AI Analysis:
This message directly addresses the user's question about MPN, PTP, authorization, delay, waiver, outside network, and treatment rights. The attorney is asking about a specific scenario where a non-MPN surgeon requested authorization for surgery, the carrier denied it without mentioning the doctor wasn't in the MPN, and whether waiver or estoppel arguments can be used to get authorization. This provides a concrete example of how waiver principles might apply when carriers fail to properly address MPN network requirements in authorization decisions, which directly answers the user's question about these interconnected workers' compensation concepts.
hey folks - a non-MPN surgeon sent an RFA to the carrier requesting authorization for a knee surgery. the carrier responded with a written decision indicating that the claim was denied and therefore they could not authorize the surgery. no mention was made that the requesting doctor was NOT in the MPN. is there any argument, such as waiver or estoppel, that we can effectively use in getting the surgery authorized? the claim is now accepted.
AI Analysis:
This message directly addresses the user's question about MPN, PTP, authorization, delays, waivers, outside network, and treatment rights. The original poster describes a situation with a PTP outside the MPN network who performed an MMI report and wants payment, creating delays in case resolution. The response provides specific legal advice about obtaining waivers to address potential conflicts of interest, strategies for handling payment authorization issues, and alternative approaches when dealing with outside network providers. This substantively answers questions about how MPN/PTP authorization delays can be managed through waivers and other procedural mechanisms.
cognitorsj@aol.com Date: December 19, 2025 4:13:00 PM Subject: Re: PTP Payments - Delaying CR Reply to list Reply to sender Print List: lawnet Sent By: Mike Richter Reply To Sender Reply To List Search Settings David You could get a waiver signed by both the doctor and the client confirming that you informed them there could be a conflict of interest if you represented both. I identify the conflict of interest, that you might have to decide between getting the doctor paid and the IW paid, and this could result in your having to decide who's interests to put first. Or you could pay the doctor only after getting the insurance company's assurances that it would reimburse you in full for every penny you paid the doctor. Or you could ask the insurance company to tell you how much it would pay the doctor, pay the doctor that amount, settle the case if your client agrees, then sue the IR for breach of contract if it fails to reimburse you. OR..there are a lot of other "ors". Good luck. Mike Richter Campbell In a message dated 12/19/2025 1:57:13 PM Pacific Standard Time, listsender-lawnet@lawnet.caaa.org writes: List: lawnet Sent By: David Nitka Reply To Sender Reply To List Search Settings Client has a PTP outside MPN, non WC PTP. PTP did an MMI report and wants to charge 10k+ for the service. We have a CR. Client wont sign unless the PTP gets paid in full. They want either 1. me to pay the PTP and get reimbursed. hard no. 2. me to represent the PTP and get them paid. I think this violates 4906 at minimum. 3. me to set a hearing on behalf of the ptp or list the bill as a PTCS issue. Judge already said they won't take it as a case in chief issue. In the meantime carrier messed up the denials, IBR etc. I got a lien rep helping the doc but my client says its not good enough. Am I missing something I am quite sure there is nothing i can do since I rep the applicant.
AI Analysis:
This message directly addresses the user's question about MPN, PTP, authorization, delays, waivers, outside network, and treatment rights. The attorney describes a specific scenario where a client has a PTP outside the MPN network, creating authorization and payment delays that are preventing the client from signing a compromise and release. The message discusses the practical consequences of using providers outside the MPN network, including payment complications and potential waiver of rights when clients refuse to proceed without full PTP payment. This provides substantive insight into how MPN network requirements, authorization delays, and outside network treatment can impact case resolution and client rights.
"David Nitka" Date: December 19, 2025 3:57:00 PM Subject: PTP Payments - Delaying CR Reply to list Reply to sender Print List: lawnet Sent By: David Nitka Reply To Sender Reply To List Search Settings Client has a PTP outside MPN, non WC PTP. PTP did an MMI report and wants to charge 10k+ for the service. We have a CR. Client wont sign unless the PTP gets paid in full. They want either 1. me to pay the PTP and get reimbursed. hard no. 2. me to represent the PTP and get them paid. I think this violates 4906 at minimum. 3. me to set a hearing on behalf of the ptp or list the bill as a PTCS issue. Judge already said they won't take it as a case in chief issue. In the meantime carrier messed up the denials, IBR etc. I got a lien rep helping the doc but my client says its not good enough. Am I missing something I am quite sure there is nothing i can do since I rep the applicant.
AI Analysis:
This message directly addresses the user's question about MPN, PTP, authorization delays, waivers, and treating outside the network. The attorney specifically explains a strategy where if the insurance company denies or delays authorization for treatment within the MPN by 'denying a body part that wasn't actually at issue,' this creates grounds to argue that the injured worker can now 'treat outside the MPN with your psychiatrist for the neurological condition.' This directly answers how authorization delays or improper denials can result in forfeiting MPN requirements and gaining the right to treat outside the network, which is exactly what the user's question seeks to understand.
"Bret Graham" Date: November 26, 2025 1:32:00 PM Subject: Re: Psych Litigation Strategy Reply to list Reply to sender Print List: lawnet Sent By: Bret Graham Reply To Sender Reply To List Search Settings SCOTT – I would reflect on whether you need a separate “psyche injury” to get where you want to go – this may ALL be neurological if there was a head injury. Take a quick re-review of AMA Guides, 5 th , page 325 (Chapter 13.3f) (“Neurologic impairments producing psychiatric conditions are assessed using the neurologic examination, with an expanded neuropsychiatric history and the necessary ancillary tests.” Vs. “Psychiatric manifestations and impairments that do not have documented neurologic impairments are evaluated using the criteria in the chapter on mental and behavioral impairments (See Table 13-8 and Chapter 14, Mental and Behavioral Disorders).”) While you MAY be able to meet the violent act/catastrophic exceptions to 4660.1(c) bar on additional psyche impairment for physical injury, why fight that battle if you don’t need to. I would argue that this is all NEUROLOGIC treatment for NEUROLOGIC conditions from the NEURO-psychologist and have it reviewed and validated by the NEUROLOGIST. If it is neurologic treatment, then they already blew the timeline to authorize a PTP (or Secondary PT) within the MPN by denying a body part that wasn’t actually at issue or the reason for the treatment. I would then argue that you now can treat outside the MPN with your psychiatrist for the neurological condition . Have a terrific Thanksgiving holiday. Bret Graham, Esq. Nava Graham Montebello 420 N. Montebello Blvd., Ste 301 Montebello, CA 90640 (323) 888-1818 Ph (323) 888-7788 Fax (213) 590-1388 cell
AI Analysis:
This message directly addresses the user's question about MPN, PTP, authorization delays, and treatment rights. The attorney discusses how MPN doctors are reluctant to fight for treatment authorizations because they fear being kicked off MPNs, explaining the practical reality of how authorization delays affect treatment within the MPN system. The message also addresses the burden on PTPs to reprove medical necessity and concerns about carriers denying previously approved treatment, which directly relates to authorization delays and potential loss of treatment rights within the network system.
"Kimberley J. Pryor" Date: November 12, 2025 1:43:00 PM Subject: Re: Patterson and pivoting Reply to list Reply to sender Print List: lawnet Sent By: Kimberley J. Pryor Reply To Sender Reply To List Search Settings Nice ideas, but in reality, not feasible. UR is rigged and most MPN doctors will not do anything as they are not paid for it and the doctors know they can be kicked off of the MPNs if they buck the system to help patients. WE , as attorneys , should not even be requesting IMR, but we know most of the doctors will not even do that. What makes us think they will actually take the time to learn how to fight for treatment? I am confident that very few will. We need a media campaign of injured workers discussing treatment denials to affect legislative change. KJ Pryor, Esq. -----Original Message----- From: dgilliam@bentleymore.com Sent: November 12, 2025 12:25:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Patterson and pivoting Unless overturned by the CA Supreme Court, Patterson is pretty much dead with this case. Per Footnote 4 on page 11, the court stated that the only ways around the IMR process are untimely URs or stipulating to resolving medical treatment disputes outside of the UR/IMR process. I cannot see a carrier agreeing to the latter now. I am very concerned for the injured workers that already have and continue to need inpatient care, a day treatment program at a rehabilitation facility, home care, and transportation. This case puts the burden on us and the PTPs to reprove medical necessity for these forms of treatment every 45 days or so. What is to stop a carrier from having their preferred UR doctor pull the plug on the previously approved treatment once a new RFA I issued? What is a catastrophically injured worker supposed to do when the authorization for the above treatment has expired, is then denied by UR, and the parties are waiting IMR to play out? Patterson was a nice safety valve to prevent these catastrophic outcomes. As I think about this decision out loud, we will need to pivot and do better with the following to keep the above forms of treatment for our clients: * Educating our doctors that they need to explain the how and the why of why the treatment is necessary and that it satisfies MTUS. * Educating our doctors on using and providing the basis for an Expedited RFA or resubmission change in facts RFA. * Ensuring our doctors request home assessments at reasonable intervals when home care is needed. * Deposing PTP to help with medical necessity. * Educating our doctors that they can write a rebuttal report to a UR denial and get paid at a ML rate for it per Marlon Green case * Using a SDT of claims file or UR doctors file when a non-certification has issued to ascertain CCR 10109 violations. * Creating En Banc decision or going to court of appeal on issue of UR doctor as to their basis for denial when treatment was previously provided for extended periods of time. So far, commissioners have only allowed UR doctor depos in penalty situations. * Writing better IMR appeals and using Petition to Appeal IMR determination more frequently. Thoughts? [cid:image003.png@01DC53BE.4CDA7870]<http://www.bentleymore.com/> DANE P. GILLIAM Trial Attorney Office: (949) 870-3800 x<tel:%28949%29%20870-3800>213 Fax: (949) 732-6291<tel:%28949%29%20870-3800> Email: dgilliam@bentleymore.com<mailto:dgilliam@bentleymore.com> 4931 Birch Street Newport Beach, CA 92660 This communication, including any attachments, may contain confidential and/or proprietary information (and, in some cases information protected by either or both doctrines of attorney-client privilege and attorney work-product), and is intended only for the individual(s) or entity or entities to whom the communication is addressed. Any review, dissemination, or copying of this email by anyone other than the intended recipient(s) is strictly prohibited. If you are not an intended recipient, please contact the sender by reply email, and delete and destroy all copies of the original message. From: Rene Munoz (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Wednesday, November 12, 2025 7:14 AM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [EXTERNAL]Re: [lawnet] 2025-b344044/ PATTERSON under attack List: lawnet Sent By: Rene Munoz<mailto:francomunozlaw@gmail.com> Reply To Sender<mailto:francomunozlaw@gmail.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> Art, Please correct me if I'm off base, but my reading of Illinois Midwest Ins. Agency is that the Court of Appeal expressly rejects Patterson "to the extent it set forth a contrary rule for injuries or medical-necessity determinations arising after the 2013 reforms," and holds there is no exception to the UR/IMR statutes for ongoing or continuing care. In other words, all post-2013 treatment disputes must proceed through UR and IMR, and the WCAB no longer has jurisdiction to award or continue treatment outside that statutory process. Practically speaking, that means for any RFA or medical-necessity issue after January 1, 2013, Patterson is effectively off the table. Our remaining leverage lies in Dubon I/II-specifically, procedural or timeliness defects in the UR process. Please correct me if I'm wrong. Steve Franco On Tue, Nov 11, 2025 at 10:00 PM Alan Snitzer (lawnet listserver) <listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org>> wrote: List: lawnet Sent By: Alan Snitzer<mailto:abs@snitzerlaw.com> Reply To Sender<mailto:abs@snitzerlaw.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> Hi, Art, Thanks for your usual, scholarly analysis of this important legal development! It's always appreciated! Best, Alan LAW OFFICES OF ALAN B. SNITZER A PROFESSIONAL CORPORATION 80 S. Lake Ave., Suite 800 Pasadena, California 91101-2585 T: 626-449-4300 F: 626-449-0830 Certified Specialist, Workers' Compensation Law Board of Legal Specialization, The State Bar of California [cid:image001.png@01DC53B7.4BCE15B0] Included in SUPER LAWYERS Southern California Edition 2015-2025 [cid:image002.png@01DC53B7.4BCE15B0] 1998-2025 -- == Franco Munoz, A P.C. 825 Washington Street. Suite 211 Oakland, CA 94607 (510) 257-4141
AI Analysis:
This message directly addresses the user's question about MPN, PTP, authorization delays, waivers, and treatment outside the network. The attorney specifically advises having the client 'discuss this issue with the treater outside of the MPN' and getting recommendations in writing, which directly relates to navigating MPN authorization issues and potential waivers. The message provides practical guidance on how to handle situations where MPN authorization may be problematic, including working with PTPs and getting treatment recommendations outside the network structure. This substantively answers questions about MPN authorization delays and strategies for obtaining treatment when facing network limitations.
Hi Hollie, I would argue that the condition has changed and worsened, and ask for another FCE. From your post it is unclear if he has a PTP. If not, try to get one for him and if you have a good rapport with treater, perhaps the treater can request a new FCE. If treater is not in the MPN, have the client discuss this issue with the treater outside of the MPN and get the recommendation for another FCE in writing - in the medical record. You can also write to the PTP and openly discuss the issue of the applicant over-exerting himself at the previous FCE and being disabled for three weeks after. If you are fortunate enough to get the recommendation of another FCE in writing from a treater - you might consider asking for a supplemental report from Dr. Hendel requesting a 2nd FCE. (I like Hendel - he is fair to injured workers) I recently had a similar situation where my client had an initial FCE at an AME eval and overexerted herself being overly stoic. The FCE showed deficits but not nearly as bad as they should have been. She then went to a different FCE after PTP recommended an updated FCE, which surprisingly the defendant agreed to, which showed how bad she was. AME did not agree with 2nd FCE and wanted his own FCE to be done by the first FCE tester connected with his office. Turned out the second FCE was much worse and AME suggested a voc rehab eval. Just a few quick thoughts. Hope this helps. Art Arthur Csillag, Esq. acsillaglaw@gmail.com Law Office Of Arthur Csillag 2410 W. Magnolia Blvd. Burbank, CA 91506 O (818) 558-7225 / Cell (818) 219-4264 / Fx (818) 558-7151
AI Analysis:
This message directly addresses the user's question about MPN, PTP, authorization delays, and potential waivers or forfeiture of rights to treat within the network. The attorney describes a specific case where TD was terminated due to PTP signature issues on reports, discusses MPN membership requirements, and questions whether the defendant's actions constitute bad faith - all core elements of the user's inquiry about authorization delays and potential network treatment rights issues. The message provides substantive legal analysis about when MPN/PTP requirements may be waived or forfeited due to improper defendant conduct.
"James Kim" Date: August 14, 2025 1:21:00 PM Subject: TD Terminated based on PR-2s lacking PTP signature Reply to list Reply to sender Print List: lawnet Sent By: James Kim Reply To Sender Reply To List Search Settings Hello All, I have an expedited this coming Monday on an issue where the Defendant terminated TD and deferred one UR based on the designated PTP not explicitly signing off on the reports and rather a different doctor (purportedly under the PTP's supervision)signing the reports. PTP sees him very infrequently, but does still sign off on almost all of the RFAs, just not the reports themselves. The reports do have a note that states, "supervising physician is in agreement with treatment plan" but unfortunately also doesn't explicitly name the designated PTP as the "supervising physician." I raised the fact that Concentra does this all the time, and DA had the gall to state that Concentra as an entity is a member of the MPN so they're allowed to do that, while my PTP's clinic is not. There are really no regs allowing an entity to be named as a member of the MPN. I don't want to make bad law here, but I believe the facts are sufficient to support that termination of TD is in bad faith. Any thoughts, advice?
AI Analysis:
This message directly addresses the user's question about MPN, PTP, authorization delays, and network issues. The attorney provides specific procedural guidance on how to handle MPN authorization delays - specifically that when facing delays or confusion about which doctors are in the MPN network, the applicant should contact the Medical Access Assistant (MAA) and have them perform their required duties to determine doctor availability, transfer medical records to the new PTP specialist, and schedule appointments within the required timeframe. The message explains how to avoid authorization delays and waiver issues by properly utilizing the MAA system rather than writing letters, which directly answers the question about MPN/PTP authorization processes and potential rights that could be lost due to delays.
