MEDICAL TREATMENT - Utilization review–Labor Code §4910–The provisions of SB899 setting forth new guidelines for the determination of reasonable medical treatment apply even when the treatment at issue was rendered before SB899 became effective. (See Sierra Pacific Industries v. Workers' Comp. Appeals Bd. (Chatham) (2006) 140 Cal.App.4th 1498, 8 WCAB Rptr. 10,203.) Paula Letherblaire v. Workers' Compensation Appeals Board, Leigh Associates 10 WCAB Rptr. 10,146 [Writ Denied]

MEDICAL TREATMENT - Medical provider networks-California Code of Regulations, Title 8 §9767.9(e)(2)-Transferring medical treatment to a medical provider network does not rescind, alter or amend an award. The employer continues to be liable under Labor Code §4600 and under the award to provide medical treatment reasonably required to cure or relieve from the effects of the industrial injury. The MPN statute simply allows another method for providing medical treatment regardless of the date of injury or the date of the award of future medical treatment. (See Babbitt v. National Market (2007) 9 WCAB Rptr. 10,049 [en banc].) Dulce Montes v. Workers' Compensation Appeals Board, Nationwide Paging, Inc. 10 WCAB Rptr. 10,145 [Writ Denied]

MEDICAL TRATMENT - Labor Code §4600–Child care as a component of medical care–In this fact-specific case, applicant was 100% disabled, his wife worked to support the family since a child tragically died, and a young sibling had to be taken care of for the applicant to be cured and relieved and attend therapy sessions. Child care was properly awarded as a component of medical treatment under the specific facts of this case. (See Smyers v. Workers' Comp. Appeals Bd. (1984) 157 Cal.App.3d 36.) City of Simi Valley v. Workers' Compensation Appeals Board (Kenneth Stephenson) 10 WCAB Rptr. 10,080[Writ Denied]

MEDICAL TREATMENT - Labor Code §4604.5-Is the 24-visit cap for chiropractic treatment constitutional? Jose Facundo-Guerrero v. Workers' Compensation Appeals Board, Nurserymen's Exchange 10 WCAB Rptr. 10,048 [Writ Granted]

MEDICAL TREATMENT - Reimbursement of home care provided by a family member–Home care services provided by a family member equivalent to those normally rendered by a licensed vocational nurse may be reimbursed at the current hourly rate for vocational nurses in the community. (See Los Angeles County Metropolitan Transportation Authority v. Workers' Comp. Appeals Bd. (Pucket) (2003) 5 WCAB Rptr. 10,114 [writ denied].) Argonaut Insurance Co. v. Workers' Compensation Appeals Board (Camilla Carmen Nunez) 9 WCAB Rptr. 10,350 [Writ Denied]

MEDICAL TREATMENT - ACOEM Guidelines–Labor Code §4604.5(c)–The ACOEM Guidelines are presumptively correct on the issue of extent and scope of medical treatment, regardless of the date of injury. The presumption is rebuttable and may be controverted by a preponderance of the evidence establishing that a variance from the guidelines is reasonably required to cure and relieve the employee from the effects of his or her injury. William R. Sutton v. Workers' Compensation Appeals Board, Schwartz & Lindheim, Inc. 9 WCAB Rptr. 10,309 ___Cal.App.4th___

MEDICAL TREATMENT - Medical Provider Networks-Labor Code §4616.3-Under the Medical Provider Network statute, injured workers have a right to choose an MPN physician with recognized expertise or specialty in treating the particular injuries or conditions in question. The injured workers have the right to change treating physicians with the network and there is a procedure to address and resolve disputes regarding diagnosis and treatment in the event of a dispute. In this case, there was no substantial evidence to justify continuing treatment by a chiropractor or acupuncturist ten years post-injury. Shao Wang v. Workers' Compensation Appeals Board, Kansas City Fire & Marine Insurance Company 9 WCAB Rptr. 10,300 [Writ Denied]

MEDICAL TREATMENT - Spinal surgery second-opinion process– Labor Code §4062–When an employee has self-procured spinal surgery before the resolution of the second-opinion process, the employer is not liable for the costs of the spinal surgery. Sacramento County Office of Education v. Workers' Compensation Appeals Board (Kim E. Burnett) 9 WCAB Rptr. 10,221 ___Cal.App.4th___

MEDICAL TREATMENT - The ACOEM Guidelines apply to recommendations on assessing and treating acute low-back problems and do not apply to chronic back problems. ___Cal.App.4th___

