER BASSETT SERVICES, Defendants.Case No. ADJ7214982OPINION AND ORDER DENYING PETITION FOR RECONSIDERATIONAND ORDER OF REMOVAL ON BOARD MOTION WITH NOTICE OF INTENTIONTO ISSUE SANCTIONS (LAB. CODE § 5813) Applicant seeks reconsideration of the Findings and Order issued October 11, 2011 wherein the workers’ compensation administrative law judge (WCJ) found that applicant had been provided with proper notice of defendant’s medical network provider in July of 2009. The WCJ also found that applicant began treatment with defendant’s medical provider network (MPN) at the time of his injury on January 13, 2010. The WCJ further found that “after hiring his attorney, applicant dropped out of the MPN and sought treatment elsewhere.” (Finding of Fact No. 4.) The WCJ ordered that “defendants are not responsible to pay for any treatment that applicant received outside the MPN nor are any of the medical reports obtained by these non-MPN doctors admissible as evidence.” Applicant contends that the WCJ erred by ordering that applicant’s non-MPN treatment is not compensable, and the medical reports are not admissible as evidence. Applicant further contends that “defendant did not provide applicant a primary treating physician, listed as being in a claimed MPN, to cure or relieve from the effects of the injury. Defendant merely sent applicant to U.S. Healthworks and could not establish at trial that the doctors at U.S. Healthworks are members of the employer’s or insurer’s MPN.” (Petition for Reconsideration, p. 9, lns. 21-24.) Applicant also contends that the WCJ’s , decision fails to explain the reasons or grounds for the decision and is therefore in violation of Labor Code section 5313. Defendant filed an answer. In the Repo
JOAQUIN GONZALEZ vs. NFI INDUSTRIES, ZURICH AMERICAN INS. CO. C/o GALLAGHER BASSETT SERVICES
This case involves Joaquin Gonzalez, who was injured on January 13, 2010 and was provided with notice of the defendant's medical provider network (MPN) in July of 2009. The workers' compensation administrative law judge (WCJ) found that after hiring his attorney, Gonzalez dropped out of the MPN and sought treatment elsewhere. The WCJ ordered that the defendants were not responsible to pay for any treatment that Gonzalez received outside the MPN nor were any of the medical reports obtained by these non-MPN doctors admissible as evidence. Gonzalez sought reconsideration of the WCJ's decision, but the WCJ denied the petition and issued a Notice of Intention to Impose Sanctions against Gonzalez's representative, Carl A. Feldman and
- Filed On:
- Court: California, San Francisco
- Case No. ADJ7214982
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