"M. Hollie Rutkowski" Date: July 17, 2025 12:32:00 PM Subject: Re: New Walmart MPN Reply to list Reply to sender Print List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings What you should have done is told the MMA listed on the letter - who you spoke to - which specialist you chose. "T he MPN applicant shall ensure that an initial appointment with a specialist in an appropriate referred specialty is available within 20 business days of a covered employee’s reasonable requests for an appointment through an MPN medical access assistant." You should have let the MAA figure out that MAA was not the MAA for MPN # 3212, if that actually turned out to be true. You trusted a DA, one whose likely knee-jerk response is always going to be that the specialist you chose was not in the MPN. I have seen this a lot where the AA does not ask the MAA to perform the MAA intended duties, which are to determine that the doctor is accepting new patients and get the medical records to the new PTP Specialist and get the first appointment scheduled in a timely manner. Why waste time writing a letter? Have the MAA do all the work. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Wednesday, July 16, 2025 3:25:55 PM Subject: [lawnet] New Walmart MPN List: lawnet Sent By: Sandra Gomes Reply To Sender Reply To List Search Settings I received a letter in February stating the new MPN for Walmart claims is through Corvel and its MPN 3212. When I called the MAA listed on this letter, she directed me to the Corvel website and advised its the California MPN network. I chose a doctor from this list and sent my 4600 letter. After no response, I followed up with DA who says that the doctor isnt on the MPN and he gave me a completely different MPN link. This MPN has zero decent doctors on it. Has anyone with a Walmart client used this new MPN to get a new doctor? If so, can you share the correct link? Thank you. Sandra Gomes
AI Analysis:
This message directly addresses the user's question about MPN, PTP, authorization, waiver, outside network, and treatment rights. The original message describes a scenario where an attorney designated a non-MPN PTP for denied body parts and the defense attorney claims they HAVE to designate an MPN physician as the PTP, then go out of network for denied parts. Kenneth Martinson's follow-up question clarifies a key aspect: whether the defense attorney will authorize care with a non-MPN doctor for denied body parts while providing care but not admitting them. This exchange provides substantive information about the interplay between MPN requirements, PTP designation rights, authorization practices, and treatment outside the network for different claim statuses.
"Kenneth Martinson" Date: June 17, 2025 8:26:00 AM Subject: Re: PTP for denied body parts Reply to list Reply to sender Print List: lawnet Sent By: Kenneth Martinson Reply To Sender Reply To List Search Settings are you saying da will authorize care with a nonmpn doctor for denied body parts? Basically, she will provide care for denied body parts but not admit them? -----Original Message----- From: info@chinlawgroup.com Sent: June 16, 2025 4:28:00 PM To: lawnet@lists.trialsmith.com Subject: PTP for denied body parts Hi All - I have an accepted case where some body parts are denied. I designated my client with a non MPN PTP (specialty in PMR) based on the denied body parts. For the accepted body part, the AME is indicating my client needs an ortho evaluation. I advised DA that I can still have my PTP be out of network but would be willing to have my client treat with an MPN provider for the ortho/accepted body part as a secondary treating physician. She claims I HAVE to designate an MPN physician as the PTP and then for the denied stuff, can go out of network. I'm pretty sure I don't have to and can go with my route. However, does anyone have any authority one way or the other? Thanks!
AI Analysis:
This message directly addresses the user's question about MPN, PTP, authorization, and treatment rights. The attorney is specifically asking about whether they can designate a non-MPN PTP for denied body parts while using an MPN provider for accepted parts, which directly relates to questions about MPN network requirements, treatment authorization, and the right to treat outside the network. The message discusses the core issue of when an attorney can waive MPN requirements and go outside the network for treatment, and whether doing so affects their rights regarding PTP designation. This provides substantive information about the interplay between MPN requirements, PTP designation rights, and treatment authorization that would help answer the user's question.
Hi All - I have an accepted case where some body parts are denied. I designated my client with a non MPN PTP (specialty in PMR) based on the denied body parts. For the accepted body part, the AME is indicating my client needs an ortho evaluation. I advised DA that I can still have my PTP be out of network but would be willing to have my client treat with an MPN provider for the ortho/accepted body part as a secondary treating physician. She claims I HAVE to designate an MPN physician as the PTP and then for the denied stuff, can go out of network. I'm pretty sure I don't have to and can go with my route. However, does anyone have any authority one way or the other? Thanks!
AI Analysis:
This message substantially addresses the user's question about MPN, PTP, authorization delays, and treatment rights. The discussion focuses on the proper procedure for accessing specialists within an MPN network, specifically addressing how to handle authorization delays and ensure timely treatment. Hollie's response explains the Medical Access Assistant's (MAA) duties to schedule appointments within 20 business days and get medical records to the new PTP specialist, which directly relates to avoiding treatment delays and maintaining rights to treatment within the network. The message provides practical guidance on how to navigate MPN procedures to prevent forfeiture of treatment rights due to authorization delays.
"Sandra Gomes" Date: July 17, 2025 2:18:00 PM Subject: Re: New Walmart MPN Reply to list Reply to sender Print List: lawnet Sent By: Sandra Gomes Reply To Sender Reply To List Search Settings Thanks Hollie. Excellent suggestion. I will still ask the MAA to schedule. DA doesn't want to be involved anyway. -----Original Message----- From: Hollie@TCLC.org Sent: July 17, 2025 12:32:00 PM To: lawnet@lists.trialsmith.com Subject: Re: New Walmart MPN What you should have done is told the MMA listed on the letter - who you spoke to - which specialist you chose. "T he MPN applicant shall ensure that an initial appointment with a specialist in an appropriate referred specialty is available within 20 business days of a covered employee's reasonable requests for an appointment through an MPN medical access assistant." You should have let the MAA figure out that MAA was not the MAA for MPN # 3212, if that actually turned out to be true. You trusted a DA, one whose likely knee-jerk response is always going to be that the specialist you chose was not in the MPN. I have seen this a lot where the AA does not ask the MAA to perform the MAA intended duties, which are to determine that the doctor is accepting new patients and get the medical records to the new PTP Specialist and get the first appointment scheduled in a timely manner. Why waste time writing a letter? Have the MAA do all the work. Hollie Rutkowski, RN, JD, MBA, Esq. [ https://the-compensation-law-center.business.site/ ' The Compensation Law Center ] Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Wednesday, July 16, 2025 3:25:55 PM Subject: [lawnet] New Walmart MPN List: lawnet Sent By: [ mailto:sgomes@sgomeslaw.com ' Sandra Gomes ] [ mailto:sgomes@sgomeslaw.com?subject=Re%3A%20New%20Walmart%20MPN ' Reply To Sender ] [ mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20New%20Walmart%20MPN ' Reply To List ] [ http://www.caaa.org/index.cfm?pg=search ' Search ] [ http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings ' Settings ] I received a letter in February stating the new MPN for Walmart claims is through Corvel and its MPN 3212. When I called the MAA listed on this letter, she directed me to the Corvel website and advised its the California MPN network. I chose a doctor from this list and sent my 4600 letter. After no response, I followed up with DA who says that the doctor isnt on the MPN and he gave me a completely different MPN link. This MPN has zero decent doctors on it. Has anyone with a Walmart client used this new MPN to get a new doctor? If so, can you share the correct link? Thank you. Sandra Gomes
AI Analysis:
This message substantially addresses the user's question about MPN, PTP, authorization, delays, waivers, and treatment rights. The attorney describes their practice of scheduling expedited hearings specifically when they 'couldn't get treatment from the mpn' and when defendants 'objected to a second medical opinion within the mpn.' This directly relates to the core issues in the user's question about MPN treatment authorization delays and the rights/procedures available when facing such delays. While it doesn't explicitly mention all terms like 'waiver,' 'forfeit,' or 'outside network,' it provides practical insight into how attorneys handle MPN treatment authorization problems through the expedited hearing process.
I am old, gray, and always had a relatively small comp practice, but once the defendant's gave me any crap I immediately scheduled the case for an Expedited Hearing. I scheduled hearings when I couldn't get treatment from the mpn, when they failed to pay a 10% add on for late t.t.d., when they objected to a second medical opinion within the mpn.
AI Analysis:
This message substantially addresses the user's question about MPN, PTP, authorization delays, and rights to treatment outside the network. The attorney describes practical experience with scheduling expedited hearings specifically when unable to get treatment from the MPN, which directly relates to scenarios where authorization delays or MPN limitations might lead to forfeiture of rights or need for outside network treatment. While it doesn't explicitly discuss waiver or forfeiture of rights, it provides actionable legal strategy for addressing MPN treatment access issues through the expedited hearing process.
I am old, gray, and always had a relatively small comp practice, but once the defendant's gave me any crap I immediately scheduled the case for an Expedited Hearing. I scheduled hearings when I couldn't get treatment from the mpn, when they failed to pay a 10% add on for late t.t.d., when they objected to a second medical opinion within the mpn.
AI Analysis:
This message substantially addresses the user's question about MPN, PTP, authorization, delays, waivers, and treatment rights outside the network. The attorney describes a specific situation where an MPN psychologist is refusing to continue treating a client who moved to Korea, citing licensing and emergency response limitations. This directly relates to questions about treatment authorization delays, potential waivers of MPN requirements, and rights to seek treatment outside the network when MPN providers cannot or will not provide care due to geographic constraints. While it doesn't explicitly discuss forfeiture of rights or provide definitive legal answers, it presents a practical scenario that illustrates the intersection of MPN obligations, treatment authorization issues, and geographic limitations that could lead to waiver situations.
Hi All - I have a client with an accepted psych case. MPN psychologist is treating. However, recently the client went to temporarily live in a different country (Korea). The psych is now saying they cannot treat her since they are only licensed in CA. I did some quick research and it seems that it shoudn't matter where the patient is for telehealth purposes as long as the provider themselves are in CA. But the psych's office is saying their reason is that if there is an emergency or they are suicidal, they need to be able to provide resources and go to the client, which they cannot if they are out of country.... Has anyone come across this issue before? Is this some sort of uniform policy that psychs have?
AI Analysis:
This message substantially addresses the user's question about MPN, PTP, authorization delays, waivers, and treatment rights. The discussion involves a PTP outside the MPN network and addresses key issues including potential waivers (conflict of interest waiver between doctor and client), authorization delays (insurance company assurances for reimbursement), and treatment rights (deciding between getting the doctor paid vs. the injured worker paid). While it doesn't comprehensively cover all aspects like forfeiture of rights, it provides practical guidance on handling PTP payment issues outside the MPN network and discusses waiver strategies to address potential conflicts.
"Lawrence R. Whiting" Date: December 20, 2025 4:14:00 PM Subject: Re: PTP Payments - Delaying CR Reply to list Reply to sender Print List: lawnet Sent By: Lawrence R. Whiting Reply To Sender Reply To List Search Settings 10 grand for a report from someone already treating the client is absurd. There is no way in hell that the judge would order that, and the carrier won''t pay w/o an order, I think you need to tell your client this. Tell them that you reccomend settling the case without the PTP bill and then proceeding to trial on the bill after settlement is concluded. Otherwise, you have to go to trial on everything. If they don't agree, go to trial on everything. Be prepared for a sub out. It's not your job to do the undoable. -----Original Message----- From: cognitorsj@aol.com Sent: December 19, 2025 4:13:00 PM To: lawnet@lists.trialsmith.com Subject: Re: PTP Payments - Delaying CR David You could get a waiver signed by both the doctor and the client confirming that you informed them there could be a conflict of interest if you represented both. I identify the conflict of interest, that you might have to decide between getting the doctor paid and the IW paid, and this could result in your having to decide who's interests to put first. Or you could pay the doctor only after getting the insurance company's assurances that it would reimburse you in full for every penny you paid the doctor. Or you could ask the insurance company to tell you how much it would pay the doctor, pay the doctor that amount, settle the case if your client agrees, then sue the IR for breach of contract if it fails to reimburse you. OR..there are a lot of other "ors". Good luck. Mike RichterCampbell In a message dated 12/19/2025 1:57:13 PM Pacific Standard Time, listsender-lawnet@lawnet.caaa.org writes: ' List: lawnet Sent By: David Nitka ' ' Reply To Sender ' Reply To List ' Search ' Settings ' Client has a PTP outside MPN, non WC PTP. PTP did an MMI report and wants to charge 10k+ for the service. We have a CR. Client wont sign unless the PTP gets paid in full. They want either 1. me to pay the PTP and get reimbursed. hard no. 2. me to represent the PTP and get them paid. I think this violates 4906 at minimum. 3. me to set a hearing on behalf of the ptp or list the bill as a PTCS issue. Judge already said they won't take it as a case in chief issue. In the meantime carrier messed up the denials, IBR etc. I got a lien rep helping the doc but my client says its not good enough. Am I missing something I am quite sure there is nothing i can do since I rep the applicant.
AI Analysis:
This message substantially addresses the user's question about MPN, PTP, authorization delays, waivers, and treatment rights outside the network. The discussion focuses on the Patterson case which involved key issues around MPN treatment authorization - specifically how a defendant authorized an NCM (nurse case manager) but then discontinued it, and how the WCAB ruled that express authorization by the defendant eliminated the need for RFA or UR processes. The message explains that 'an RFA and UR are not necessary when the Defendant expressly authorized the care' and discusses the burden on defendants regarding medical necessity. While the message is part of a larger discussion about Patterson being overruled, it provides substantive information about how authorization, treatment rights, and MPN procedures interact in workers' compensation cases.
