What the panel ordered
The WCAB affirmed the WCJ's Findings and Order, allowing applicant to treat with Dr. Curtis Spencer as her primary treating physician (PTP) outside of defendant's MPN, subject to defendant's future compliance with transfer of care provisions.
Defendant sought reconsideration of the WCJ's Findings and Order issued on February 9, 2021, which permitted applicant to treat with Dr. Curtis Spencer outside of defendant's medical provider network (MPN). The WCJ recommended denial of defendant's petition for reconsideration.
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The evidence showed applicant treated with a non-MPN physician, Dr. Spencer, for years and continued after selecting Dr. Small as PTP. There was no substantial evidence that Dr. Small was in the MPN or that applicant was treating within the MPN when requesting Dr. Spencer as PTP again. Defendant did not object to the request. Therefore, applicant was entitled to treat with Dr. Spencer outside the MPN.
From the decision · page 7Defendant argues that applicant was brought back into the MPN when she selected Dr. Small as her PTP and thus, she may not now choose a non-MPN physician absent a denial of care. We agree that the evidence does not indicate a denial of care by defendant. Instead, the evidence shows that applicant treated with a non-MPN physician for years and continued to treat with Dr. Spencer after she began treating with Dr. Small. If Dr. Small is a member of defendant's MPN (whether the old or new MPN), there may be a viable argument that applicant voluntarily returned herself to the MPN by selecting Dr. Small as her PTP and she may not now choose a PTP outside the MPN absent a denial of care. However, this conclusion presumes that Dr. Small is actually in the MPN, a fact that applicant has not conceded and is not supported by substantial evidence in the record. (See Hamilton v. Lockheed Corp. (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc) [decisions of the Appeals Board "must be based on admitted evidence in the record"].) We do not presume Dr. Small is in the MPN based solely on defendant's assertion that he is a member of it.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant treated with Dr. Spencer as PTP outside the MPN for several years and continued after selecting Dr. Small as PTP.
Favours Applicant prevailed
This showed applicant was not effectively transferred into the MPN and supported entitlement to treat with Dr. Spencer outside the MPN.
From the decision · page 2Applicant treated with Dr. Spencer as her PTP from 2014 to 2019. (Minutes of Hearing and Summary of Evidence, December 1, 2020, p. 2.) Defendant corresponded with Dr. Spencer about applicant and authorized several treatment modalities recommended by Dr. Spencer. (Applicant's Exhibits Nos. 12-22.)
There was no substantial evidence that Dr. Small was in the MPN or that applicant was treating within the MPN when requesting Dr. Spencer as PTP again.
Favours Applicant prevailed
Without evidence of MPN treatment, applicant's request to treat with Dr. Spencer outside the MPN was valid.
From the decision · page 7Defendant argues that applicant was brought back into the MPN when she selected Dr. Small as her PTP and thus, she may not now choose a non-MPN physician absent a denial of care. We agree that the evidence does not indicate a denial of care by defendant. Instead, the evidence shows that applicant treated with a non-MPN physician for years and continued to treat with Dr. Spencer after she began treating with Dr. Small. If Dr. Small is a member of defendant's MPN (whether the old or new MPN), there may be a viable argument that applicant voluntarily returned herself to the MPN by selecting Dr. Small as her PTP and she may not now choose a PTP outside the MPN absent a denial of care. However, this conclusion presumes that Dr. Small is actually in the MPN, a fact that applicant has not conceded and is not supported by substantial evidence in the record. (See Hamilton v. Lockheed Corp. (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc) [decisions of the Appeals Board "must be based on admitted evidence in the record"].) We do not presume Dr. Small is in the MPN based solely on defendant's assertion that he is a member of it.
Defendant did not object to applicant's June 1, 2020 request to have Dr. Spencer act as PTP again.
Favours Applicant prevailed
Lack of objection supported applicant's entitlement to treat with Dr. Spencer outside the MPN.
From the decision · page 8MPN when she requested to have Dr. Spencer resume his role as PTP. There is also no evidence in the record that defendant objected to applicant's June 1, 2020 request to have Dr. Spencer act as her PTP again. There is substantial evidence to show years of treatment outside the MPN and no effective transfer of care returning applicant to treatment within the MPN. Under these circumstances, applicant is entitled to resume treatment with her non-MPN physician, Dr. Spencer, as her PTP.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Dr. Spencer treated applicant as PTP from 2014 to 2019 and was authorized for several treatment modalities. Applicant wished to re-elect Dr. Spencer as PTP in 2020 because she trusted him and he knew her condition.