MEDICAL TREATMENT - Second opinion for spinal surgery procedures–Labor Code §4062(b)–The procedures for resolving disputes concerning spinal surgery set forth in Labor Code 4602(b) and in the case of a represented injured worker provide that when the parties cannot agree on a board-certified or board-eligible orthopedic surgeon or a neurosurgeon to prepare a second-opinion report resolving the disputed surgical recommendation, the administrative director must randomly select an orthopedic surgeon or neurosurgeon to prepare a second-opinion report resolving the dispute. James Laing v. Workers' Compensation Appeals Board, Kaiser Engineers, Liberty Mutual Fire Insurance Co. 9 WCAB Rptr. 10,216 ___Cal.App.4th___

MEDICAL TREATMENT - Treatment of nonindustrial injuries-Labor Code §4600-If medical treatment is reasonably required to cure or relieve from the effects of the industrial injury, the employer is required to provide treatment, and treatment of nonindustrial conditions may be required where it becomes essential in curing or relieving from the effects of industrial injury. See Granado v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 399.) Gallagher Bassett Services v. Workers' Compensation Appeals Board (Chung Charles) 9 WCAB Rptr. 10,207 [Writ Denied]

MEDICAL TREATMENT - Housekeeping services-Labor Code §4600-Housekeeping services are recoverable as medical treatment if there is a medical recommendation or prescription that such services are medically reasonable and necessary to cure or relieve the effects of the industrial injury. (See Smyers v. Workers' Comp. Appeals Bd. (1984) 157 Cal.App.3d 36.) [Writ Denied]

MEDICAL TREATMENT - Home health care-An employer is only responsible for home health care provided by a relative from the date it knew such treatment was necessary and was being provided. (See California Casualty Indemnity Exchange v. Industrial Acc. Com. (Ellison) (1948) 13 Cal.Comp.Cases 50; Henson v. Workers' Comp. Appeals Bd. (1972) 37 Cal.Comp.Cases 546.) [Writ Denied]

MEDICAL TREATMENT - Treatment outside a medical provider network-An employer's failure to to provide the required notice to the employee of his/her rights under the Medical Provider Network renders the employer liable for reasonable medical treatment self-procured by the employee. Barrett Business Services, Inc. v. Workers' Compensation Appeals Board (Leticia Sanchez) 9 WCAB Rptr. 10,195 [Writ Denied]

MEDICAL TREATMENT - Required use of Medical Provider Network-Labor Code §4600-An employer may satisfy its obligation under Labor Code §4600 to provide reasonable medical treatment by transferring an injured worker into an authorized Medical Provider Network regardless of the date of injury or the date of an award of future medical treatment. Sharon Babbitt v. Ow Jing dba National Market and Golden Eagle Insurance Company 9 WCAB Rptr. 10,190 [Writ Denied]

MEDICAL TREATMENT - ACOEM Guidelines–Did the Appeals Board err in applying the ACOEM Treatment Guidelines to the injured worker's pre-existing back problems, which were chronic? James Laing v. Workers' Compensation Appeals Board, Kaiser Engineers, Liberty Mutual Fire Insurance Co. 9 WCAB Rptr. 10,126 [Writ Granted]

MEDICAL TREATMENT - ACOEM Guidelines–Labor Code §4604.5–Medical treatment that is reasonably required to cure or relieve the injured worker from the effects of his or her injury means treatment based on ACOEM Guidelines. ACOEM Guidelines are presumptively correct on the issue of extent and scope of medical treatment. (See Simmons v. State of California, Dept of Mental Health (2005) 7 WCAB Rptr. 10,206 [en banc].) If ACOEM Guidelines recommend against treatment, applicant has the burden of proof to show that a variance from the Guidelines is necessary. Lake Tahoe Unified School District v. Workers' Compensation Appeals Board (Toni L. Kelly) 9 WCAB Rptr. 10,031 [Writ Denied]

MEDICAL TREATMENT - Labor Code §4600–An employer must provide medical treatment "reasonably required to relieve the injured worker from the effects of his or her injury." The employer is also liable for any subsequent injury, whether an aggravation of the original injury or a new and distinct injury, resulting from the direct and natural consequences of a compensable primary injury. (See Rodgers v. Real Property Mgt. Co. (1984) 49 Cal.Comp. Cases 561 [en banc[.) [In this case, the WCJ found the spinal surgery necessary and the employer was liable for the unfavorable results.] Lithia Motors Support Services v. Workers' Compensation Appeals Board (Jewell Locke) 8 WCAB Rptr. 10,352 ___Cal.App.4th___