"Kimberley J. Pryor" Date: November 12, 2025 1:17:00 PM Subject: Re: 2025-b344044/ PATTERSON under attack Reply to list Reply to sender Print List: lawnet Sent By: Kimberley J. Pryor Reply To Sender Reply To List Search Settings I agree with Hollie, completely. Patterson was a fluke The sad reality is, most of the MPN doctors will not/cannot do what is needed to ensure continuity of care and we all know that UR Is rigged against the worker. This is another reason we need universal healthcare with a mechanism for making carriers reimburse the state for treatment costs. Hope springs eternal KJ Pryor, Esq. otherwise, we are all doomed . -----Original Message----- From: Hollie@TCLC.org Sent: November 12, 2025 12:46:00 PM To: lawnet@lists.trialsmith.com Subject: Re: 2025-b344044/ PATTERSON under attack I agree with Steve Franco. This is not a hard decisi on to understand. The Sec on d DCA in a Published Opini on overruled a WCAB Significant Panel Decisi on . There is no part of Patters on that survives. I also disagree with the Patters on facts as stated below. Patters on did not involve UR . The facts are that Patters on developed cognitive/psychological problems from overuse of medicati on s leading to scheduling problems like keeping medical appointments . In 2011 the AME internist said that applicant needed an NCM to aid her i n dealing with such problems. The Defendant approved the NCM, but Patters on and the NCM clashed because Patters on was "difficult". The Defendant disc on tinued providing the NCM because of logistic and pers on ality reas on s . Patters on filed a DOR for E xpedited Hearing. In 2014, the Trial WCJ said the AME found an NCM was medically necessary and so did not required an RFA or UR . The WCAB Commissi on ers agreed. They found that an RFA and UR are not necessary when the Defendant expressly authorized the care. The WCAB put the burden on the Defendant to prove that NCM were no l on ger medically required because of a change in applicant's c on diti on . So Patters on was a loophole where a Judge determined that an RFA and UR were not required if the Defendant authorized the care. How often does that happen? How often does the WCAB find that it has jurisdiction to determine the medical necessity of medical treatment in lieu of the RFA/UR statutory scheme? * he WCAB (significant panel decision) treated a nurse case manager as "medical treatment" under Lab. Code §4600 because coordinating/facilitating care helps cure or relieve the industrial injury. * Once a particular course of treatment is authorized, the defendant cannot unilaterally terminate it unless : 1. there's a change in the worker's condition or circumstances , and 2. the treatment is no longer reasonably required to cure or relieve. * The burden is on the defendant to justify termination. * The Board emphasized continuity of care -approved treatment can't be cut off at an adjuster's whim. That's why Patterson became shorthand for " once authorized, always authorized absent change ." * Many of us (me included) used it successfully, particularly for home care and similar ongoing services. We must scrutinize the original authorization and the current facts : * Was the original approval voluntary or via RFA/UR? * Have conditions changed ? * Has the applicant improved , stayed the same, or declined? * Did the defendant properly invoke UR/IMR for continuation/renewal? All Illinois Midwest/Rodriguez did was to take WCAB jurisdiction to determine medical necessity away from the WCAB and impose the extra-judicial UR process. I disagree that Illinois Midwest/Rodriguez "shifts the landscape" so that AA's have to " scrutinize the original authorization and the current facts". What AAs need to do is make sure that the PTPs, to they extent that they knew about the Patterson decision, to get Patterson out of their minds. There is no loophole where medical treatment does not required and RFA and UR. If PTPs want a certain treatment to continue, it is the same analysis as any other treatment that has worked before. The PTP says that the treatment worked before, the IW became more functional due to less pain, and so on, always stressing that the medical care, whatever it is has increased IW's function. I disagree with the conclusion that " Patterson isn't 'overruled' outright, but its reach is narrowed , especially where initial authorizations were non-UR/voluntary . The 'once authorized, forever authorized' rule is largely gone." Don't waste your time on dissecting the original authorization and the current facts about whether the medical condition changed. Just make sure that the PTP knows that every medical treatment has to be approved by UR. If the PTPs actually read UR decisions to find out what was wrong with the initial Report and RFA, that would help enormously. I still have PTPs who tell their patients/my clients that medical treatment decision take several moths to get authorized by UR and that the AA can litigate denied medical treatment in court. I disagree that ,"AAs now have to do a deep dive and justify our positions with a close analysis of the facts and circumstances. To put it succinctly, we now have to place it in 'context'." No amount of AA action is going to matter the least bit to medical treatment being governed by UR. (I have not mentioned UR very limited exceptions A(untimely, UR denied treatment that was not requested in RFA) and IMR because we should all know about the UR exceptions and the Stevens case is now 12 years old.) Hollie Rutkowski, RN, JD, MBA, Esq. [ https://the-compensation-law-center.business.site/ ' The Compensation Law Center ] Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Wednesday, November 12, 2025 7:13:47 AM Subject: Re: [lawnet] 2025-b344044/ PATTERSON under attack List: lawnet Sent By: [ mailto:francomunozlaw@gmail.com ' Rene Munoz ] [ mailto:francomunozlaw@gmail.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack ' Reply To Sender ] [ mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack ' Reply To List ] [ http://www.caaa.org/index.cfm?pg=search ' Search ] [ http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings ' Settings ] Art, Please correct me if I'm off base, but my reading of Illinois Midwest Ins. Agency is that the Court of Appeal expressly rejects Patterson "to the extent it set forth a contrary rule for injuries or medical-necessity determinations arising after the 2013 reforms," and holds there is no exception to the UR/IMR statutes for ongoing or continuing care. In other words, all post-2013 treatment disputes must proceed through UR and IMR, and the WCAB no longer has jurisdiction to award or continue treatment outside that statutory process. Practically speaking, that means for any RFA or medical-necessity issue after January 1, 2013, Patterson is effectively off the table. Our remaining leverage lies in Dubon I/II -specifically, procedural or timeliness defects in the UR process. Please correct me if I'm wrong. Steve Franco On Tue, Nov 11, 2025 at 10:00 PM Alan Snitzer (lawnet listserver) < [ mailto:listsender-lawnet@lawnet.caaa.org ' listsender-lawnet@lawnet.caaa.org ] > wrote: List: lawnet Sent By: [ mailto:abs@snitzerlaw.com ' Alan Snitzer ] [ mailto:abs@snitzerlaw.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack ' Reply To Sender ] [ mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack ' Reply To List ] [ http://www.caaa.org/index.cfm?pg=search ' Search ] [ http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings ' Settings ] Hi, Art, Thanks for your usual, scholarly analysis of this important legal development! It's always appreciated! Best, Alan LAW OFFICES OF ALAN B. SNITZER A PROFESSIONAL CORPORATION 80 S. Lake Ave., Suite 800 Pasadena, California 91101-2585 T: 626-449-4300 F: 626-449-0830 Certified Specialist, Workers' Compensation Law Board of Legal Specialization, The State Bar of California Included in SUPER LAWYERS Southern California Edition 2015-2025 1998-2025 -- == Franco Munoz, A P.C. 825 Washington Street. Suite 211 Oakland, CA 94607 (510) 257-4141
AI Analysis:
This message substantially addresses the user's question about MPN, PTP, authorization delays, and treatment outside the network. The attorney describes a specific case where their client had PTPs (Dr. Bratbaur and associate) but the Claims Administrator denied treatment for Long COVID, forcing the client to use private insurance for treatment at facilities outside the workers' compensation network (UCDMC and Stanford Long COVID clinic). This directly illustrates the practical consequences when authorization is denied - patients may lose their right to treatment within the MPN system and must seek care elsewhere. While it doesn't explicitly discuss formal waiver or forfeiture procedures, it provides a real-world example of how authorization delays/denials can result in patients going outside the network for treatment.
"M. Hollie Rutkowski" Date: November 10, 2025 1:01:00 PM Subject: Re: Bay Area PTP for post-Covid treatment Reply to list Reply to sender Print List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings My client with Long COVID treated at UCDMC and Stanford Long COVID clinic, but he used his private insurance because the Claims Administrator accepted two COVID claims then denied that COVID infection caused Long COVID. I can give you the names of the primary doctors who coordinated treatment at both facilities if that will help. Dr. Bratbaur and his associate in LA were my client's PTPs, but then the Claims Administrator denied treatment for Long COVID. Yes, I have a PQME who says Long COVID is industrial but it is very time consuming obtaining treatment records that number into the tens of thousands of pages and, of course, the DA is being an ass about sending them to the PQME at $3/page. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Cc: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Saturday, November 8, 2025 12:27:56 PM Subject: Re: [lawnet] Bay Area PTP for post-Covid treatment List: lawnet Sent By: Steven Scardino Reply To Sender Reply To List Search Settings Maybe Stanford Long Covid program Steve Scardino, Partner Mail to: Gordon, Edelstein, et al. 3250 Wilshire Blvd., Ste. 200 LA CA 90010 On Nov 7, 2025, at 2:07 PM, Bonnie Binder-Wilson (lawnet listserver) wrote: List: lawnet Sent By: Bonnie Binder-Wilson Reply To Sender Reply To List Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > Unfortunately, that is the issue with long covid. The MD’s have to discover what autoimmune diseases it caused and start treating that. Ask Tom Butts or Meredith Wisler - - Bonnie Binder Wilson, Esq. Wilson & Wisler, LLP Attorneys at Law 21 Maple Street Salinas, California 93901 Telephone: (831) 269-3787 Facsimile: (831) 269-3783 www.doubleulaw.com < http://www.doubleulaw.com/ > *************** PRIVATE AND CONFIDENTIAL **************** THIS ELECTRONIC MESSAGE TRANSMISSION IS A COMMUNICATION FROM THE LAW FIRM OF WILSON & WISLER, LLP. THIS MESSAGE CONTAINS INFORMATION PROTECTED BY THE ATTORNEY/CLIENT PRIVILEGE AND IS CONFIDENTIAL OR OTHERWISE THE EXCLUSIVE PROPERTY OF THE INTENDED RECIPIENT OR WILSON & WISLER, LLP. THIS INFORMATION IS SOLELY FOR THE USE OF THE INDIVIDUAL OR ENTITY THAT IS THE INTENDED RECIPIENT. From: Mark Berg (lawnet listserver) Sent: Thursday, November 6, 2025 5:01 PM To: Statewide List Service Subject: [lawnet] Bay Area PTP for post-Covid treatment List: lawnet Sent By: Mark Berg Reply To Sender Reply To List Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > Any recommendations for a physician or group who will treat long Covid applicant? She has several injuries and was treating with Timothy Lo and Morley, but says they are not helping with the Covid symptoms. No MPN. Thank you for any recommendations. Mark Berg Elder and Berg Concord/Brentwood Service of documents by electronic mail per WCAB Rule 10625 to this email address is not authorized, accepted or binding upon Gordon, Edelstein, Krepack, Grant, Felton & Goldstein, LLP, or its clients.
AI Analysis:
This message substantially addresses the user's question about MPN, PTP, authorization delays, waivers, and rights to treat outside the network. The message contains two key responses: 1) Hollie Rutkowski asks about UR/IMR denial reasons and whether this creates options for QME panels or re-exams when PTP visits are denied, and 2) Kenneth Martinson directly advises to 'Pick a new treater as backup and also get judge to order you can pick somebody outside mpn.' This second response specifically addresses the right to treat outside the MPN network through judicial order, which is directly relevant to understanding options when facing authorization delays and potential waivers of MPN requirements.
"M. Hollie Rutkowski" Date: November 06, 2025 11:41:00 AM Subject: Re: UR denied ptp visits for 12 months - set for expedited Reply to list Reply to sender Print List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings What did the UR and IMR say were the reasons for no further PTP visits? Would this allow for a QME Panel (if this is the first one) or a PQME/AME re-exam since this Denial is in practice a "release as cured" determination? Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Thursday, November 6, 2025 6:02:49 AM Subject: Re:[lawnet] UR denied ptp visits for 12 months - set for expedited List: lawnet Sent By: Kenneth Martinson Reply To Sender Reply To List Search Settings Pick a new treater as backup and also get judge to order you can pick somebody outside mpn. ABOGADO GOMEZ Compensacion al Trabajador Workers Compensation Kenneth Martinson San Bruno 👉Mail: 1212 El Camino Real, #H103 San Bruno, CA. 94066 - Effect 09/15/2025 Phone/telefono: (408) 375 - 8135 Fax: (408) 409 - 2536 Email: kennethmesq@msn.com KENNETH MARTINSON SAN BRUNO 4453784 The California Constitution declares that Workers' Compensation shall accomplish substantial justice in all cases expeditiously, inexpensively, and without incumbrance of any character. �
AI Analysis:
This message substantially addresses the user's question about MPN, PTP, authorization delays, waivers, and rights to treat outside the network. The attorney specifically advises to 'get judge to order you can pick somebody outside mpn' which directly relates to the waiver/forfeiture of MPN network restrictions and the right to obtain treatment outside the network. While brief, it provides actionable legal strategy for circumventing MPN limitations when there are treatment access issues, which is central to understanding when and how network restrictions can be waived or bypassed.
"Kenneth Martinson" Date: November 06, 2025 8:03:00 AM Subject: Re: UR denied ptp visits for 12 months - set for expedited Reply to list Reply to sender Print List: lawnet Sent By: Kenneth Martinson Reply To Sender Reply To List Search Settings Pick a new treater as backup and also get judge to order you can pick somebody outside mpn. ABOGADO GOMEZ Compensacion al Trabajador Workers Compensation Kenneth Martinson San Bruno 👉Mail: 1212 El Camino Real, #H103 San Bruno, CA. 94066 - Effect 09/15/2025 Phone/telefono: (408) 375 - 8135 Fax: (408) 409 - 2536 Email: kennethmesq@msn.com KENNETH MARTINSON SAN BRUNO 4453784 The California Constitution declares that Workers' Compensation shall accomplish substantial justice in all cases expeditiously, inexpensively, and without incumbrance of any character. �
AI Analysis:
This message substantially addresses the user's question about MPN, PTP, authorization, delays, waivers, outside network, and treatment rights. The attorney explains that in Chico there are no valid MPNs, which means clients are 'outside the MPN' and must seek treatment in other cities like Red Bluff, Redding, or Sacramento. This directly relates to the core issues of MPN networks, PTP availability, and what happens when patients need to go outside the network for treatment. While it doesn't explicitly discuss authorization delays or forfeiture of rights, it provides practical insight into how MPN limitations affect treatment access and the need to seek care outside the network.
Hollie, the only PTP's in Chico proper are Work Health Solutions or COMP/DNP Suhas under David McKinney, M.D. We do not have valid MPN's here so a lot of our clients are outside the MPN and got to Red Bluff, Redding, or Sac.
AI Analysis:
This message substantially addresses the user's question about MPN, PTP, authorization delays, waivers, and rights regarding treatment outside the network. The message discusses key legal concepts including: (1) how insurance carriers' failure to investigate treatment recommendations can make subsequent UR untimely, (2) how untimely UR gives the WCAB jurisdiction over treatment authorization, (3) specific case law (Dubon v World Restoration) explaining when UR denials are untimely and how this affects treatment rights, and (4) practical scenarios where carriers may forfeit their right to deny treatment through procedural failures. While it doesn't use the exact terminology of 'forfeiting rights to treat outside the network,' it explains the legal mechanism by which authorization delays and procedural failures can result in loss of carrier control over treatment decisions.
