Mainstay Business Solutions, Permissibly Self-Insured Patricia Nunez WORKERS-COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAPATRICIA NUNEZ, Applicant,vs.MAINSTAY BUSINESS SOLUTIONS, permissibly self-insured, Defendant,FRED HAFEZI, M.D., INC.; WHITTIER/ANAHEIM PHYSICAL THERAPY CENTER, Lien claimants.Case No. ADJ603509 (LAO 888258)OPINION AND ORDER DENYING RECONSIDERATION Lien claimants Fred Hafezi, M.D., Inc., and Whittier/Anaheim Physical Tlicrapy Center JwAPTC), jointly petition for reconsideration of our earlier August 3, 2010 Opinion And Order Granting Reconsideration And Decision After Reconsideration (Decision After) wherein wegranted defendant’s petition for reconsideration of the May 19, 2010 Findings and Award of the workers’ compensation administrative law judge (WCJ), who found that applicant reasonably and necessarily secured medical treatment services from lien claimants and awarded Dr. Hafezi S 10,623.82 and WAPTC $1,046.29 on their lien claims.1 The WCJ further found that defendant had a valid Medical Provider Network (MPN), but allowed the liens even though lien claimants did not show they were members of the MPN at the time they provided services.In our Decision After, which is incorporated by this reference, we reversed and rescinded 1 Applicant’ claim of industrial injury io her hips. back, leg and other body parts while working for defendant Mainstay Business Solutions as a laborer/housekeeper on May 22. 2008, was earlier settled by compromise and release on October 26. 2009. with a lump sum payment of $40.500.00. , ihc WCJ’s May 19, 2010 Findings and Award because lien claimants knew of defendant’s MPN but did not prove they were qualified to provide medical treatment by being within the MPN at the time they provided services. Lien claimants contend that our August 3, 2010 Decision After should be rescinded because defendant did not prove at trial that it had a valid MPN and because their right to due process was violated by d
Patricia Nunez vs. Mainstay Business Solutions, Permissibly Self-insured
In this case, Mainstay Business Solutions, a permissibly self-insured defendant, denied liability to lien claimants Fred Hafezi, M.D., Inc., and Whittier/Anaheim Physical Therapy Center (WAPTC) on the grounds that they were not within its Medical Provider Network (MPN). The Workers' Compensation Administrative Law Judge (WCJ) found that defendant had a valid MPN, but nevertheless allowed the liens. The Workers' Compensation Appeals Board (WCAB) reversed the WCJ's decision, finding that lien claimants had failed to meet their burden of proving that they had the necessary qualifications to provide the claimed services, and that defendant had met its obligation to provide reasonable and necessary medical treatment
- Filed On:
- Court: California, Los Angeles
- Case No. ADJ603509
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