MEDICAL TREATMENT - Labor Code §4600—Treatment for non industrial conditions—When continuing medical treatment has been appropriately awarded, the employer has liability of the treatment of the effects of the industrial injury. This includes conditions which may even have preexisted the industrial injury or resulted because of the impairment caused by the industrial injury or its sequellae. (See Dorman v. Workers' Comp. Appeals Bd. (1978) 78 Cal.App.3d 1009.) [in this case the injured worker was suffering from neurological changes cased by his cervical and lumbar industrial injury and by his non-industrial Hepatitis C condition. Treatment for the non-industrial Hepatitis C condition would be indicated on an industrial basis to prevent worsening of the industrial injury.] Christian Salveson v. Workers' Compensation Appeals Board (Clayton Coble) 8 WCAB Rptr. 10,341 [Writ Denied]

MEDICAL TREATMENT-Labor Code §4600—Unlike permanent disability, medical treatment cannot be apportioned to non industrial factors (See Granado v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.App.4th 320.) The right of an injured worker to recover medical expense reasonably necessary to relieve from the effects of an industrial injury is independent of the right to recover for disability. (See Cedillo v. Workmen's Comp. Appeals Bd. (1971) 5 Cal.3d 450.)

MEDICAL TREATMENT-Labor Code §4600—Once it is established that an industrial injury contributed to the need for medical treatment, Labor Code §4600 requires the employer to provide the treatment. (See Rouseyrol v. Workers' Comp. Appeals Bd. (1992) 234 Cal.App.3d 1476.) [In this case the worker injured her leg and the treating physician recommended refitting and replacing a leg brace required for pre-existing weakness in the leg cause by post-polio syndrome.] County of Stanislaus v. Workers' Compensation Appeals Board (Judy B. Credille) 8 WCAB Rptr. 10,316 ___Cal.App.4th___

MEDICAL TREATMENT- Labor Code §4600-An injured worker is entitled to reimbursement for self-procured care when the employer has notice of the injury but fails to promptly tender treatment, and in such a case the injured worker is not required to request the medical treatment from his employer. (See McCoy v. Industrial Acc. Comm. (1966) 64 Cal.2d 82.)

MEDICAL TREATMENT- Labor Code §4600-Upon receiving notice of an industrial injury, the employer must specifically instruct the injured worker what to do and whom to see, and if that is not done, the employer loses the right to control the injured worker's medical care and becomes liable for the reasonable value of self-procured medical treatment. (See Voss v. Workers' Comp. Appeals Bd. (1974) 10 Cal.3d 583.)

MEDICAL TREATMENT- Labor Code §4600-Home health care-An employer may be held liable for necessary home care services obtained by an injured worker even though the services provided by a family member were not previously requested. (See Los Angeles Times v. Workers' Comp. Appeals Bd. (Herbinger) (2005) 7 WCAB Rptr. 10,109 [writ denied].) J.C. Penney, Liberty Mutual Insurance Company v. Workers' Compensation Appeals Board (Laurie Bohannan) 8 WCAB Rptr. 10,306

MEDICAL TREATMENT- Need for medical treatment–The question of whether medical treatment is reasonably required to cure or relieve from the effects of the injury is a question of fact. (See Smyers v. Workers' Comp. Appeals Bd. (1984) 157 Cal.App.3d 36.) Margarita Solorio v. Workers' Compensation Appeals Board, Joseph Stan, D.D.S. 8 WCAB Rptr. 10,294 [Writ Denied]

MEDICAL TREATMENT-ACOEM Guidelines–Labor Code §4604.5–To rebut the ACOEM Guidelines requires only that the preponderance of the evidence establish that a variance from the Guidelines is reasonably required to cure and/or relieve the injured worker from the effects of his or her injury. It does not require reference to any other treatment guidelines.AT&T v. Workers' Compensation Appeals Board (Michael Bigel) 8 WCAB Rptr. 10,243 [Writ Denied]

MEDICAL TREATMENT-Labor Code §4610—ACOEM Treatment Guidelines—The ACOEM guidelines apply to treatment provided prior to January 1, 2004 in cases for which the determination of reasonable medical treatment has not yet been made. Sierra Pacific Industries v. Workers' Compensation Appeals Board (Corey Chatham) 8 WCAB Rptr. 10,203 ___Cal.App.4th___