"Lawrence R. Whiting" Date: August 29, 2025 10:59:00 AM Subject: Re: Neuro Psych recommends Home Care Reply to list Reply to sender Print List: lawnet Sent By: Lawrence R. Whiting Reply To Sender Reply To List Search Settings And don't forget your sanctions petition. I would also recommend an audit referral. I've never done one but I'm sure Hollie could tell you how. -----Original Message----- From: cognitorsj@aol.com Sent: August 28, 2025 7:46:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Neuro Psych recommends Home Care Hey Joshua, If you think you have evidence to prove IR knew or should have known that IW needed HHC or other treatment, but still didn't investigate the issue further, then I think you have a case a judge could award the care. I've got a case right now where the adjuster literally put in the claims notes, "I jumped at the opportunity to stop TD" after a doctor's recommendations had been repeatedly refused and the doctor gave up and declared my client P&S. You have notice to the IR and the IR's failure to investigate or send to UR. I think that makes any subsequent UR untimely and gives the WCJ jurisdiciton. Mike RichterCampbell On Thursday, August 28, 2025 at 02:52:39 PM PDT, Lawrence R. Whiting (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> wrote: ' List: lawnet Sent By: Lawrence R. Whiting ' ' Reply To Sender ' Reply To List ' Search ' Settings ' Dubon v World Restoration 79 CCC 1298 (en banc) This decision goes through the process of UR appeals of denials and appeals. Normally, an appeal of a UR denial must be resolved by IMR. However, where there is no UR denial or an untimely UR denial under circumstances that would've required an investigation, the UR is considered untimely in the WCAB has jurisdiction. Weimer v Hilliard 2017 cal wrk comp pd lexis 104. Citing Dubon. An RFA was submitted that identified the employee to the adjuster who received information reasonably necessary to make the determination that the treatment was necessary. An untimely UR gives the board jurisdiction to decide the issue of medical necessity. San Francisco 49ers v WCAB 83 CCC 1434. An RFA does not have to be signed by the PTP. Although these cases referred to our four incomplete or ignored RFA's, I think the reasoning that sufficient information submitted that is ignored should result in an untimely UR denial. -----Original Message----- From: josh@accidentdefenders.com Sent: August 27, 2025 10:08:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Neuro Psych recommends Home Care Thank you mike. I did send a duty to investigate letter. So at this point I presume, I should just file MSc. On this issue of duty to investigate an authorization of the home care assessment, correct? Joshua R. Kohanbash, Esq. ' Managing Partner Accident Defenders APC *Physical Office: 18345 Ventura Blvd. Suite 518 Tarzana, CA 91356* *NEW:** MAILING ADDRESS FOR WC CLAIMS ONLY: **PO Box 1200 Portsmouth, NH 03802* *t:* 323.591.2829 '* f: *323.831.6828 ' *e:Josh@accidentdefenders.com <e%3AJosh@accidentdefenders.com> * *WWW.ACCIDENTDEFENDERS.COM <http://WWW.ACCIDENTDEFENDERS.COM>* *SERVICING LOS ANGELES ' ORANGE COUNTY ' COACHELLA VALLEY ' INLAND EMPIRE ' SAN DIEGO '* CONFIDENTIALITY: This communication, including attachments, is for the exclusive use of the addressee(s) and may contain proprietary, confidential, or privileged information. If you are not the intended recipient, any use, copying, disclosure, or distribution or the taking of any action in reliance upon this information is strictly prohibited. If you are not the intended recipient, please notify the sender immediately and delete this communication and destroy all copies. *Our office does not accept electronic service whether by email or facsimile; of ANY correspondence or pleadings, that includes service of Panels. You have been put on notice. * On Wed, Aug 27, 2025, 5:19 PM Mike Richter (lawnet listserver) < listsender-lawnet@lawnet.caaa.org> wrote: > *List:* lawnet *Sent By:* Mike Richter <cognitorsj@aol.com> > Reply To Sender > <cognitorsj@aol.com?subject=Re%3A%20%5Blawnet%5D%20Neuro%20Psych%20recommends%20Home%20Care> > Reply To List > <lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Neuro%20Psych%20recommends%20Home%20Care> > Search <http://www.caaa.org/index.cfm?pg=search> > Settings > <http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> > > Read attached > > *Blosser v. RB Spencer, Inc., 2025 Cal. Wrk. Comp. P.D. LEXIS 145; 2025 LX > 150251* > <https://advance.lexis.com/api/document?collection=administrative-materials&id=urn:contentItem:6G3V-C3Y3-RT0N-R3KW-00000-00&context=1000516> > > Workers' Compensation Appeals Board (Board Panel Decision) > > April 28, 2025 Opinion Filed > > W.C.A.B. Nos. ADJ17146948, ADJ17146930, ADJ15040609-WCJ Parker Shelton > (SAC); WCAB Panel: Commissioners Snellings, Razo, Capurro > > > > *Reporter* > > 2025 Cal. Wrk. Comp. P.D. LEXIS 145 *; 2025 LX 150251 > > > *Wayne Blosser, Applicant v. RB Spencer, Inc., Air Conditioning and > Heating, Insurance Company of the West, Defendants* > > In a message dated 8/27/2025 5:00:12 PM Pacific Daylight Time, > listsender-lawnet@lawnet.caaa.org writes: > > > *List:* lawnet *Sent By:* Joshua Kohanbash <josh@accidentdefenders.com> > Reply To Sender > <josh@accidentdefenders.com?subject=Re%3A%20Neuro%20Psych%20recommends%20Home%20Care> > Reply To List > <lawnet@lawnet.caaa.org?subject=Re%3A%20Neuro%20Psych%20recommends%20Home%20Care> > Search <http://www.caaa.org/index.cfm?pg=search> > Settings > <http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> > Hi All > > Thanks in advance. Our Neuro Psych Dr. Ponton (who we agreed to use for a > consult) recommended a Home Care Assessment. DA says he wont authorize > one. And because it was a consult and they will not authorize it until UR > approves it..... Rx from a MPN doctor saying so. > > > Is that the only way? Any advice would be greatly appreciated to get this > moving. 🙠> > > Joshua R. Kohanbash, Esq. ' Managing Partner > Accident Defenders APC > > *Physical Office: 18345 Ventura Blvd. Suite 518 Tarzana, CA 91356 > <https://www.google.com/maps/search/18345+Ventura+Blvd.+Suite+518+Tarzana,+CA+91356?entry=gmail&source=g>* > > *NEW:* *MAILING ADDRESS FOR WC CLAIMS ONLY: **PO Box 1200 Portsmouth, NH > 03802* > > *t:* 323.591.2829 ' *f:* 323.831.6828 ' *e:Josh@accidentdefenders.com > <e%3AJosh@accidentdefenders.com> * > > *WWW.ACCIDENTDEFENDERS.COM <http://WWW.ACCIDENTDEFENDERS.COM>* > > > *SERVICING LOS ANGELES ' ORANGE COUNTY ' COACHELLA VALLEY ' INLAND EMPIRE > ' SAN DIEGO ' * > > CONFIDENTIALITY: This communication, including attachments, is for the > exclusive use of the addressee(s) and may contain proprietary, > confidential, or privileged information. If you are not the intended > recipient, any use, copying, disclosure, or distribution or the taking of > any action in reliance upon this information is strictly prohibited. If > you are not the intended recipient, please notify the sender immediately > and delete this communication and destroy all copies. *Our office does > not accept electronic service whether by email or facsimile; of ANY > correspondence or pleadings, that includes service of Panels. You have been > put on notice. * > > > > > > >
AI Analysis:
This message substantially addresses the user's question about MPN, PTP, authorization delays, waivers, and rights in workers' compensation treatment. Lawrence Whiting provides specific case law (Dubon v World Restoration, Weimer v Hilliard, San Francisco 49ers v WCAB) that directly explains how untimely utilization review (UR) denials affect treatment authorization processes. The message explains that when there is no UR denial or an untimely UR denial, the WCAB has jurisdiction to decide medical necessity issues, which relates to treatment rights and authorization delays. It also discusses how sufficient information submitted but ignored can result in untimely UR denial, addressing the waiver/forfeiture aspect of treatment rights. While it doesn't explicitly mention MPN networks or PTPs losing rights to treat outside networks, it provides crucial legal framework for understanding authorization delays and their consequences in the workers' compensation system.
"Lawrence R. Whiting" Date: August 28, 2025 4:53:00 PM Subject: Re: Neuro Psych recommends Home Care Reply to list Reply to sender Print List: lawnet Sent By: Lawrence R. Whiting Reply To Sender Reply To List Search Settings Dubon v World Restoration 79 CCC 1298 (en banc) This decision goes through the process of UR appeals of denials and appeals. Normally, an appeal of a UR denial must be resolved by IMR. However, where there is no UR denial or an untimely UR denial under circumstances that would've required an investigation, the UR is considered untimely in the WCAB has jurisdiction. Weimer v Hilliard 2017 cal wrk comp pd lexis 104. Citing Dubon. An RFA was submitted that identified the employee to the adjuster who received information reasonably necessary to make the determination that the treatment was necessary. An untimely UR gives the board jurisdiction to decide the issue of medical necessity. San Francisco 49ers v WCAB 83 CCC 1434. An RFA does not have to be signed by the PTP. Although these cases referred to our four incomplete or ignored RFA's, I think the reasoning that sufficient information submitted that is ignored should result in an untimely UR denial. -----Original Message----- From: josh@accidentdefenders.com Sent: August 27, 2025 10:08:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Neuro Psych recommends Home Care Thank you mike. I did send a duty to investigate letter. So at this point I presume, I should just file MSc. On this issue of duty to investigate an authorization of the home care assessment, correct? Joshua R. Kohanbash, Esq. ' Managing Partner Accident Defenders APC *Physical Office: 18345 Ventura Blvd. Suite 518 Tarzana, CA 91356* *NEW:** MAILING ADDRESS FOR WC CLAIMS ONLY: **PO Box 1200 Portsmouth, NH 03802* *t:* 323.591.2829 '* f: *323.831.6828 ' *e:Josh@accidentdefenders.com <e%3AJosh@accidentdefenders.com> * *WWW.ACCIDENTDEFENDERS.COM <http://WWW.ACCIDENTDEFENDERS.COM>* *SERVICING LOS ANGELES ' ORANGE COUNTY ' COACHELLA VALLEY ' INLAND EMPIRE ' SAN DIEGO '* CONFIDENTIALITY: This communication, including attachments, is for the exclusive use of the addressee(s) and may contain proprietary, confidential, or privileged information. If you are not the intended recipient, any use, copying, disclosure, or distribution or the taking of any action in reliance upon this information is strictly prohibited. If you are not the intended recipient, please notify the sender immediately and delete this communication and destroy all copies. *Our office does not accept electronic service whether by email or facsimile; of ANY correspondence or pleadings, that includes service of Panels. You have been put on notice. * On Wed, Aug 27, 2025, 5:19 PM Mike Richter (lawnet listserver) < listsender-lawnet@lawnet.caaa.org> wrote: > *List:* lawnet *Sent By:* Mike Richter <cognitorsj@aol.com> > Reply To Sender > <cognitorsj@aol.com?subject=Re%3A%20%5Blawnet%5D%20Neuro%20Psych%20recommends%20Home%20Care> > Reply To List > <lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Neuro%20Psych%20recommends%20Home%20Care> > Search <http://www.caaa.org/index.cfm?pg=search> > Settings > <http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> > > Read attached > > *Blosser v. RB Spencer, Inc., 2025 Cal. Wrk. Comp. P.D. LEXIS 145; 2025 LX > 150251* > <https://advance.lexis.com/api/document?collection=administrative-materials&id=urn:contentItem:6G3V-C3Y3-RT0N-R3KW-00000-00&context=1000516> > > Workers' Compensation Appeals Board (Board Panel Decision) > > April 28, 2025 Opinion Filed > > W.C.A.B. Nos. ADJ17146948, ADJ17146930, ADJ15040609-WCJ Parker Shelton > (SAC); WCAB Panel: Commissioners Snellings, Razo, Capurro > > > > *Reporter* > > 2025 Cal. Wrk. Comp. P.D. LEXIS 145 *; 2025 LX 150251 > > > *Wayne Blosser, Applicant v. RB Spencer, Inc., Air Conditioning and > Heating, Insurance Company of the West, Defendants* > > In a message dated 8/27/2025 5:00:12 PM Pacific Daylight Time, > listsender-lawnet@lawnet.caaa.org writes: > > > *List:* lawnet *Sent By:* Joshua Kohanbash <josh@accidentdefenders.com> > Reply To Sender > <josh@accidentdefenders.com?subject=Re%3A%20Neuro%20Psych%20recommends%20Home%20Care> > Reply To List > <lawnet@lawnet.caaa.org?subject=Re%3A%20Neuro%20Psych%20recommends%20Home%20Care> > Search <http://www.caaa.org/index.cfm?pg=search> > Settings > <http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> > Hi All > > Thanks in advance. Our Neuro Psych Dr. Ponton (who we agreed to use for a > consult) recommended a Home Care Assessment. DA says he wont authorize > one. And because it was a consult and they will not authorize it until UR > approves it..... Rx from a MPN doctor saying so. > > > Is that the only way? Any advice would be greatly appreciated to get this > moving. 🙠> > > Joshua R. Kohanbash, Esq. ' Managing Partner > Accident Defenders APC > > *Physical Office: 18345 Ventura Blvd. Suite 518 Tarzana, CA 91356 > <https://www.google.com/maps/search/18345+Ventura+Blvd.+Suite+518+Tarzana,+CA+91356?entry=gmail&source=g>* > > *NEW:* *MAILING ADDRESS FOR WC CLAIMS ONLY: **PO Box 1200 Portsmouth, NH > 03802* > > *t:* 323.591.2829 ' *f:* 323.831.6828 ' *e:Josh@accidentdefenders.com > <e%3AJosh@accidentdefenders.com> * > > *WWW.ACCIDENTDEFENDERS.COM <http://WWW.ACCIDENTDEFENDERS.COM>* > > > *SERVICING LOS ANGELES ' ORANGE COUNTY ' COACHELLA VALLEY ' INLAND EMPIRE > ' SAN DIEGO ' * > > CONFIDENTIALITY: This communication, including attachments, is for the > exclusive use of the addressee(s) and may contain proprietary, > confidential, or privileged information. If you are not the intended > recipient, any use, copying, disclosure, or distribution or the taking of > any action in reliance upon this information is strictly prohibited. If > you are not the intended recipient, please notify the sender immediately > and delete this communication and destroy all copies. *Our office does > not accept electronic service whether by email or facsimile; of ANY > correspondence or pleadings, that includes service of Panels. You have been > put on notice. * > > > > > > >
AI Analysis:
This message substantially addresses the user's question about MPN, PTP, authorization, delays, waivers, outside network treatment, and forfeiting rights to treatment. The attorney provides specific guidance on how to handle situations where there are 'insufficient network treaters' and mentions doctors who 'will work to get authorized' and who 'treat on a lien basis' when network options are unavailable. The message directly addresses the practical solutions for obtaining treatment authorization when MPN networks are inadequate, including working with providers who understand UR processes to avoid denials and using lien-basis treatment as an alternative. This provides actionable information about preserving treatment rights and avoiding delays when network limitations arise.
"Joel Campbell" Date: August 21, 2025 8:37:00 AM Subject: Re: PTP in Madera / Fresno - MPN or Lien Reply to list Reply to sender Print List: lawnet Sent By: Joel Campbell Reply To Sender Reply To List Search Settings My favorite overall PTP in Fresno is Thomas Jacques at Boomerang. He's a pain management specialist, is very knowledgeable, and has a great staff. They're in a lot of networks, and they will work to get authorized if there are insufficient network treaters, etc. Boomerang is statewide, and they have a group of docs who do nothing but respond to UR questions, so they don't play phone tag and get denied. My UR denial rate is lower with Boomerang. Other options include Daniel Brubaker who was out of comp for a while (his staff member who understood comp billing and UR retired, his new office manager has experience though). He's a good treater. Sanjay Chauhan used to be everyone's go to. He's a neurologist and very thorough in finding additional compensable consequence, etc. He had a staffing problem at the end of Covid, and I'm not sure he's fully recovered from that. He's on some networks because they need neurologists, but the carriers don't like him. Good chiro is Paul Schroeder. He writes a QME quality report. Used to be a QME, but I don't think he renewed. He's the only Fresno doc I personally know who will treat on a lien basis, but he's in some networks as well. There's another outfit that came by my office yesterday and dropped off brownies, saying they now have lien docs who will treat in Fresno, but I can't remember the name and I'll have to look them up. Good luck, Joel Campbell Valley Law Group, PC -----Original Message----- From: claims@yedalyanlaw.com Sent: August 20, 2025 12:20:00 PM To: lawnet@lists.trialsmith.com Subject: PTP in Madera / Fresno - MPN or Lien Any treaters in / near Madera or Fresno? Accepted case with MPN but no available PTP in network.
AI Analysis:
This message substantially addresses the user's question about MPN, PTP, authorization, and treatment rights by discussing a specific strategic approach to physician designation. The attorney explains wanting to use a non-MPN PTP for denied body parts while using an MPN physician for accepted parts, which directly relates to questions about MPN networks, treatment rights, and authorization procedures. While it doesn't explicitly discuss delays, waivers, or forfeiting rights, it provides practical insight into how attorneys navigate MPN requirements and treatment authorization issues for different claim scenarios.
No. DA wants to force me to designate an MPN PTP for accepted body parts and then can have a secondary for denied parts. I want to have non MPN PTP for denied parts and secondary MPN physician for accepted part.
AI Analysis:
This message substantially addresses the user's question about MPN, PTP, authorization, delays, waivers, outside network treatment, and forfeiting rights to treatment. The attorney discusses how PTPs within MPNs may be hesitant to authorize treatment that extends beyond their network scope (mentioning PTPs being 'afraid they will get kicked out of the MPN' for ordering treatment that is 'in part non-industrial'). The message provides legal authority showing that defendants must take reasonable steps to treat non-industrial conditions to enable proper industrial treatment, which directly relates to authorization requirements and treatment rights within MPN frameworks. While it doesn't explicitly discuss delays or waivers, it addresses the core tension between MPN restrictions and treatment authorization rights.
