What the panel ordered
Findings and Order of July 18, 2023, denying applicant's request to designate Casa Colina as primary treating physician and to treat outside the MPN, is affirmed.
Applicant sought reconsideration of the WCJ's Findings and Order denying her request to designate Casa Colina as her primary treating physician and to treat outside the MPN; WCAB granted reconsideration for further study and now affirms the WCJ's decision.
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.
Applicant designated a facility, not an individual physician, as primary treating physician, contrary to regulations; defendant provided access to three neurologists within the MPN, meeting statutory and regulatory requirements for access to care; applicant did not meet burden to show neglect or refusal to provide care.
From the decision · page 5In the present case, applicant designated Casa Colina rather than any individual physician as her primary treating physician. This designation violates AD Rule 9785(a)(1), which defines the primary treating physician as an actual physician and not a facility or other entity.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant designated a facility, not an individual physician, as primary treating physician.
Favours Defendant prevailed
This violated the regulation requiring a primary treating physician to be an individual, not a facility, and was a basis for denying the request.
From the decision · page 5In the present case, applicant designated Casa Colina rather than any individual physician as her primary treating physician. This designation violates AD Rule 9785(a)(1), which defines the primary treating physician as an actual physician and not a facility or other entity.
Defendant provided names of three neurologists within the MPN for applicant's condition.
Favours Defendant prevailed
This satisfied the statutory and regulatory requirements for access to care, defeating applicant's claim of denial of care.
From the decision · page 5The MPN access standards measure adequacy for brain-injury conditions according to the availability of recognized medical specialists. There is no board-certified specialty titled "brain injury specialist" in the manner that neurology exists as an established specialty. A boardcertified neurologist possesses the medical qualifications necessary to diagnose, treat, and manage brain injuries including post-concussion syndrome and post-traumatic vertigo. Defendant therefore satisfied its obligation under section 4600 when it provided applicant with the names of three qualified neurologists located within the required geographic boundaries.
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.
Recommended additional treatment for post-concussion syndrome and post-traumatic vertigo, including neuropsychological evaluation, cognitive behavioral therapy, otolaryngology referral, and vision rehabilitation therapy.
From the decision · page 2In his report dated December 7, 2021, Panel Qualified Medical Evaluator (PQME) Pedram Navab, D.O., after evaluating applicant, took a history that, on March 20, 2018, she struck her head forcefully against a metal bar while she attempted to lift a large piece of cardboard and her view became obstructed as she stood up suddenly in the warehouse. (App. Ex. 4, p. 3.) On March 5, 2021, she fell backwards after her right foot caught on a pallet while she pulled plastic at work and dizziness from the prior head injury caused injury to her low back and left wrist. (Id. at p. 9.) PQME Dr. Navab recommended that applicant receive additional treatment for her post-concussion syndrome and post-traumatic vertigo including a neuropsychological evaluation for cognitive impairment, cognitive behavioral therapy for insomnia, re-referral to an otolaryngologist, and vision rehabilitation therapy. (Id. at pp. 17-18, 20-21.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Cal. Code Regs., tit. 8, § 9785(a)(1)
A primary treating physician must be an actual physician, not a facility or entity.
Applicant's designation of Casa Colina, a facility, as primary treating physician violates this regulation.
From the decision · page 5In the present case, applicant designated Casa Colina rather than any individual physician as her primary treating physician. This designation violates AD Rule 9785(a)(1), which defines the primary treating physician as an actual physician and not a facility or other entity.
Labor Code §§ 4600, 4616; Cal. Code Regs., tit. 8, §§ 9767.5, 9767.6
MPN must provide adequate number and type of physicians to treat common injuries, and employee may select a physician of appropriate specialty within the MPN.
Defendant met requirements by providing access to three neurologists within the MPN for applicant's brain injury condition.
From the decision · page 5The MPN access standards measure adequacy for brain-injury conditions according to the availability of recognized medical specialists. There is no board-certified specialty titled "brain injury specialist" in the manner that neurology exists as an established specialty. A boardcertified neurologist possesses the medical qualifications necessary to diagnose, treat, and manage brain injuries including post-concussion syndrome and post-traumatic vertigo. Defendant therefore satisfied its obligation under section 4600 when it provided applicant with the names of three qualified neurologists located within the required geographic boundaries.
Labor Code §§ 3202.5, 5705; Knight v. United Parcel Service (2006) 71 Cal.Comp.Cases 1423 (en banc)
Employee seeking treatment outside the MPN bears the burden to show employer's neglect or refusal to provide care.
Applicant did not meet burden to show neglect or refusal to provide care by employer.
What proof carried it
The evidence the panel weighed, by kind.
Applicant designated a facility, not an individual physician, as primary treating physician, contrary to regulations.
From the decision · page 5In the present case, applicant designated Casa Colina rather than any individual physician as her primary treating physician. This designation violates AD Rule 9785(a)(1), which defines the primary treating physician as an actual physician and not a facility or other entity.
Defendant provided names of three neurologists within the MPN, meeting access requirements.
From the decision · page 5The MPN access standards measure adequacy for brain-injury conditions according to the availability of recognized medical specialists. There is no board-certified specialty titled "brain injury specialist" in the manner that neurology exists as an established specialty. A boardcertified neurologist possesses the medical qualifications necessary to diagnose, treat, and manage brain injuries including post-concussion syndrome and post-traumatic vertigo. Defendant therefore satisfied its obligation under section 4600 when it provided applicant with the names of three qualified neurologists located within the required geographic boundaries.
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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.
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