MEDICAL TREATMENT-Treatment of nonindustrial condition–An injured worker is entitled to treatment of a nonindustrial condition whenever that treatment is necessary, as a precondition, to cure or relieve an injured worker from the effects of an industrial injury. Alicia Zarzosa v. Workers' Compensation Appeals Board, Costco Wholesale 8 WCAB Rptr. 10,212 [Writ Denied]

MEDICAL TREATMENT-ACOEM Treatment Guidelines–Labor Code §4604.5–The ACOEM Treatment Guidelines for treating low-back conditions are for symptoms of less than three months' duration. Zenith Insurance Company v. Workers' Compensation Appeals Board (Hugo Moreira) 8 WCAB Rptr. 10,160 [writ denied]

MEDICAL TREATMENT Labor Code §4600–If the employee's industrial injury materially contributes to the need for further medical treatment, there can be no apportionment of the award of medical treatment. (See Granado v. Workers' Comp. Appeals Bd. (1968) 69 Cal.2d 399.) Zurich North America v. Workers' Compensation Appeals Board (George Garduno) 8 WCAB Rptr. 10,164 [writ denied]

MEDICAL TREATMENT-Medical Provider Networks–Labor Code 4600—When the parties agree that medical treatment will be provided under a medical provider network, the employee does not have a free choice of physicians and must select a physician within the medical provider network. Ropert Laier v. Workers' Compensation Appeals Board, Comtech Communications 8 WCAB Rptr. 10,181 [Writ Denied]

MEDICAL TREATMENT- Treatment reasonably required to cure or relieve from the effects of an industrial injury–The issue presented in six cases involving CHP officers with industrial heart injuries was whether cholesterol medication was a medical treatment reasonably required to cure or relieve from the effects of the injury. The general rule is that for such medication to come within the scope of further medical treatment, the applicant must establish there is a causal chain between the medication and the industrial condition and/or establish that it is necessary to treat a nonindustrial condition to treat the industrial condition. (See Granado v. Workers' Comp. Appeals Bd. (1968) 69 Cal.3d 399.) [Writ Denied]

MEDICAL TREATMENT- Treatment reasonably required to cure or relieve from the effects of an industrial injury–Treatment for nonindustrial conditions may be the employer's responsibility where it becomes essential in curing and relieving from the effects of the industrial injury itself. (See Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159.) But if it is established that the medical treatment or medication in question is required separate and apart from, or independent of, an industrial injury or condition, then the employer may avoid liability. (See Melnyk v. Workers' Comp. Appeals Bd. (1990) 55 Cal.Comp.Cases 357 [writ denied].) [Writ Denied]

MEDICAL TREATMENT- ACOEM Guidelines–Labor Code §4604.5–The failure of the ACOEM guidelines to specifically mention a treatment modality does not mean that such modality is inconsistent with ACOEM. [In this case the injured worker's injury included thoracic outlet syndrome and the ACOEM Guidelines suggested conservative treatment first, followed by confirmatory testing, followed by surgery, if necessary. The WCJ properly found that rib resection surgery was a modality of treatment for thoracic outlet syndrome.] Glaxo Smith Kline v. Workers' Compensation Appeals Board (Hollis Batterman) 8 WCAB Rptr. 10,070 [Writ Denied

MEDICAL TREATMENT- Reimbursement of medical lien for self-procured medical treatment–In the absence of medical confirmation, an injured worker cannot be charged with knowledge that his disability or need for medical treatment is work-related, unless, given the nature of the disability and the worker's qualifications, he should have recognized the relationship. (See City of Fresno v. Workers' Comp. Appeals Bd. (1985) 165 Cal.App.3d 467. (In this case, no evidence in the record justified a finding that the injured worker was aware that his employment was the cause of his heart attacks and his need for bypass surgery.) LSG Sky Chefs and Broadspire v. Workers' Compensation Appeals Board (Horacio Naranjo) 8 WCAB Rptr. 10,068 [Writ Denied]

MEDICAL TREATMENT- Reimbursement for self-procured medical treatment–Reimbursement for the reasonable expense of self-procured medical treatment is allowed where the employee does not know or have reason to know that his condition was industrially caused. (See Simien v. Workers' Comp. Appeals Bd. (1956) 138 Cal.App.2d 397.) [Writ Denied]