"M. Hollie Rutkowski" Date: May 13, 2025 1:42:00 PM Subject: Re: Industrial Injury Worsened by Non-Industrial Treatment Reply to list Reply to sender Print List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings I hope the PTP will have the wherewithal to order HHC based on both the industrial eye injury and the (potentially) non-industrial aggravation. If so, the law is clear: When an industrially injured employee is suffering from a non-industrial condition which prevents the full implementation of medical care for his industrial problem, defendant must take reasonable steps to treat the non-industrial condition so that the appropriate treatment may be rendered for the industrial problems. [ Braewood Convalescent Hospital et al. v. WCAB (Bolton), 34 CA3d 159, 48 CCC 566 (1983); Vela v. WCAB , 22 CA3d 513, 36 CCC 807 (1971); SCRTD v. WCAB (Romero), 42 CCC 917 (W/D-1977); LAUSD v. WCAB (Williams), 46 CCC 389 (W/D-1981).] I hope the PTP is not one to worry about his/her/their MPN status for ordering treatment that is in part non-industrial, i.e. afraid they will get kicked out of the MPN. Here in Sacramento, the PTPs are not the type to go out on a limb when requesting medical treatment. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Tuesday, May 13, 2025 11:12:06 AM Subject: Re:[lawnet] Industrial Injury Worsened by Non-Industrial Treatment List: lawnet Sent By: Richard Alpers Reply To Sender Reply To List Search Settings she was not getting it before -----Original Message----- From: Hollie@TCLC.org Sent: May 13, 2025 1:07:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Industrial Injury Worsened by Non-Industrial Treatment Did your client have HHC before and needs more hours now or is HHC a new RFA due to your client being almost blind now? Hollie Rutkowski, RN, JD, MBA, Esq. [ https://the-compensation-law-center.business.site/ ' The Compensation Law Center ] Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Tuesday, May 13, 2025 10:31:39 AM Subject: [lawnet] Industrial Injury Worsened by Non-Industrial Treatment List: lawnet Sent By: [ mailto:rca@alperslawgroup.com ' Richard Alpers ] [ mailto:rca@alperslawgroup.com?subject=Re%3A%20Industrial%20Injury%20Worsened%20by%20Non-Industrial%20Treatment ' Reply To Sender ] [ mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20Industrial%20Injury%20Worsened%20by%20Non-Industrial%20Treatment ' Reply To List ] [ http://www.caaa.org/index.cfm?pg=search ' Search ] [ http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings ' Settings ] All, I have client with an eye injury from a severe chemical burn. 1 year after the eye injury, and before being PS/MMI from the severe chemical burn, she was diagnosed with breast cancer and received treatment. After receiving this breast cancer treatment, her visual acuity worsened. Assuming a substantial QME report finds that this worsening in acuity was contributed to by the breast cancer treatment (and this cancer is non-industrial), what happens in the WC case? I understand there could be an argument for apportionment of PD, but would the need for home health due to blindness still be the responsibility of WC carrier? Thanks Richard
AI Analysis:
This message does not directly answer the user's question about MPN, PTP, authorization delays, waivers, outside network treatment, or forfeiting rights to treatment. While the message discusses medical treatment denials and the Patterson case, it focuses on unilateral denials not based on UR/IMR and the challenges with treating doctors providing continued care. The message lacks specific information about MPN/PTP procedures, authorization processes, network restrictions, or the circumstances under which patients might waive or forfeit treatment rights. Someone reading this message would not learn the answer to the user's specific question about these workers' compensation procedural issues.
I totally agree with KJ, Hollie, and Steve to the extent that Patterson was truly unique and fluke. To the extent Patterson was based upon a unilateral denial of medical treatment, not based upon UR/IMR, it was, as KJ said, a fluke. I and probably many others here have successfully used Patterson as an argument to continue medical treatment once approved which was successfully used as an argument against UR denial of treatment for a long time. Sadly, those days are gone as Illinois Midwest Ins. Agency unfortunately was bound to come along at some point and reaffirm that UR and IMR is alive and well despite initial approval for certain treatment. I do believe, as I have said before, that Patterson is still alive - to the extent that we ever have those kinds of unique facts, which will be very rare. The real root cause problem in our system is that treating doctors do not want to take the time and effort to do what is really needed to allow for continued care and provide continued reporting - especially in our catastrophic cases which is a very real concern. Dane's suggestions are also great. Art Arthur Csillag, Esq. acsillaglaw@gmail.com Law Office Of Arthur Csillag 2410 W. Magnolia Blvd. Burbank, CA 91506 O (818) 558-7225 / Cell (818) 219-4264 / Fx (818) 558-7151
AI Analysis:
This message does not answer the user's real question about MPN, PTP, authorization delays, waivers, outside network treatment, and forfeiting rights to treatment. While the message mentions PTP (Primary Treating Physician) in the context of a specific case about TD termination based on unsigned reports, it does not address the core issues the user is asking about: authorization delays, waivers of MPN requirements, outside network treatment rights, or forfeiture of treatment rights. The message focuses on a narrow procedural issue about report signatures and good faith investigation obligations, which is tangentially related but does not provide substantive information about the user's actual question regarding MPN authorization processes and patient rights.
cognitorsj@aol.com Date: August 14, 2025 1:38:00 PM Subject: Re: TD Terminated based on PR-2s lacking PTP signature Reply to list Reply to sender Print List: lawnet Sent By: Mike Richter Reply To Sender Reply To List Search Settings Well, interesting. I know you are quoting 8 CCR 10109(b)(1), obligation to investigate without limiting investigation only to disculpatory facts and 8 CCR 10109(e) obligation to treat injured worker with good faith. It seems that taking the time to lift a phone or write an email to ask MD whether she/he meant to sign the reports would not place an unreasonable burden on the claims examiner. You have a dead-bang penalty - or two if they did it more than once - separated by a new and different report, AND I would ask for 5813 sanctions and accompanying attorney's fees. You may want to ask for and then subpoena the claims file. The worst I've every seen out of a claims file was a Zurich adjuster who, after reading the doctor's opinion that my brain injured client was P&S because the insurance company had denied all the treatment he was recommending and said, "There's nothing more I can do as a neurologist", wrote in the claims file, “I jumped at the opportunity to stop the TTD ” Not a good demonstration of good faith. Good Luck. Have at! Mike Richter Campbell In a message dated 8/14/2025 11:20:53 AM Pacific Daylight Time, listsender-lawnet@lawnet.caaa.org writes: List: lawnet Sent By: James Kim Reply To Sender Reply To List Search Settings Hello All, I have an expedited this coming Monday on an issue where the Defendant terminated TD and deferred one UR based on the designated PTP not explicitly signing off on the reports and rather a different doctor (purportedly under the PTP's supervision)signing the reports. PTP sees him very infrequently, but does still sign off on almost all of the RFAs, just not the reports themselves. The reports do have a note that states, "supervising physician is in agreement with treatment plan" but unfortunately also doesn't explicitly name the designated PTP as the "supervising physician." I raised the fact that Concentra does this all the time, and DA had the gall to state that Concentra as an entity is a member of the MPN so they're allowed to do that, while my PTP's clinic is not. There are really no regs allowing an entity to be named as a member of the MPN. I don't want to make bad law here, but I believe the facts are sufficient to support that termination of TD is in bad faith. Any thoughts, advice?
AI Analysis:
This message does not answer the user's real question about MPN/PTP authorization delays, waivers, and rights regarding treatment outside the network. While the message mentions MPN and discusses issues with a specific doctor's practice (Dr. Shin), it focuses on quality of care and organizational problems rather than addressing any legal aspects of authorization delays, waiver of rights, or forfeiture of network requirements. The discussion is about practice management issues, not the procedural or legal consequences the user is asking about regarding MPN authorization processes.
"Kevin Bryant" Date: April 16, 2026 12:37:00 PM Subject: Re: PTP MPN or Lien - Lincoln / Placer County Reply to list Reply to sender Print List: lawnet Sent By: Kevin Bryant Reply To Sender Reply To List Search Settings I have heard numerous complaints about Dr. Shin’s offices since he started expanding to Yuba City and Stockton. Seems that things are a bit disorganized with staff and the new MDs he has brought in come across as uninformed about the patient’s injuries/prior treatment/treatment plan and uninterested in providing the level of care that I was used to seeing from Dr. Shin himself. When clients ask to be seen by Dr. Shin they are told he is too busy with the new offices. Just my two cents. Sincerely, Kevin Bryant, Esq. Law Office of Kevin L. Bryant Mailing Address: P.O. Box 1033, Citrus Heights, CA 95611 Physical Address: 1100 Melody Ln., Suite 131, Roseville, CA 95678 P: (916) 520-4322 F: (916) 520-4322 E: kbryant@klbryantlaw.com From: Sandra Gomes (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Thursday, April 16, 2026 10:30 AM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: Re:[lawnet] PTP MPN or Lien - Lincoln / Placer County List: lawnet Sent By: Sandra Gomes Reply To Sender Reply To List Search Settings Dr. Shin at the Center for Interdisciplinary Spine opened a Yuba City Office. -----Original Message----- From: claims@yedalyanlaw.com Sent: April 16, 2026 12:10:00 PM To: lawnet@lists.trialsmith.com Subject: PTP MPN or Lien - Lincoln / Placer County Looking for PTP in Lincoln 95648 or Placer County for accepted case. No MPN PTP available - open to different specialties. Lower leg amputation. Thank you! Armen Yedalyan, Esq. Certified Specialist
AI Analysis:
This message does not answer the user's question about MPN, PTP, authorization delays, waivers, outside network treatment rights, or forfeiture of treatment rights. The message is simply a brief exchange about finding a pulmonologist who will act as a PTP, with one attorney saying 'Thank you!!' and another providing contact information for Dr. Frank Ganzhorn. While it mentions 'PTP' (Primary Treating Physician), it provides no substantive information about authorization processes, delays, waivers, network requirements, or patients' rights regarding treatment outside the MPN network. The message is purely about physician referrals and does not address any of the legal concepts the user is seeking information about.
"Robert Mack" Date: April 15, 2026 5:22:00 PM Subject: Re: East Bay Pulmonologist Reply to list Reply to sender Print List: lawnet Sent By: Robert Mack Reply To Sender Reply To List Search Settings Thank you!! Robert G. Mack, Esq. Attorney KURLANDER, BURTON, & MACK 100 BUSH STREET, SUITE 2150 SAN FRANCISCO, CA 94104 (415) 392-8920 ex: 1005 (415) 392-8921 Fax rmack@kurlanderburtonlaw.com www.kbmlawsf.com The information in this email may be confidential and/or privileged. This email is intended to be reviewed only by the individual or organization named above. If you are not the intended recipient or an authorized representative of the intended recipient, you are hereby notified that any review, dissemination or copying of this email and its attachments, if any, and any use or disclosure of the information contained herein, is prohibited. If you have received this email in error, please immediately notify the sender by email or telephone and permanently delete this email from your system. From: Hollie Rutkowski (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Date: Wednesday, April 15, 2026 at 12:24 PM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: Re: [lawnet] East Bay Pulmonologist List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings Dr. Frank Ganzhorn is probably the only pulmonologist who will act as PTP in NorCal. He is the PTP for a client of mine who lives in El Dorado Hills. I have an email to his office elavina@cypresshealthcare.com . Address : 1033 Los Palos Dr Suite A, Salinas, CA 93901 Phone : (831) 757-2058 Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Wednesday, April 15, 2026 12:18:24 PM Subject: [lawnet] East Bay Pulmonologist List: lawnet Sent By: Robert Mack Reply To Sender Reply To List Search Settings Hi All, Does anyone have any recommendations for a pulmonologist near the East Bay (or anywhere in the Bay Area)? We are outside the MPN, at this point, so any recommendations are greatly appreciated! Thanks! Rob Robert G. Mack, Esq. Attorney KURLANDER, BURTON, & MACK 100 BUSH STREET, SUITE 2150 SAN FRANCISCO, CA 94104 (415) 392-8920 ex: 1005 (415) 392-8921 Fax rmack@kurlanderburtonlaw.com www.kbmlawsf.com
AI Analysis:
This message does not answer the user's question about MPN, PTP, authorization delays, waivers, outside network treatment rights, or forfeiture of treatment rights. While the message mentions being 'outside the MPN' and discusses finding a PTP (Primary Treating Physician), it is simply a straightforward referral request and response for a pulmonologist recommendation. The message does not address any legal issues about authorization delays, waiver of rights, or the consequences of seeking treatment outside an MPN network. It provides no substantive legal information about the complex workers' compensation issues the user is asking about.
"M. Hollie Rutkowski" Date: April 15, 2026 2:24:00 PM Subject: Re: East Bay Pulmonologist Reply to list Reply to sender Print List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings Dr. Frank Ganzhorn is probably the only pulmonologist who will act as PTP in NorCal. He is the PTP for a client of mine who lives in El Dorado Hills. I have an email to his office elavina@cypresshealthcare.com . Address : 1033 Los Palos Dr Suite A, Salinas, CA 93901 Phone : (831) 757-2058 Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Wednesday, April 15, 2026 12:18:24 PM Subject: [lawnet] East Bay Pulmonologist List: lawnet Sent By: Robert Mack Reply To Sender Reply To List Search Settings Hi All, Does anyone have any recommendations for a pulmonologist near the East Bay (or anywhere in the Bay Area)? We are outside the MPN, at this point, so any recommendations are greatly appreciated! Thanks! Rob Robert G. Mack, Esq. Attorney KURLANDER, BURTON, & MACK 100 BUSH STREET, SUITE 2150 SAN FRANCISCO, CA 94104 (415) 392-8920 ex: 1005 (415) 392-8921 Fax rmack@kurlanderburtonlaw.com www.kbmlawsf.com
AI Analysis:
This message does not answer the user's question about MPN, PTP, authorization delays, waivers, outside network treatment, or forfeiting rights to treatment. The message is a general discussion about litigation strategy regarding PQMEs (Panel Qualified Medical Evaluators), scheduling expedited hearings, and setting a strong tone with defendants. While it mentions 'treatment from the mpn' in passing, it does not address the specific legal issues around authorization delays, waivers of rights, or consequences of going outside the MPN network that the user is asking about. The message focuses on general litigation tactics rather than the substantive MPN/PTP authorization and waiver issues the user needs information about.
