This matter involved an admitted Specific Injury, occurring June 29, 2013, to Heidy Estrada. Despite allegations of injury to a litany of body parts, only the Applicant’s back and right knee were admitted by the carrier. Ms. Estrada began treating within the Employer’s Medical Provider Network (MPN) before retaining counsel and abruptly abandoning MPN treatment in favor of a non-MPN Primary Treating Physician, Dr. Randy Higashi.
Dr. Higashi then referred the Applicant to various Secondary Treating Physicians and treaters, amassing over 13 Lien Claimants of record. All the while, defense issued timely to objections to both Applicant’s attorney and the medical providers, citing non-MPN status as the basis for withholding payment.
On July 26, 2016 the matter was heard and submitted on the record before Judge Famiglietti at the Santa Ana WCAB. Defense argued that Ms. Estrada was properly noticed of her employer’s MPN and voluntarily chose to abandon care, effectively insulating Defendant from any liability accruing from non-MPN services. The Lien Claimant’s argued that there was a delay/denial of care within the MPN which permitted the Applicant to treat outside, the services provided were reasonable and necessary, and the court should award compensation to the claimants for their full balances.
On August 23, 2016 Judge Famiglietti issued his Findings and Order, appearing persuaded that there was no denial of treatment and that any issue regarding the extent of treatment should have been addressed within the MPN. The liens of Sleep Treatment Clinic of California, Advance Care Specialists, and National Script Pharmacy were DISALLOWED in their entirety.
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