MEDICAL TREATMENT- ACOEM Guidelines—Labor Code §4600(a)—In this case, the employer failed to provide the Court of Appeal with a copy of the ACOEM Guidelines and thus the Court of Appeal could not determine whether the ACOEM Guidelines apply beyond the first 90 days following an injured worker's industrial injury. Doctors Medical Center of Modesto v. Workers' Compensation Appeals Board (Jessica Bonar) 8 WCAB Rptr. 10,005 ___Cal.App.4th___

MEDICAL TREATMENT– Labor Code §4604.5– ACOEM Guidelines presumption of correctness– The presumption of correctness on the issue of extent and scope of medical treatment given the American College of Occupational and Environmental Medicine (ACOEM) is rebuttable and may be controverted by a preponderance of the evidence establishing that a variance from the guidelines is reasonably required to cure and relieve the employee of the effects of the industrial injury. [In this case, the WCJ awarded 30 chiropractic treatments per year indefinitely, after the injured worker was found to be permanent and stationary.] Regents of the University of California v. Workers' Compensation Appeals Board (Thomas Macari) 7 WCAB Rptr. 10,362 [Writ Denied]

MEDICAL TREATMENT– Labor Code §4610– ACOEM Treatment Guidelines– Do ACOEM Guidelines apply to treatment provided prior to January 1, 2004? Sierra Pacific Industries v. Workers' Compensation Appeals Board (Corey Chatham) 7 WCAB Rptr. 10,358 [Writ Granted]

MEDICAL TREATMENT– Award of future medical treatment– An award stating that applicant "may be" entitled to future medical treatment simply reserves jurisdiction to make findings concerning medical treatment in the future, subject to the five-year jurisdiction of the Appeals Board. David Silver, M.D. v. Workers' Compensation Appeals Board, Prudential Capital Group (Pamela Fagan) 7 WCAB Rptr. 10,317 [Writ Denied]

MEDICAL TREATMENT– Labor Code §4600– Although the applicant testified at trial that she self-procured housekeeping assistance from her sister and from a friend, applicant neither claimed nor presented any evidence that she paid for the housekeeping. Applicant did not seek reimbursement for housekeeping expenses, which might have been compensable if medically reasonable and necessary. (See Smyers v. Workers' Comp. Appeals Bd.(1984) 157 Cal.App.3d 36.) Gracie Creel v. Workers' Compensation Appeals Board, Longs Drugs 7 WCAB Rptr. 10,269 [Writ Denied]

MEDICAL TREATMENT– Apportioment of medical treatment– Although an employer may not apportion payments for medical care when it is impossible to separate nonindustrial and industrial need for treatment, in this case it was possible to separate the treatment for a disc protrusion related to applicant's retirement activities rather than industrial back strain injury. (See Boehm & Associates v. Workers' Comp. Appeals Bd. (1996) 61 Cal.Comp.Cases 494.) Stuart Rubinstein v. Workers' Compensation Appeals Board, Westside Neighborhood Medical Clinic 7 WCAB Rptr. 10,259 [Writ Denied]

MEDICAL TREATMENT– ACOEM guidelines– The ACOEM guidelines approve back surgery for the symptoms applicant displayed, but the guidelines do not approve that surgery during the acute phase of the injury until conservative methods have been attempted and have failed. Therefore, in this case, the WCJ properly found that applicant reasonably required further medical treatment for his injury, but that the disputed back surgery was not reasonably incurred. Travelers Property Casualty Company of America v. Workers' Compensation Appeals Board (Matthew Shuman) 7 WCAB Rptr. 10,248 [Writ Denied]

MEDICAL TREATMENT– Medical treatment is not substantial evidence if it is no longer germane. (See Place v. Workers' Comp. Appeals Bd. (1970) 3 Cal.3d 372.) [In this case, the injured worker underwent further surgery after the Agreed Medical Evaluator performed his examination and the AME did not perform an examination or review the medical records after the last surgery.] Dole Fresh Vegetables v. Workers' Compensation Appeals Board (Gloria Bernal) 7 WCAB Rptr. 10,247 [Writ Denied]

MEDICAL TREATMENT– Labor Code §4610– ACOEM Guidelines apply only to the 90-day acute stage post-injury. IWC/Explorer Insurance Company v. Workers' Compensation Appeals Board (Cecilia Ulloa) 7 WCAB Rptr. 10,244 [Writ Denied]