"Lawrence R. Whiting" Date: April 10, 2026 4:00:00 PM Subject: Re: Reality Check on Letters to PQMEs Reply to list Reply to sender Print List: lawnet Sent By: Lawrence R. Whiting Reply To Sender Reply To List Search Settings I agree with you. Let them know you won't let them screw around. I would even consider a subpoena of the DA fees if I am going for sanctions. May sway the judge on fees to you. Bar #58523 -----Original Message----- From: picow51@yahoo.com Sent: April 09, 2026 2:40:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Reality Check on Letters to PQMEs I am old, gray, and always had a relatively small comp practice, but once the defendant's gave me any crap I immediately scheduled the case for an Expedited Hearing. I scheduled hearings when I couldn't get treatment from the mpn, when they failed to pay a 10% add on for late t.t.d., when they objected to a second medical opinion within the mpn. By scheduling a hearing, you are setting the tone for the entire case. Both the adjuster and defense attorney will respect what you are doing and know you will call them out when they screw up in the future, and they will. Before setting a hearing I always send at least one, and probably two communications setting out what I want and the reasons I am entitled to obtain the relief. I do not ambush defense attorneys. Also, when I set an e.h., I am extremely confident I will prevail. I have always practiced at the Long Beach judges. They have never given me grief for setting an e.h. Never, ever let defendants get away with giving you crap. Always be in a position of strength. That's just my 2 cents. Paul Cowan (70508- that's really old) On Thursday, April 9, 2026 at 12:26:42 PM PDT, Mike Richter (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> wrote: ' List: lawnet Sent By: Mike Richter ' ' Reply To Sender ' Reply To List ' Search ' Settings ' Voice of reason yet again. Thank you Hollie. Mike Richter In a message dated 4/9/2026 11:35:21 AM Pacific Daylight Time, listsender-lawnet@lawnet.caaa.org writes: ' List: lawnet Sent By: Hollie Rutkowski ' ' Reply To Sender ' Reply To List ' Search ' Settings ' Oh For Pete's Sake People!! The proper answer is to reject the DA's Medical F**ng Index and reject the DA's PQME cover letter since it is based on the DA's Medical Index and file a DOR for Suon for Def refusing to comply with Reg 35(a), which all AAs should have memorized by now:§35. Exchange of Information and Ex Parte Communications. (a) The claims administrator, or if none the employer, shall provide, and the injured worker may provide, the following information to the evaluator, whether an AME, Agreed panel QME or QME:(1) All records prepared or maintained by the employee's treating physician or physicians; (2) Other medical records, including any previous treatment records or information, which are relevant to determination of the medical issue(s) in dispute. By the way, Shall means Shall and All means All, including All RFAs and All UR decisions. If any AA doesn't know the meaning of "Shall" and "All", ask me. I may blow a fuse, but I have answers. Does anyone see anywhere in Reg 35(a) that the AA is required to do the Medical Index and send medical records to the PQME/AME? Why is it "the gold standard" for the AA to do the Medical Index and send records to the PQME/AME? How does AA even know AA has all the medical records? I never assume that and I am pretty sure that the vast majority of the time, I have not gotten all the medical records. I am also positive that the DA got the same, or fewer, medical records that I did. Has any AA ever wondered why the California Legislature wrote Reg 35(a) the way it did? I'll tell you why. Because the Claims Administrator is the only party who has all the medical records because the Claims Administrator is the only party who has to pay for medical treatment. And don't tell me Judges don't care what Reg 5(a) says. I KNOW THAT! They hate me for requiring them to Order that the Claims Administrator is required to comply with 8 CCR 35(a). In addition, violating a Reg is sanctionable and entitles the aggrieved party to costs and fees per the actual words of 8 CCR 10421 (b) Bad faith actions or tactics that are frivolous or solely intended to cause unnecessary delay include actions or tactics that result from a willful failure to comply with a statutory or regulatory obligation,(3) Failure to timely serve documents (including but not limited to medical reports and medical-legal reports) as required by the rules of the Workers' Compensation Appeals Board, or the Administrative Director, where the documents are within the party's possession or control, unless that failure resulted from mistake, inadvertence or excusable neglect. That means that if an AA actually has to weed through the DA's submission and send records that the Claims Administrator has in its possession, the AA should Petition for sanctions, Costs!!! and Fees!!! for DA willfully violating Reg 35(a). Please, All My Wonderful Colleagues, you have to start forcing the Appeal Board to Order that the Claims Administrator must comply with 35(a) and that you want a Sanction and costs and fees for making sure the Evaluator has all the records prepared and maintained by the PTP. Just imagine if every time a Judge has a Conference calendar, at least one Conference is to force the Claims Administratorto do what they are already legally required to do? I think it would get the point across. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Thursday, April 9, 2026 10:12:44 AM Subject: Re: [lawnet] Reality Check on Letters to PQMEs ' List: lawnet Sent By: Brian Grafstrom ' ' Reply To Sender ' Reply To List ' Search ' Settings ' Furthermore, I always insist on the entire medical file being sent to Med-Legal evaluators because records are relevant not only for what they show, but also for what they do *not* show. The lack of complaints to a body part or body system can weaken apportionment arguments/inclinations --- it can show lack of pre-existing P.D. for a CT, it can show recovery from a prior injury, it can show lack of Rx for any given condition, etc. etc. etc.. It is up to the doctors, not the attorneys, to decide what is - and is not - medically relevant. From: Brian A. Grafstrom Sent: Thursday, April 9, 2026 9:59 AM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: RE: [lawnet] Reality Check on Letters to PQMEs My experience with Martin was similar. What I will never forget about him is how he would tell material lies to the judge and how he told a material lie in his response to my Petition For Recon on an issue. This was a few years ago, so it's quite disheartening to hear this brand of behavior persists to this day. From: Scott Solis (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Wednesday, April 8, 2026 5:36 PM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [lawnet] Reality Check on Letters to PQMEs ' List: lawnet Sent By: Scott Solis ' ' Reply To Sender ' Reply To List ' Search ' Settings ' My understanding was that defendants have to send the entire medical file to a PQME, unless both sides agree otherwise. Am I incorrect? I have a Defendant who has decided to enclose only 200 pages of medical reports for a PQME starting in 2022, when the injuries were sustained in 2016 and amount to at least 10 times that number of pages. I don't want to have to provide them -- I thought Defendant has to. This is for a PQME in Internal Medicine -- Gastroenterology, so I would think it would be appropriate for the doctor to see the entire course of treatment and records to determine whether medications or stress or anything else may have contributed to Applicant's problem. I've never had a defendant do this with me, and whenever I've noticed something missing in a defense advocacy letter's medical index, the defendant has happily added it. He's also refused to amend the alleged body parts in his advocacy letter, even though his recitation of them to the PQME is partially incorrect and incomplete. I even identified the dates of my amendments and clarified "right" or "left", since presumably he just got the info off the codes used in EAMS, which for example says Shoulders, implying bilateral. I don't like that going to a PQME, because if it's just one shoulder, then it could be perceived by the doctor as the applicant overclaiming his injuries and not being honest. I should note the Defense Attorney in this case is Martin Vardanyan, Esq. of Hanna Brophy. Anyone else have problems with him? He was yelling at me in the hallway of the Board at an Expedited Hearing because he didn't like some argument, though he very politely agreed to my position in front of the Judge. He seems completely unhinged, as corroborated by a couple emails I received today all in caps ("WHAT'S WRONG WITH YOU" followed by two lines of question marks, and then "DO YOU LOVE TO WASTE TIME" followed by only 20-some question marks). He has objected to my changes and instructed me to "FILE ANOTHER DOR."
AI Analysis:
This message does not answer the user's question about MPN, PTP, authorization delays, waivers, outside network treatment, and forfeiting rights to treatment. While the message mentions 'waiver' in the context of conflict of interest between doctor and client representation, it is discussing attorney ethical obligations rather than MPN/PTP authorization procedures or patient rights regarding network treatment. The waiver discussed here is unrelated to the medical provider network authorization and treatment rights that the user is asking about.
"Dane P. Gilliam" Date: December 19, 2025 4:17:00 PM Subject: Re: PTP Payments - Delaying CR Reply to list Reply to sender Print I would give the doctor Bill Tappin’s number. Best, DANE P. GILLIAM Trial Attorney Office: (949) 870-3800 x 213 Fax: (949) 732-6291 Email: dgilliam@bentleymore.com 4931 Birch Street Newport Beach, CA 92660 This communication, including any attachments, may contain confidential and/or proprietary information (and, in some cases information protected by either or both doctrines of attorney-client privilege and attorney work-product), and is intended only for the individual(s) or entity or entities to whom the communication is addressed. Any review, dissemination, or copying of this email by anyone other than the intended recipient(s) is strictly prohibited. If you are not an intended recipient, please contact the sender by reply email, and delete and destroy all copies of the original message. From: Mike Richter (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Friday, December 19, 2025 2:13 PM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [EXTERNAL]Re: [lawnet] PTP Payments - Delaying CR List: lawnet Sent By: Mike Richter Reply To Sender Reply To List Search Settings David You could get a waiver signed by both the doctor and the client confirming that you informed them there could be a conflict of interest if you represented both. I identify the conflict of interest, that you might have to decide between getting the doctor paid and the IW paid, and this could result in your having to decide who's interests to put first. Or you could pay the doctor only after getting the insurance company's assurances that it would reimburse you in full for every penny you paid the doctor. Or you could ask the insurance company to tell you how much it would pay the doctor, pay the doctor that amount, settle the case if your client agrees, then sue the IR for breach of contract if it fails to reimburse you. OR..there are a lot of other "ors". Good luck. Mike Richter Campbell In a message dated 12/19/2025 1:57:13 PM Pacific Standard Time, listsender-lawnet@lawnet.caaa.org writes: List: lawnet Sent By: David Nitka Reply To Sender Reply To List Search Settings Client has a PTP outside MPN, non WC PTP. PTP did an MMI report and wants to charge 10k+ for the service. We have a CR. Client wont sign unless the PTP gets paid in full. They want either 1. me to pay the PTP and get reimbursed. hard no. 2. me to represent the PTP and get them paid. I think this violates 4906 at minimum. 3. me to set a hearing on behalf of the ptp or list the bill as a PTCS issue. Judge already said they won't take it as a case in chief issue. In the meantime carrier messed up the denials, IBR etc. I got a lien rep helping the doc but my client says its not good enough. Am I missing something I am quite sure there is nothing i can do since I rep the applicant.
AI Analysis:
This message does not answer the user's real question about MPN, PTP, authorization delays, waivers, outside network rights, forfeiture of treatment rights, etc. While the message mentions 'MPN doctors' in passing and discusses the Patterson case, it primarily focuses on legislative reform challenges and campaign contributions rather than providing substantive information about medical provider network procedures, authorization processes, or patient rights regarding treatment outside the network. The discussion is tangential to the specific procedural and rights-based issues the user is seeking information about.
"Lawrence R. Whiting" Date: November 13, 2025 12:03:00 AM Subject: Re: 2025-b344044/ PATTERSON under attack Reply to list Reply to sender Print List: lawnet Sent By: Lawrence R. Whiting Reply To Sender Reply To List Search Settings Unfortunately, we don't have what it would really take to change the laws. That is substantial contributions to the legislator's campaigns. Good arguments and express need will never conquer contributions. -----Original Message----- From: kjpcaaa@kjpryorlaw.com Sent: November 12, 2025 1:17:00 PM To: lawnet@lists.trialsmith.com Subject: Re: 2025-b344044/ PATTERSON under attack I agree with Hollie, completely. Patterson was a fluke The sad reality is, most of the MPN doctors will not/cannot do what is needed to ensure continuity of care and we all know that UR Is rigged against the worker. This is another reason we need universal healthcare with a mechanism for making carriers reimburse the state for treatment costs. Hope springs eternal KJ Pryor, Esq. otherwise, we are all doomed . -----Original Message----- From: Hollie@TCLC.org Sent: November 12, 2025 12:46:00 PM To: lawnet@lists.trialsmith.com Subject: Re: 2025-b344044/ PATTERSON under attack I agree with Steve Franco. This is not a hard decisi on to understand. The Sec on d DCA in a Published Opini on overruled a WCAB Significant Panel Decisi on . There is no part of Patters on that survives. I also disagree with the Patters on facts as stated below. Patters on did not involve UR . The facts are that Patters on developed cognitive/psychological problems from overuse of medicati on s leading to scheduling problems like keeping medical appointments . In 2011 the AME internist said that applicant needed an NCM to aid her i n dealing with such problems. The Defendant approved the NCM, but Patters on and the NCM clashed because Patters on was "difficult". The Defendant disc on tinued providing the NCM because of logistic and pers on ality reas on s . Patters on filed a DOR for E xpedited Hearing. In 2014, the Trial WCJ said the AME found an NCM was medically necessary and so did not required an RFA or UR . The WCAB Commissi on ers agreed. They found that an RFA and UR are not necessary when the Defendant expressly authorized the care. The WCAB put the burden on the Defendant to prove that NCM were no l on ger medically required because of a change in applicant's c on diti on . So Patters on was a loophole where a Judge determined that an RFA and UR were not required if the Defendant authorized the care. How often does that happen? How often does the WCAB find that it has jurisdiction to determine the medical necessity of medical treatment in lieu of the RFA/UR statutory scheme? * he WCAB (significant panel decision) treated a nurse case manager as "medical treatment" under Lab. Code §4600 because coordinating/facilitating care helps cure or relieve the industrial injury. * Once a particular course of treatment is authorized, the defendant cannot unilaterally terminate it unless : 1. there's a change in the worker's condition or circumstances , and 2. the treatment is no longer reasonably required to cure or relieve. * The burden is on the defendant to justify termination. * The Board emphasized continuity of care -approved treatment can't be cut off at an adjuster's whim. That's why Patterson became shorthand for " once authorized, always authorized absent change ." * Many of us (me included) used it successfully, particularly for home care and similar ongoing services. We must scrutinize the original authorization and the current facts : * Was the original approval voluntary or via RFA/UR? * Have conditions changed ? * Has the applicant improved , stayed the same, or declined? * Did the defendant properly invoke UR/IMR for continuation/renewal? All Illinois Midwest/Rodriguez did was to take WCAB jurisdiction to determine medical necessity away from the WCAB and impose the extra-judicial UR process. I disagree that Illinois Midwest/Rodriguez "shifts the landscape" so that AA's have to " scrutinize the original authorization and the current facts". What AAs need to do is make sure that the PTPs, to they extent that they knew about the Patterson decision, to get Patterson out of their minds. There is no loophole where medical treatment does not required and RFA and UR. If PTPs want a certain treatment to continue, it is the same analysis as any other treatment that has worked before. The PTP says that the treatment worked before, the IW became more functional due to less pain, and so on, always stressing that the medical care, whatever it is has increased IW's function. I disagree with the conclusion that " Patterson isn't 'overruled' outright, but its reach is narrowed , especially where initial authorizations were non-UR/voluntary . The 'once authorized, forever authorized' rule is largely gone." Don't waste your time on dissecting the original authorization and the current facts about whether the medical condition changed. Just make sure that the PTP knows that every medical treatment has to be approved by UR. If the PTPs actually read UR decisions to find out what was wrong with the initial Report and RFA, that would help enormously. I still have PTPs who tell their patients/my clients that medical treatment decision take several moths to get authorized by UR and that the AA can litigate denied medical treatment in court. I disagree that ,"AAs now have to do a deep dive and justify our positions with a close analysis of the facts and circumstances. To put it succinctly, we now have to place it in 'context'." No amount of AA action is going to matter the least bit to medical treatment being governed by UR. (I have not mentioned UR very limited exceptions A(untimely, UR denied treatment that was not requested in RFA) and IMR because we should all know about the UR exceptions and the Stevens case is now 12 years old.) Hollie Rutkowski, RN, JD, MBA, Esq. [ https://the-compensation-law-center.business.site/ ' The Compensation Law Center ] Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Wednesday, November 12, 2025 7:13:47 AM Subject: Re: [lawnet] 2025-b344044/ PATTERSON under attack List: lawnet Sent By: [ mailto:francomunozlaw@gmail.com ' Rene Munoz ] [ mailto:francomunozlaw@gmail.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack ' Reply To Sender ] [ mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack ' Reply To List ] [ http://www.caaa.org/index.cfm?pg=search ' Search ] [ http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings ' Settings ] Art, Please correct me if I'm off base, but my reading of Illinois Midwest Ins. Agency is that the Court of Appeal expressly rejects Patterson "to the extent it set forth a contrary rule for injuries or medical-necessity determinations arising after the 2013 reforms," and holds there is no exception to the UR/IMR statutes for ongoing or continuing care. In other words, all post-2013 treatment disputes must proceed through UR and IMR, and the WCAB no longer has jurisdiction to award or continue treatment outside that statutory process. Practically speaking, that means for any RFA or medical-necessity issue after January 1, 2013, Patterson is effectively off the table. Our remaining leverage lies in Dubon I/II -specifically, procedural or timeliness defects in the UR process. Please correct me if I'm wrong. Steve Franco On Tue, Nov 11, 2025 at 10:00 PM Alan Snitzer (lawnet listserver) < [ mailto:listsender-lawnet@lawnet.caaa.org ' listsender-lawnet@lawnet.caaa.org ] > wrote: List: lawnet Sent By: [ mailto:abs@snitzerlaw.com ' Alan Snitzer ] [ mailto:abs@snitzerlaw.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack ' Reply To Sender ] [ mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack ' Reply To List ] [ http://www.caaa.org/index.cfm?pg=search ' Search ] [ http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings ' Settings ] Hi, Art, Thanks for your usual, scholarly analysis of this important legal development! It's always appreciated! Best, Alan LAW OFFICES OF ALAN B. SNITZER A PROFESSIONAL CORPORATION 80 S. Lake Ave., Suite 800 Pasadena, California 91101-2585 T: 626-449-4300 F: 626-449-0830 Certified Specialist, Workers' Compensation Law Board of Legal Specialization, The State Bar of California Included in SUPER LAWYERS Southern California Edition 2015-2025 1998-2025 -- == Franco Munoz, A P.C. 825 Washington Street. Suite 211 Oakland, CA 94607 (510) 257-4141
AI Analysis:
This message does not answer the user's real question about MPN/PTP authorization delays, waivers, and rights regarding treatment outside the network. While the message mentions PTPs and discusses treatment authorization issues in a Long COVID case, it focuses on specific doctor recommendations and a particular case scenario rather than explaining the legal framework around MPN authorization delays, waiver rights, or what happens when patients seek treatment outside the network. The message discusses treatment denial and PTP issues but does not address the core legal concepts the user is seeking to understand about MPN procedures and patient rights.
