Phil Bruno Enterprises, Inc., dba Exclusive Fresh, Inc.; Procentury Insurance Company Jovanni Montelongo WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIA JOVANNI MONTELONGO, Applicant, vs. PHIL BRUNO ENTERPRISES, INC., dba EXCLUSIVE FRESH, INC.; PROCENTURY INSURANCE COMPANY, Defendants. Case No. ADJ9338499 / ADJ9338498 OPINION AND ORDER GRANTING PETITION FOR RECONSIDERATION AND DECISION AFTER RECONSIDERATION Defendant seeks reconsideration of the March 16, 2015 Findings Of Fact of the workers’ compensation administrative law judge (WCJ), whofound in Finding of Fact 1 that applicant sustained industrial injury to his back and left knee on January 4, 2014, while employed as a delivery driver, then insured by Procentury Insurance Company (PIC). The WCJ further found in Finding of Fact 5 that “Rising Interplan is the proper Medical Provider Network (“MPN”) in this case,” and in Finding of Fact that the “physician(s) chosen by the Applicant from the Rising Interplan MPN are the proper treating physician(s).” Defendant contends that the WCJ should have found that Midwest Rising is the proper MPN, and that the physicians chosen by the applicantwere not from that MPN. An answer was not received from applicant. The WCJ was not available to provide a Report And Recommendation On Petition For Reconsideration. Reconsideration is granted. The WCJ’ s Finding of Fact 5 and Finding of Fact 6 are reversed as the Decision After Reconsideration. Defendant provided sufficient notice to applicant that Midwest Rising is the proper MPN, and the physicians selected by applicant are not from that plan. Applicant did not show that he was misled or otherwise unable to use the correct MPN, and defendant did not neglect to provide reasonable medical treatment through its MPN. , BACKGROUND The WCJ provided a summary of the background facts and reasons for his decision in his Opini
Jovanni Montelongo vs. Phil Bruno Enterprises, Inc., Dba Exclusive Fresh, Inc.; Procentury Insurance Company
In this case, Phil Bruno Enterprises, Inc., dba Exclusive Fresh, Inc. and Procentury Insurance Company appealed the March 16, 2015 Findings of Fact of the workers' compensation administrative law judge (WCJ) that found Jovanni Montelongo sustained industrial injury to his back and left knee on January 4, 2014, while employed as a delivery driver, then insured by Procentury Insurance Company (PIC). The WCJ found that Rising Interplan was the proper Medical Provider Network ("MPN") in this case and that the physician(s) chosen by the Applicant from the Rising Interplan MPN were the proper treating physician(s). The defendant argued that the WCJ should have found that Midwest Rising is the proper MPN
- Filed On:
- Court: California, Oakland
- Case No. ADJ9338499
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