MEDICAL TREATMENT– Home health care by spouse–Home health care by the applicant's spouse applying ice packs and massage for pain relief was reasonable in this case and the ACOEM guidelines discussing pain management during the injury's acute phase are not applicable to this case because the injury occurred 14 years ago and the injury is long past the acute phase. Los Angeles Times v. Workers' Compensation Appeals Board (Kurt Herbinger) 7 WCAB Rptr. 10,109

UTILIZATION REVIEW– Did the Appeals Board's en banc decision properly determine that utilization review deadlines are mandatory and if a defendant fails to meet the deadlines, the defendant is precluded from using the utilization review procedure for the particular medical treatment dispute in question? State Compensation Insurance Fund v. Workers' Compensation Appeals Board (Brice Sandhagen) 7 WCAB Rptr. 10,091

MEDICAL TREATMENT– Limit on chiropractic treatment–Although SB 899 amendments to the Labor Code on medical treatment limiting chiropractic treatments to 24 treatments for the life of an injury is effective only on injuries occurring after January 1, 2004, there is nothing unreasonable in considering that provisions in the new law could be a guideline for dealing with reasonable and necessary treatment based on utilization review. Janet Garman v. Workers' Compensation Appeals Board, Antlers Resort & Marina 7 WCAB Rptr. 10,026

MEDICAL TREATMENT– Labor Code §5307.1–Usual and customary medical fees–In deciding whether fees in excess of the Official Medical Fee Schedule are reasonable, the WCAB may consider evidence of the medical provider's training, qualifications, and length of time in practice; the nature of the services provided; the fees usually charged by the medical provider; the fees usually charged in the general geographical area in which the services were rendered; other aspects of the economics of the medical provider's practice that are relevant; and any unusual circumstances of the case. (See Gould v. Workers' Comp. Appeals Bd. (1992) 4 Cal.App.4th 1059.) Hughes Aircraft Company v. Workers' Compensation Appeals Board (Bernard H. Billik) 6 WCAB Rptr. 10,283

MEDICAL TREATMENT– Health Care Organization designation–Labor Code §4600.3–If an employer complies with the legal requirements in notifying a worker of his right to choose not to be involved in an HCO contract and the worker fails to designate a personal physician, the employer can select an HCO on behalf of the worker. [In this case, the evidence confirmed that the worker had signed an Employee Confirmation Letter, in both English and Spanish, acknowledging that if he did not complete the enrollment form and return it to the employer within 30 days that the employer could select an HCO on behalf of the worker.] Rafael Romero v. Workers' Compensation Appeals Board, Atrium Hotel 6 WCAB Rptr. 10,286

MEDICAL TREATMENT– Health Care Organization enrollment– Labor Code §4600.3– The employer must give every employee an affirmative choice at the time of employment and at least annually thereafter to designate or change the designation of an HCO or personal physician; and any employee who fails to select a personal physician, chiropractor, or acupuncturist must be treated by the HCO. [In this case, the injured worker could not understand or read English and could not read Spanish. The employer did not read, discuss or explain the content of the HCO Enrollment Form and the Appeals Board found that the employer did not properly enroll the employee in its HCO and was therefore not required to follow the restrictive change in physician procedures of Labor Code 4600.3.] Wawona Packing Company v. Workers' Compensation Appeals Board (Armando Valencia) 6 WCAB Rptr. 10,259

MEDICAL TREATMENT– Health Care Organization– Labor Code 4600.3– An employer is not liable for the costs of an employee's self-procured medical treatment within the employer's medical control period when the employee intentionally refuses to cooperate with the provisions of the HCO contract. There is no statutory remedy to extend the 90-day control period for the period of noncompliance by the employee. H & F Farms v. Workers' Compensation Appeals Board (Benito Velasquez) 6 WCAB Rptr. 10,260

MEDICAL TREATMENT– Health Care Organization–Labor Code §4600.2(e)–When an applicant is covered by the provisions of a health care organization contract, the applicant must submit to the medical treatment under that contract. If the applicant is dissatisfied with that treatment, there are two options: (1) the applicant must seek a change of treating physician pursuant to Labor Code §4600.3(e), or (2) the applicant must object to the treatment being provided pursuant to the provisions of Labor Code §§4061 and 4062 and follow the AME/QME process. If the applicant simply selects a different physician, the applicant will be precluded from obtaining retroactive temporary disability indemnity or self-procured medical expenses for the period during which the employer was supposed to have medical control as specified in Labor Code §4600.3. Rizzoli's Automotive, California Indemnity Insurance Company v. Workers' Compensation Appeals Board (Timothy Parrish) 6 WCAB Rptr. 10,218