"Jenny Jerez" Date: November 10, 2025 2:47:00 PM Subject: Re: Bay Area PTP for post-Covid treatment Reply to list Reply to sender Print List: lawnet Sent By: Jenny Jerez Reply To Sender Reply To List Search Settings Dr. Robert Harrison is pretty good at those cases. And I am not sure if he treats but Dr. Juan Larach the QME is an expert on it and has a clinic. -----Original Message----- From: Hollie@TCLC.org Sent: November 10, 2025 1:01:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Bay Area PTP for post-Covid treatment My client with Long COVID treated at UCDMC and Stanford Long COVID clinic, but he used his private insurance because the Claims Administrator accepted two COVID claims then denied that COVID infection caused Long COVID. I can give you the names of the primary doctors who coordinated treatment at both facilities if that will help. Dr. Bratbaur and his associate in LA were my client's PTPs, but then the Claims Administrator denied treatment for Long COVID. Yes, I have a PQME who says Long COVID is industrial but it is very time consuming obtaining treatment records that number into the tens of thousands of pages and, of course, the DA is being an ass about sending them to the PQME at $3/page. Hollie Rutkowski, RN, JD, MBA, Esq. [ https://the-compensation-law-center.business.site/ ' The Compensation Law Center ] Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Cc: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Saturday, November 8, 2025 12:27:56 PM Subject: Re: [lawnet] Bay Area PTP for post-Covid treatment List: lawnet Sent By: [ mailto:Scardino@geklaw.com ' Steven Scardino ] [ mailto:Scardino@geklaw.com?subject=Re%3A%20%5Blawnet%5D%20Bay%20Area%20PTP%20for%20post-Covid%20treatment ' Reply To Sender ] [ mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Bay%20Area%20PTP%20for%20post-Covid%20treatment ' Reply To List ] [ http://www.caaa.org/index.cfm?pg=search ' Search ] [ http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings ' Settings ] Maybe Stanford Long Covid program Steve Scardino, Partner Mail to: Gordon, Edelstein, et al. 3250 Wilshire Blvd., Ste. 200 LA CA 90010 On Nov 7, 2025, at 2:07 PM, Bonnie Binder-Wilson (lawnet listserver) wrote: List: lawnet Sent By: Bonnie Binder-Wilson Reply To Sender Reply To List Search< [ http://www.caaa.org/index.cfm?pg=search ' http://www.caaa.org/index.cfm?pg=search ] > Settings< [ http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings ' http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings ] > Unfortunately, that is the issue with long covid. The MD's have to discover what autoimmune diseases it caused and start treating that. Ask Tom Butts or Meredith Wisler - - Bonnie Binder Wilson, Esq. Wilson & Wisler, LLP Attorneys at Law 21 Maple Street Salinas, California 93901 Telephone: (831) 269-3787 Facsimile: (831) 269-3783 [ https://mail.tclc.org/www.doubleulaw.com ' www.doubleulaw.com ] < [ http://www.doubleulaw.com/ ' http://www.doubleulaw.com/ ] > *************** PRIVATE AND CONFIDENTIAL **************** THIS ELECTRONIC MESSAGE TRANSMISSION IS A COMMUNICATION FROM THE LAW FIRM OF WILSON & WISLER, LLP. THIS MESSAGE CONTAINS INFORMATION PROTECTED BY THE ATTORNEY/CLIENT PRIVILEGE AND IS CONFIDENTIAL OR OTHERWISE THE EXCLUSIVE PROPERTY OF THE INTENDED RECIPIENT OR WILSON & WISLER, LLP. THIS INFORMATION IS SOLELY FOR THE USE OF THE INDIVIDUAL OR ENTITY THAT IS THE INTENDED RECIPIENT. From: Mark Berg (lawnet listserver) Sent: Thursday, November 6, 2025 5:01 PM To: Statewide List Service Subject: [lawnet] Bay Area PTP for post-Covid treatment List: lawnet Sent By: Mark Berg Reply To Sender Reply To List Search< [ http://www.caaa.org/index.cfm?pg=search ' http://www.caaa.org/index.cfm?pg=search ] > Settings< [ http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings ' http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings ] > Any recommendations for a physician or group who will treat long Covid applicant? She has several injuries and was treating with Timothy Lo and Morley, but says they are not helping with the Covid symptoms. No MPN. Thank you for any recommendations. Mark Berg Elder and Berg Concord/Brentwood Service of documents by electronic mail per WCAB Rule 10625 to this email address is not authorized, accepted or binding upon Gordon, Edelstein, Krepack, Grant, Felton & Goldstein, LLP, or its clients.
AI Analysis:
This message does not answer the user's question about MPN, PTP, authorization delays, waivers, outside network treatment, or forfeiting rights to treatment. The message is a brief discussion thread about finding physicians to treat long COVID, with suggestions for Stanford's Long Covid program and references to autoimmune disease treatment. While it mentions 'PTP' in the subject line, the content focuses entirely on physician recommendations for long COVID treatment rather than addressing any issues related to MPN authorization processes, treatment delays, waivers, or patient rights regarding outside network care.
"Steve Scardino" Date: November 08, 2025 2:28:00 PM Subject: Re: Bay Area PTP for post-Covid treatment Reply to list Reply to sender Print List: lawnet Sent By: Steven Scardino Reply To Sender Reply To List Search Settings Maybe Stanford Long Covid program Steve Scardino, Partner Mail to: Gordon, Edelstein, et al. 3250 Wilshire Blvd., Ste. 200 LA CA 90010 On Nov 7, 2025, at 2:07 PM, Bonnie Binder-Wilson (lawnet listserver) wrote: List: lawnet Sent By: Bonnie Binder-Wilson Reply To Sender Reply To List Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > Unfortunately, that is the issue with long covid. The MD’s have to discover what autoimmune diseases it caused and start treating that. Ask Tom Butts or Meredith Wisler - - Bonnie Binder Wilson, Esq. Wilson & Wisler, LLP Attorneys at Law 21 Maple Street Salinas, California 93901 Telephone: (831) 269-3787 Facsimile: (831) 269-3783 www.doubleulaw.com < http://www.doubleulaw.com/ > *************** PRIVATE AND CONFIDENTIAL **************** THIS ELECTRONIC MESSAGE TRANSMISSION IS A COMMUNICATION FROM THE LAW FIRM OF WILSON & WISLER, LLP. THIS MESSAGE CONTAINS INFORMATION PROTECTED BY THE ATTORNEY/CLIENT PRIVILEGE AND IS CONFIDENTIAL OR OTHERWISE THE EXCLUSIVE PROPERTY OF THE INTENDED RECIPIENT OR WILSON & WISLER, LLP. THIS INFORMATION IS SOLELY FOR THE USE OF THE INDIVIDUAL OR ENTITY THAT IS THE INTENDED RECIPIENT. From: Mark Berg (lawnet listserver) Sent: Thursday, November 6, 2025 5:01 PM To: Statewide List Service Subject: [lawnet] Bay Area PTP for post-Covid treatment List: lawnet Sent By: Mark Berg Reply To Sender Reply To List Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > Any recommendations for a physician or group who will treat long Covid applicant? She has several injuries and was treating with Timothy Lo and Morley, but says they are not helping with the Covid symptoms. No MPN. Thank you for any recommendations. Mark Berg Elder and Berg Concord/Brentwood Service of documents by electronic mail per WCAB Rule 10625 to this email address is not authorized, accepted or binding upon Gordon, Edelstein, Krepack, Grant, Felton & Goldstein, LLP, or its clients.
AI Analysis:
This message does not answer the user's real question about MPN, PTP, authorization delays, waivers, outside network treatment, and forfeiting rights. The message is a brief response about long COVID treatment recommendations, mentioning that MDs need to discover autoimmune diseases caused by COVID and suggesting the inquirer contact specific attorneys. While it mentions 'No MPN' in the original inquiry, the response itself provides no substantive information about MPN procedures, PTP authorization processes, treatment delays, waivers, or rights that could be forfeited when seeking care outside the network. The message is focused solely on medical treatment recommendations rather than the procedural and legal aspects the user is seeking to understand.
"Bonnie Wilson" Date: November 07, 2025 4:07:00 PM Subject: Re: Bay Area PTP for post-Covid treatment Reply to list Reply to sender Print List: lawnet Sent By: Bonnie Binder-Wilson Reply To Sender Reply To List Search Settings Unfortunately, that is the issue with long covid. The MD’s have to discover what autoimmune diseases it caused and start treating that. Ask Tom Butts or Meredith Wisler - - Bonnie Binder Wilson, Esq. Wilson & Wisler, LLP Attorneys at Law 21 Maple Street Salinas, California 93901 Telephone: (831) 269-3787 Facsimile: (831) 269-3783 www.doubleulaw.com *************** PRIVATE AND CONFIDENTIAL **************** THIS ELECTRONIC MESSAGE TRANSMISSION IS A COMMUNICATION FROM THE LAW FIRM OF WILSON & WISLER, LLP. THIS MESSAGE CONTAINS INFORMATION PROTECTED BY THE ATTORNEY/CLIENT PRIVILEGE AND IS CONFIDENTIAL OR OTHERWISE THE EXCLUSIVE PROPERTY OF THE INTENDED RECIPIENT OR WILSON & WISLER, LLP. THIS INFORMATION IS SOLELY FOR THE USE OF THE INDIVIDUAL OR ENTITY THAT IS THE INTENDED RECIPIENT. From: Mark Berg (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Thursday, November 6, 2025 5:01 PM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [lawnet] Bay Area PTP for post-Covid treatment List: lawnet Sent By: Mark Berg Reply To Sender Reply To List Search Settings Any recommendations for a physician or group who will treat long Covid applicant? She has several injuries and was treating with Timothy Lo and Morley, but says they are not helping with the Covid symptoms. No MPN. Thank you for any recommendations. Mark Berg Elder and Berg Concord/Brentwood
AI Analysis:
This message does not answer the user's real question about MPN, PTP, authorization delays, waivers, outside network treatment, or forfeiting/losing rights to treatment. The message is focused on filing audit complaints and sanctions petitions related to home care recommendations, with discussion of utilization review timing and jurisdiction issues. While it mentions treatment authorization concepts peripherally, it does not address the specific legal framework around MPN/PTP authorization delays, network waivers, or the consequences of delays on treatment rights that the user is asking about.
"M. Hollie Rutkowski" Date: August 29, 2025 11:24:00 AM Subject: Re: Neuro Psych recommends Home Care Reply to list Reply to sender Print List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings Here it is: How to file a complaint with the Audit & Enforcement Unit https://www.dir.ca.gov/dwc/Audcomp.pdf Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Friday, August 29, 2025 8:58:23 AM Subject: Re:[lawnet] Neuro Psych recommends Home Care List: lawnet Sent By: Lawrence R. Whiting Reply To Sender Reply To List Search Settings And don't forget your sanctions petition. I would also recommend an audit referral. I've never done one but I'm sure Hollie could tell you how. -----Original Message----- From: cognitorsj@aol.com Sent: August 28, 2025 7:46:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Neuro Psych recommends Home Care Hey Joshua, If you think you have evidence to prove IR knew or should have known that IW needed HHC or other treatment, but still didn't investigate the issue further, then I think you have a case a judge could award the care. I've got a case right now where the adjuster literally put in the claims notes, "I jumped at the opportunity to stop TD" after a doctor's recommendations had been repeatedly refused and the doctor gave up and declared my client P&S. You have notice to the IR and the IR's failure to investigate or send to UR. I think that makes any subsequent UR untimely and gives the WCJ jurisdiciton. Mike RichterCampbell On Thursday, August 28, 2025 at 02:52:39 PM PDT, Lawrence R. Whiting (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> wrote: ' List: lawnet Sent By: Lawrence R. Whiting ' ' Reply To Sender ' Reply To List ' Search ' Settings ' Dubon v World Restoration 79 CCC 1298 (en banc) This decision goes through the process of UR appeals of denials and appeals. Normally, an appeal of a UR denial must be resolved by IMR. However, where there is no UR denial or an untimely UR denial under circumstances that would've required an investigation, the UR is considered untimely in the WCAB has jurisdiction. Weimer v Hilliard 2017 cal wrk comp pd lexis 104. Citing Dubon. An RFA was submitted that identified the employee to the adjuster who received information reasonably necessary to make the determination that the treatment was necessary. An untimely UR gives the board jurisdiction to decide the issue of medical necessity. San Francisco 49ers v WCAB 83 CCC 1434. An RFA does not have to be signed by the PTP. Although these cases referred to our four incomplete or ignored RFA's, I think the reasoning that sufficient information submitted that is ignored should result in an untimely UR denial. -----Original Message----- From: josh@accidentdefenders.com Sent: August 27, 2025 10:08:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Neuro Psych recommends Home Care Thank you mike. I did send a duty to investigate letter. So at this point I presume, I should just file MSc. On this issue of duty to investigate an authorization of the home care assessment, correct? Joshua R. Kohanbash, Esq. ' Managing Partner Accident Defenders APC *Physical Office: 18345 Ventura Blvd. Suite 518 Tarzana, CA 91356* *NEW:** MAILING ADDRESS FOR WC CLAIMS ONLY: **PO Box 1200 Portsmouth, NH 03802* *t:* 323.591.2829 '* f: *323.831.6828 ' *e:Josh@accidentdefenders.com <e%3AJosh@accidentdefenders.com> * *WWW.ACCIDENTDEFENDERS.COM <http://WWW.ACCIDENTDEFENDERS.COM>* *SERVICING LOS ANGELES ' ORANGE COUNTY ' COACHELLA VALLEY ' INLAND EMPIRE ' SAN DIEGO '* CONFIDENTIALITY: This communication, including attachments, is for the exclusive use of the addressee(s) and may contain proprietary, confidential, or privileged information. If you are not the intended recipient, any use, copying, disclosure, or distribution or the taking of any action in reliance upon this information is strictly prohibited. If you are not the intended recipient, please notify the sender immediately and delete this communication and destroy all copies. *Our office does not accept electronic service whether by email or facsimile; of ANY correspondence or pleadings, that includes service of Panels. You have been put on notice. * On Wed, Aug 27, 2025, 5:19 PM Mike Richter (lawnet listserver) < listsender-lawnet@lawnet.caaa.org> wrote: > *List:* lawnet *Sent By:* Mike Richter <cognitorsj@aol.com> > Reply To Sender > <cognitorsj@aol.com?subject=Re%3A%20%5Blawnet%5D%20Neuro%20Psych%20recommends%20Home%20Care> > Reply To List > <lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Neuro%20Psych%20recommends%20Home%20Care> > Search <http://www.caaa.org/index.cfm?pg=search> > Settings > <http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> > > Read attached > > *Blosser v. RB Spencer, Inc., 2025 Cal. Wrk. Comp. P.D. LEXIS 145; 2025 LX > 150251* > <https://advance.lexis.com/api/document?collection=administrative-materials&id=urn:contentItem:6G3V-C3Y3-RT0N-R3KW-00000-00&context=1000516> > > Workers' Compensation Appeals Board (Board Panel Decision) > > April 28, 2025 Opinion Filed > > W.C.A.B. Nos. ADJ17146948, ADJ17146930, ADJ15040609-WCJ Parker Shelton > (SAC); WCAB Panel: Commissioners Snellings, Razo, Capurro > > > > *Reporter* > > 2025 Cal. Wrk. Comp. P.D. LEXIS 145 *; 2025 LX 150251 > > > *Wayne Blosser, Applicant v. RB Spencer, Inc., Air Conditioning and > Heating, Insurance Company of the West, Defendants* > > In a message dated 8/27/2025 5:00:12 PM Pacific Daylight Time, > listsender-lawnet@lawnet.caaa.org writes: > > > *List:* lawnet *Sent By:* Joshua Kohanbash <josh@accidentdefenders.com> > Reply To Sender > <josh@accidentdefenders.com?subject=Re%3A%20Neuro%20Psych%20recommends%20Home%20Care> > Reply To List > <lawnet@lawnet.caaa.org?subject=Re%3A%20Neuro%20Psych%20recommends%20Home%20Care> > Search <http://www.caaa.org/index.cfm?pg=search> > Settings > <http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> > Hi All > > Thanks in advance. Our Neuro Psych Dr. Ponton (who we agreed to use for a > consult) recommended a Home Care Assessment. DA says he wont authorize > one. And because it was a consult and they will not authorize it until UR > approves it..... Rx from a MPN doctor saying so. > > > Is that the only way? Any advice would be greatly appreciated to get this > moving. 🙠> > > Joshua R. Kohanbash, Esq. ' Managing Partner > Accident Defenders APC > > *Physical Office: 18345 Ventura Blvd. Suite 518 Tarzana, CA 91356 > <https://www.google.com/maps/search/18345+Ventura+Blvd.+Suite+518+Tarzana,+CA+91356?entry=gmail&source=g>* > > *NEW:* *MAILING ADDRESS FOR WC CLAIMS ONLY: **PO Box 1200 Portsmouth, NH > 03802* > > *t:* 323.591.2829 ' *f:* 323.831.6828 ' *e:Josh@accidentdefenders.com > <e%3AJosh@accidentdefenders.com> * > > *WWW.ACCIDENTDEFENDERS.COM <http://WWW.ACCIDENTDEFENDERS.COM>* > > > *SERVICING LOS ANGELES ' ORANGE COUNTY ' COACHELLA VALLEY ' INLAND EMPIRE > ' SAN DIEGO ' * > > CONFIDENTIALITY: This communication, including attachments, is for the > exclusive use of the addressee(s) and may contain proprietary, > confidential, or privileged information. If you are not the intended > recipient, any use, copying, disclosure, or distribution or the taking of > any action in reliance upon this information is strictly prohibited. If > you are not the intended recipient, please notify the sender immediately > and delete this communication and destroy all copies. *Our office does > not accept electronic service whether by email or facsimile; of ANY > correspondence or pleadings, that includes service of Panels. You have been > put on notice. * > > > > > > >
AI Analysis:
This message does not answer the user's question about MPN, PTP, authorization delays, waivers, outside network treatment, or forfeiture of rights. The message discusses a general strategy for proving an insurance company's failure to investigate home health care needs, but it does not address the specific legal framework around Medical Provider Networks (MPNs), Primary Treating Physicians (PTPs), authorization processes, or the consequences of delays in MPN systems. While it mentions treatment authorization concepts broadly, it lacks any discussion of the MPN/PTP context that is central to the user's question.