Dr. Spencer was the non-MPN physician applicant was entitled to treat with outside the MPN.
From the decision · page 2Applicant treated with Dr. Spencer as her PTP from 2014 to 2019. (Minutes of Hearing and Summary of Evidence, December 1, 2020, p. 2.) Defendant corresponded with Dr. Spencer about applicant and authorized several treatment modalities recommended by Dr. Spencer. (Applicant's Exhibits Nos. 12-22.)
Dr. Small was selected by applicant as PTP in 2019 and provided treatment into 2020. Defendant asserted Dr. Small was in the MPN, but there was no substantial evidence to support this.
Dr. Small's MPN membership was disputed and not supported by substantial evidence, affecting applicant's entitlement to treat outside the MPN.
From the decision · page 2On September 3, 2019, applicant sent defendant a letter selecting Scott Small, M.D. as her PTP. (Defendant's Exhibit B, Applicant's request to change PTP, September 3, 2019.) Dr. Small provided treatment to applicant from 2019 into 2020. (Defendant's Exhibits C-U, Reports of Dr. Small, various dates from November 13, 2019 to August 8, 2020.) Applicant also continued to receive treatment from Dr. Spencer from July 2019 to at least December 2019 while also treating with Dr. Small. (Applicant's Exhibits Nos. 1-6, Reports of Dr. Spencer, various dates from July 29, 2019 to December 12, 2019; Minutes of Hearing and Summary of Evidence, December 1, 2020, p. 6.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, §§ 4600(a), 4600(c)
Labor Code section 4600(a) and 4600(c) regarding medical treatment and MPN limitations.
Applicant may treat outside MPN if defendant neglects or refuses to provide necessary treatment.
From the decision · page 5If an employer has established an MPN, injured workers are generally limited to treating
Cal. Code Regs., tit. 8, §§ 9767.9(a), (e)-(f), 9767.12(a), (a)(2)
Administrative Director Rule 9767.9(a), (e)-(f) and 9767.12(a), (a)(2) regarding transfer of care and MPN notification requirements.
Defendant must comply with transfer of care provisions and provide proper MPN notice to transfer applicant's care into the MPN.
From the decision · page 5Cal.Comp.Cases 70, 71 (Appeals Board en banc).) Administrative Director (AD) Rule 9767.9
Babbitt v. Ow Jing (2007) 72 Cal.Comp.Cases 70
Babbitt v. Ow Jing (2007) 72 Cal.Comp.Cases 70 (Appeals Board en banc) on transfer of care into MPN.
Transfer of care into MPN must conform with statutes and regulations.
From the decision · page 5The Appeals Board has held en banc that "a defendant may satisfy its obligation under
Hamilton v. Lockheed Corp. (2001) 66 Cal.Comp.Cases 473
Hamilton v. Lockheed Corp. (2001) 66 Cal.Comp.Cases 473 (Appeals Board en banc) on evidence requirements.
Decisions must be based on admitted evidence; no presumption that Dr. Small is in MPN without evidence.
From the decision · page 7Defendant argues that applicant was brought back into the MPN when she selected Dr. Small as her PTP and thus, she may not now choose a non-MPN physician absent a denial of care. We agree that the evidence does not indicate a denial of care by defendant. Instead, the evidence shows that applicant treated with a non-MPN physician for years and continued to treat with Dr. Spencer after she began treating with Dr. Small. If Dr. Small is a member of defendant's MPN (whether the old or new MPN), there may be a viable argument that applicant voluntarily returned herself to the MPN by selecting Dr. Small as her PTP and she may not now choose a PTP outside the MPN absent a denial of care. However, this conclusion presumes that Dr. Small is actually in the MPN, a fact that applicant has not conceded and is not supported by substantial evidence in the record. (See Hamilton v. Lockheed Corp. (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc) [decisions of the Appeals Board "must be based on admitted evidence in the record"].) We do not presume Dr. Small is in the MPN based solely on defendant's assertion that he is a member of it.
What proof carried it
The evidence the panel weighed, by kind.
Applicant's testimony about treatment with Dr. Spencer and Dr. Small, including distances to their offices and trust in Dr. Spencer.
From the decision · page 3applicant treated with Dr. Spencer as her PTP from July 2014 to June 2019. (Id.) Applicant
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
- Issues, outcomes and weights were extracted by AI and released only where the source passage checked. Read the official decision before relying on anything here. Not legal advice.
- If you are named in this decision and want this page removed, write to privacy@similarcase.com.