A & L STAFFING and STATE COMPENSATION INSURANCE FUND, MANUELA RAMIREZ, WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAMANUELA RAMIREZ, Applicant,vs.A & L STAFFING and STATE COMPENSATION INSURANCE FUND, Defendants.Case No. ADJ6642689OPINION AND DECISION AFTER RECONSIDERATION On July 2, 2009, we granted reconsideration in this matter to provide an opportunity to further study the legal and factual issues raised by the petition for reconsideration. Having completed our review, we now issue our Decision After Reconsideration. Defendant, State Compensation Insurance Fund (SCIF), on behalf of its insured, A & L Staffing, filed a petition for reconsideration from the Finding and Order, issued April 16, 2009, in which a workers’ compensation administrative law judge (WCJ) ordered defendant to authorize applicant’s change of treating physician within its Medical Provider Network (MPN), concluding that applicant’s dispute with her treating physician’s release from care constitutes a dispute over “the diagnosis or the treatment prescribed by the treating physician” pursuant to Labor Code section 4616.3(c).1 SCIF contests the WCJ’s order allowing applicant to obtain a second physician within SCIF’s MPN, arguing that applicant’s request for another physician within the MPN is not controlled by Section 4616.3(c). Rather, SCIF argues applicant’s request for a new treating physician is controlled by Rule 9785(b) (Cal.Code Regs. Title 8, §9785(b)), which requires applicant to initiate the dispute resolution process pursuant to Sections 4061 and 4062. Applicant 1All further statutory references are to the Labor Code. , has filed an answer to defendant’s petition. Following our review of the record, and for the reasons set forth below, we shall, as our Decision After Reconsideration, affirm the WCJ’s Finding and Order requiring defendant to authorize applicant’s change of treating physician within its MPN.BackgroundApplicant, Manuela
Manuela Ramirez, vs. A & L Staffing And State Compensation Insurance Fund,
In this case, Manuela Ramirez was injured at work and received medical treatment from Dr. David Rollins through SCIF's MPN, U.S. Healthworks. When Dr. Rollins released her from care, she requested a new treating physician from within SCIF's MPN, which SCIF objected to on the grounds that she was required to follow the dispute resolution procedures provided in Section 4061 and 4062. After an expedited hearing, the WCJ found that because there was a dispute over the diagnosis or medical treatment recommended by applicant's prior primary treating physician, she was entitled to select another physician from within SCIF's MPN, pursuant to Section 4616.3(c). The Workers' Compensation Appeals Board affirmed the WCJ
- Filed On:
- Court: California, San Francisco
- Case No. ADJ6642689
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