If you think you have evidence to prove IR knew or should have known that IW needed HHC or other treatment, but still didn't investigate the issue further, then I think you have a case a judge could award the care.
AI Analysis:
This message does not answer the user's question about MPN/PTP authorization delays, waivers, or rights regarding outside network treatment. While the message mentions MPN and PTP, it is simply a request for referrals to treaters in the Madera/Fresno area for an accepted case where no PTP is available in the network. It does not provide any substantive information about authorization processes, delays, waivers, or patients' rights to forfeit or lose treatment rights when seeking care outside the network. The message is a practical referral request rather than legal guidance on the complex authorization and waiver issues the user is seeking to understand.
"Armen Yedalyan" Date: August 20, 2025 12:20:00 PM Subject: PTP in Madera / Fresno - MPN or Lien Reply to list Reply to sender Print List: lawnet Sent By: Armen Yedalyan Reply To Sender Reply To List Search Settings Any treaters in / near Madera or Fresno? Accepted case with MPN but no available PTP in network.
AI Analysis:
This message does not answer the user's real question about MPN/PTP authorization delays, waivers, or rights regarding treatment outside the network. While the message discusses PTP designation and mentions MPN in passing, it focuses on the procedural question of whether attorneys should choose PTPs for clients versus letting clients choose from the MPN. The message does not address authorization delays, waiver of rights, forfeiture of treatment rights, or the ability to seek treatment outside the network - which are the core elements of what the user is seeking to understand.
"Kevin Bryant" Date: July 02, 2025 2:16:00 PM Subject: Re: New PTP Designation Reply to list Reply to sender Print List: lawnet Sent By: Kevin Bryant Reply To Sender Reply To List Search Settings Thanks everyone for your responses. I appreciate the information. Sincerely, Kevin Bryant, Esq. Law Office of Kevin L. Bryant Mailing Address: P.O. Box 1033, Citrus Heights, CA 95611 Physical Address: 1100 Melody Ln., Suite 131, Roseville, CA 95678 P: (916) 520-4322 F: (916) 520-4322 E: kbryant@klbryantlaw.com From: Guadalupe Carrasco (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Wednesday, July 2, 2025 12:05 PM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: Re: [lawnet] New PTP Designation List: lawnet Sent By: Guadalupe Carrasco Reply To Sender Reply To List Search Settings I almost always pick my client’s PTP, and would do that at least twice, before letting them pick their doctor. They just don’t know the doctor’s WC reputations, and that could really hurt them in the long run. Plus, some facilities are way better at getting treatment approved through UR, and the clients would never know that. Lupe Carrasco Eason & Tambornini From: Kevin Bryant (lawnet listserver) < listsender-lawnet@lawnet.caaa.org > Sent: Wednesday, July 2, 2025 11:19 AM To: Statewide List Service < lawnet@lawnet.caaa.org > Subject: [lawnet] New PTP Designation List: lawnet Sent By: Kevin Bryant Reply To Sender Reply To List Search Settings Just wondering how your various offices approach this issue. When designating a new PTP for your client, especially when they are currently treating at Concentra or Kaiser, do you give them the MPN with recommended doctors to choose who they want to use or do you just designate someone for them yourselves? Thanks
AI Analysis:
This message does not answer the user's question about MPN/PTP authorization delays, waivers, and rights regarding outside network treatment. While the message discusses PTP designation and mentions that some facilities are better at getting treatment approved through UR, it focuses on attorney strategy for selecting PTPs rather than addressing the specific legal issues around authorization delays, waivers of MPN rights, or forfeiture of rights to treat outside the network. The message provides general practice advice but does not substantively address the legal framework the user is asking about.
"Lupe Carrasco" Date: July 02, 2025 2:05:00 PM Subject: Re: New PTP Designation Reply to list Reply to sender Print List: lawnet Sent By: Guadalupe Carrasco Reply To Sender Reply To List Search Settings I almost always pick my client’s PTP, and would do that at least twice, before letting them pick their doctor. They just don’t know the doctor’s WC reputations, and that could really hurt them in the long run. Plus, some facilities are way better at getting treatment approved through UR, and the clients would never know that. Lupe Carrasco Eason & Tambornini From: Kevin Bryant (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Wednesday, July 2, 2025 11:19 AM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [lawnet] New PTP Designation List: lawnet Sent By: Kevin Bryant Reply To Sender Reply To List Search Settings Just wondering how your various offices approach this issue. When designating a new PTP for your client, especially when they are currently treating at Concentra or Kaiser, do you give them the MPN with recommended doctors to choose who they want to use or do you just designate someone for them yourselves? Thanks
AI Analysis:
This message does not answer the user's question about MPN, PTP, authorization delays, waivers, outside network treatment, or forfeiting rights to treatment. The message discusses attorney practices for selecting PTPs and client sophistication in choosing doctors, but does not address the specific legal issues around authorization delays, network waivers, or forfeiture of treatment rights that the user is asking about. While it mentions PTPs and briefly references authorization letters, it focuses on client selection processes rather than the substantive legal questions about delays, waivers, and rights forfeiture.
"Esequiel Solorio" Date: July 02, 2025 1:46:00 PM Subject: Re: New PTP Designation Reply to list Reply to sender Print List: lawnet Sent By: Esequiel Solorio Reply To Sender Reply To List Search Settings I do not believe the clients, for the most part, are sophisticated enough to know and research the known players like we can. I can count on one hand the number of clients who did their own research only to be stopped at "the doctor needs to see the records and get a letter of authorization before deciding if he will accept you as a patient." Why make the injured worker do work that you can streamline for them? On a few occasions, i have had clients not like my selection and then i give them the list and tell them to call around and confirm that they will take them as a patient. If i don't do that, they switch attorneys and i don't know from there if they had success in getting the doctor they wanted. Zeke Modesto -----Original Message----- From: kbryant@klbryantlaw.com Sent: July 02, 2025 1:19:00 PM To: lawnet@lists.trialsmith.com Subject: New PTP Designation Just wondering how your various offices approach this issue. When designating a new PTP for your client, especially when they are currently treating at Concentra or Kaiser, do you give them the MPN with recommended doctors to choose who they want to use or do you just designate someone for them yourselves? Thanks
AI Analysis:
This message does not answer the user's question about MPN, PTP, authorization delays, waivers, outside network treatment rights, or forfeiture of treatment rights. While the message mentions MPN and PTP in the context of finding a primary treating physician, it is simply a recommendation for specific doctors and does not address any of the legal concepts the user is asking about regarding authorization processes, delays, waivers, or rights related to outside network treatment.
"Nooshin Dalili" Date: June 30, 2025 2:37:00 PM Subject: Re: Need PTP For San Ramon (NorCal Bay Area) Reply to list Reply to sender Print List: lawnet Sent By: Nooshin Dalili Reply To Sender Reply To List Search Settings We regularly work with Pain & Rehab (Drs Jamasbi, Morely, Lo ). Our clients are happy and the doctors are very responsive. Nooshin Dalili -----Original Message----- From: cmallory@mlawca.com Sent: June 30, 2025 1:48:00 PM To: lawnet@lists.trialsmith.com Subject: Need PTP For San Ramon (NorCal Bay Area) Morning Everyone, Per the MPN, these are the available PTPs near the San Ramon area and I am seeking input on who to select. Client is 58 y.o. female (originally from Indonesia who has lived in the US since 25 y.o.) with multiple cervical spine fusion/revisions surgeries. She is working on a part-time basis and needs a PTP willing to manage her pain complaints including prescribing pain medication. Her current PTP is Dr. Talwar who wants to perform another surgery (I think it would #5 or 6 at this point). He is threatening to cut her off since she has told him that she does not want any more surgery. Her pain management doctor is in Tracy and will only do epidural injections, no pain medications. Client's preference is a treater in San Ramon (where she lives) or Walnut Creek (where she works), however, if there is someone you would recommend outside of those two cities off this list, please let me know. Thank you!!! James Han (San Ramon / Walnut Creek) Susan Gutierrez (San Ramon / Walnut Creek) Behzad Emad (San Ramon) Albert Retodo (San Ramon) Co Bahn (Pleasanton) Ruben Kalra (Pleasanton) David Chow (Pleasanton) Filp Cheng (Castro Valley / Walnut Creek) Timothy Lo (Castro Valley / Walnut Creek) Nazir Noor (Castro Valley) Arzhang Zereshki (Castro Valley) Mark Chan (Castro Valley) Babak Jamasbi (Castro Valley / Walnut Creek) Brendan Morely (Castro Valley / Walnut Creek) David Chow (Walnut Creek) Very truly yours, Christy Mallory Law Office of Christy A. Mallory P.O. Box 947, Fair Oaks, CA 95628 T: (916) 292-9099 / F: (916) 266-9059 CONFIDENTIALITY NOTICE: This electronic message is intended to be viewed only by the individual or entity to whom it is addressed. It may contain information that is privileged, confidential and exempt from disclosure under applicable law. Any dissemination, distribution or copying of this communication is strictly prohibited without our prior permission. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering the message to the intended recipient, or if you have received this communication in error, please notify us immediately by return e-mail and delete the original message and any copies of it from your computer system.
AI Analysis:
This message does not answer the user's question about MPN/PTP authorization delays, waivers, forfeiting rights, or treatment outside the network. While the message mentions MPN and PTP in the context of selecting a primary treating physician from an MPN list, it is simply a request for attorney recommendations for specific doctors in the San Ramon area. The message does not discuss authorization processes, delays, waivers of rights, or the consequences of seeking treatment outside the network. It's a straightforward referral request that only tangentially relates to MPN/PTP concepts without addressing any of the substantive legal issues the user is asking about.
"Christy Mallory" Date: June 30, 2025 1:48:00 PM Subject: Need PTP For San Ramon (NorCal Bay Area) Reply to list Reply to sender Print List: lawnet Sent By: Christy Mallory Reply To Sender Reply To List Search Settings Morning Everyone, Per the MPN, these are the available PTPs near the San Ramon area and I am seeking input on who to select. Client is 58 y.o. female (originally from Indonesia who has lived in the US since 25 y.o.) with multiple cervical spine fusion/revisions surgeries. She is working on a part-time basis and needs a PTP willing to manage her pain complaints including prescribing pain medication. Her current PTP is Dr. Talwar who wants to perform another surgery (I think it would #5 or 6 at this point). He is threatening to cut her off since she has told him that she does not want any more surgery. Her pain management doctor is in Tracy and will only do epidural injections, no pain medications. Client's preference is a treater in San Ramon (where she lives) or Walnut Creek (where she works), however, if there is someone you would recommend outside of those two cities off this list, please let me know. Thank you!!! James Han (San Ramon / Walnut Creek) Susan Gutierrez (San Ramon / Walnut Creek) Behzad Emad (San Ramon) Albert Retodo (San Ramon) Co Bahn (Pleasanton) Ruben Kalra (Pleasanton) David Chow (Pleasanton) Filp Cheng (Castro Valley / Walnut Creek) Timothy Lo (Castro Valley / Walnut Creek) Nazir Noor (Castro Valley) Arzhang Zereshki (Castro Valley) Mark Chan (Castro Valley) Babak Jamasbi (Castro Valley / Walnut Creek) Brendan Morely (Castro Valley / Walnut Creek) David Chow (Walnut Creek) Very truly yours, Christy Mallory Law Office of Christy A. Mallory P.O. Box 947, Fair Oaks, CA 95628 T: (916) 292-9099 / F: (916) 266-9059 CONFIDENTIALITY NOTICE: This electronic message is intended to be viewed only by the individual or entity to whom it is addressed. It may contain information that is privileged, confidential and exempt from disclosure under applicable law. Any dissemination, distribution or copying of this communication is strictly prohibited without our prior permission. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering the message to the intended recipient, or if you have received this communication in error, please notify us immediately by return e-mail and delete the original message and any copies of it from your computer system.
AI Analysis:
This message does not answer the user's question about MPN, PTP, authorization delays, waivers, network issues, or forfeiting rights to treatment. The message is an incomplete request asking for Bay Area PTP recommendations for post-Covid treatment, which is a completely different topic focused on finding specific physicians rather than addressing procedural issues around medical provider networks, treatment authorization delays, or waiver of rights.
Any recommendations for a physician or group who will treat long
AI Analysis:
The message appears to be incomplete - it only contains header information (sender, subject, date) without any actual content or body text. Since there is no substantive content to analyze, this message cannot provide any information about MPN, PTP, authorization delays, waivers, or rights regarding treatment outside the network that would help answer the user's real question about these workers' compensation concepts.
On Apr 18, 2026, at 2:28 PM, Lawrence R. Whiting (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> wrote:
AI Analysis:
No message content was provided to analyze. Cannot determine if this message helps answer the user's question about MPN, PTP, authorization delays, waivers, outside network treatment rights, or forfeiture of treatment rights without the actual message text.
James Butler Attorney at Law Rains Lucia Stern St. Phalle & Silver, PC 415.341.9341 Phone 415.780.9929 Fax www.RLSlawyers.com ******************************************************************** NOTICE: This email and all attachments are CONFIDENTIAL and intended SOLELY for the recipients as identified in the "To," "Cc" and "Bcc" lines of this email. If you are not an intended recipient, your receipt of this email and its attachments is the result of an inadvertent disclosure or unauthorized transmittal. Sender reserves and asserts all rights to confidentiality, including all privileges that may apply. Pursuant to those rights and privileges, immediately DELETE and DESTROY all copies of the email and its attachments, in whatever form, and immediately NOTIFY the sender of your receipt of this email. DO NOT review, copy, forward, or rely on the email and its attachments in any way. NO DUTIES ARE ASSUMED, INTENDED, OR CREATED BY THIS COMMUNICATION. If you have not executed a fee contract or an engagement letter, this firm does NOT represent you as your attorney. You are encouraged to retain counsel of your choice if you desire to do so. All rights of the sender for violations of the confidentiality and privileges applicable to this email and any attachments are expressly reserved. ********************************************************************
AI Analysis:
Cannot analyze relevance because no message content was provided. The message appears to be empty or missing, so it cannot help answer the user's question about MPN, PTP, authorization delays, waivers, outside network treatment rights, or forfeiture of treatment rights.
AI Analysis:
This message appears to be incomplete - it only contains header information (from, subject, date) without any actual message content. The subject line 'Re: Bay Area PTP for post-Covid treatment' suggests it may relate to Primary Treating Physicians (PTP), but there is no substantive content to analyze. Without the actual message body, it's impossible to determine if this message addresses the user's question about MPN/PTP authorization delays, waivers, network issues, or treatment rights. An incomplete message cannot provide any useful information to answer the real question.
On Nov 7, 2025, at 4:30 AM, Kenneth Martinson (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> wrote:
AI Analysis:
This message appears to be an incomplete email header or forward without any substantive content. It only shows sender information and a partial subject line about 'UR denied ptp visits for 12 months - set for expedited' but contains no actual message body or discussion that would help answer the user's question about MPN, PTP, authorization delays, waivers, outside network treatment rights, or forfeiture of treatment rights. Without any substantive content, this message provides no information to address the user's legal question.
On Nov 6, 2025, at 9:40 AM, Hollie Rutkowski (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> wrote: