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Marialaine Tabak vs. San Diego Unified School District Permissibly Self-insured Administered By York Risk Services Group

SAN DIEGO UNIFIED SCHOOL DISTRICT permissibly self-insured administered by YORK RISK SERVICES GROUP MARIALAINE TABAK WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAMARIALAINE TABAK, Applicant,vs.SAN DIEGO UNIFIED SCHOOL DISTRICT,permissibly self- insured, administered byYORK RISK SERVICES GROUP, Defendants.Case Nos. ADJ7735518ADJ7735519ADJ7735513ADJ7735501ADJ7735502ADJ7736429ADJ7736449ADJ7735498ADJ7098593ADJ7735514(San Diego District Office)OPINION AND ORDERDENYING PETITION FORRECONSIDERATION            Applicant, Marialaine Tabak, seeks reconsideration of the Joint Findings of Fact, issued by a workers’ compensation administrative law judge (WCJ) on May 7, 2014. In that decision, the WCJ held that defendant, San Diego Unified School District properly denied authorization of medical treatment with Lawrence Miller, M.D., because, although Dr. Miller was listed as a provider in defendant’s Medical Provider Network (MPN), applicant sought medical treatment at an office location of Dr. Miller that was not authorized as part of defendant’s MPN. The WCJ further held that any treatment procured by applicant outside the MPN would be at her own expense.            Applicant contests the WCJ’s conclusion that defendant may limit the specific location where she can obtain treatment from an MPN physician. Applicant argues that defendant has no legal authority to limit the location at which an MPN doctor can provide medical treatment, such that applicant can obtain treatment from the MPN physician at a location other than that listed on defendant’s website.Alternatively, applicant argues that by refusing authorization to obtain MPN treatment from Dr. Miller, she may self-procure her medical treatment outside defendant’s MPN at defendant’s expense. Applicant further argues that the WCJ erred in stating that a defendant may place a “reasonable geographic limit” on its MPN providers. ,             Defendant has filed an answer to applicant’s petition, contending that its


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