MEDICAL TREATMENT– Health Care Organization–When the injured worker intentionally circumvents the requirements of Labor Code §4600.3 [medical treatment covered by a health care organization], the defendant has no liability for benefits during the control period and during the period of intentional lack of cooperation and the injured worker is not able to obtain reimbursement of medical treatment or indemnity benefits during the period of non-cooperation. Rizzoli's Automotive, California Indemnity Insurance Company v. Workers' Compensation Appeals Board (Timothy Parrish) 6 WCAB Rptr. 10,218

MEDICAL TREATMENT– Health Care Organization–Labor Code §4600.3 gives the employer medical control for 90 days from the date the injury is reported to the employer. There is no extension of the 90-day period for periods of time that the injured worker intentionally circumvents the requirements of section 4600.3. Rizzoli's Automotive, California Indemnity Insurance Company v. Workers' Compensation Appeals Board (Timothy Parrish) 6 WCAB Rptr. 10,218

MEDICAL TRATMENT– Labor Code §4600– Employer Liability for Self-Procured Medical Treatment– When an employer does not provide medical treatment that is reasonably necessary to cure or relieve the effects of the injury, the employer is liable for the reasonable medical expenses for self-procured medical treatment. (See McCoy v. Industrial Accident Commission, (1966) 64 Cal.2d 82.) [In this case, the physician to whom the employee had initially been directed by the employer was not adequately treating her injury and she exercised her right to request a change of physician, which was refused by the employer. The injured worker then sought medical treatment on a self-procured basis.] Home Depot v. Workers' Compensation Appeals Board (Levana McCurn) 6 WCAB Rptr. 10,176

MEDICAL TREATMENT– The employer has the duty to offer, tender, and provide medical care and treatment pursuant to a Finding and Award. The failure to offer, provide or tender medical treatment subjects the carrier to a penalty. (See Ralphs Grocery Co. v. Workers' Comp. Appeals Bd. (Lara) (1995) 38 Cal.App.4th 820.) When the applicant raises the issue of penalty after submitting medical bills with adequate documentation, the burden shifts to the employer to prove a genuine medical/legal doubt about why the medical bills have not been adjusted. (See Kerley v. Workers' Comp. Appeals Bd. (1971) 4 Cal.App.3d 223.) Federal Express v. Workers' Compensation Appeals Board (John Tozek) 6 WCAB Rptr. 10,126

MEDICAL TREATMENT– Treatment for Nonindustrial Condition– An employer must pay for treatment of a nonindustrial condition, if resolution of the nonindustrial condition is necessary to cure the industrial injury. (See Perry v. Workers' Comp. Appeals Bd. (1977) 28 Cal.App.3d 887.) [In this case, the injured worker had a dental infection that precluded neck surgery for the industrial injury.] Los Medanos Health Care Corporation v. Workers' Compensation Appeals Board (Marisa Belleci) 6 WCAB Rptr. 10,121

MEDICAL TREATMENT– Treatment of aggravation or new injury caused by medical malpractice in treatment of industrial injury– The employer who is liable for workers' compensation benefits must pay workers' compensation benefits for aggravation or new injury resulting from medical malpractice in treating the industrial injury. (See Heaton v. Kerlan 91946) 27 Cal.2d 16, Fitzpatrick v. Fidelity & Casualty Company (1936) 7 Cal.2d 230.) Los Medanos Health Care Corporation v. Workers' Compensation Appeals Board (Marisa Belleci) 6 WCAB Rptr. 10,121

MEDICAL TREATMENT– Labor Code §4600– An employer is liable for medical treatment that is reasonable and necessary to cure or relieve from the effects of an industrial injury. If as a result of an injury, medical treatment is required, liability for that treatment is not apportionable as between different injuries. (See Grando v. Workers' Comp. Appeals Bd. (1968) 69 Cal.2d 399.) The subsequent injury and any resulting need for treatment may result in liability for treatment as to subsequent defendants, but there is no statutory or case law to support a contention that a subsequent injury extinguishes the liability for treatment with respect to the prior injury. Thrifty Corporation v. Workers' Compensation Appeals Board, Boehm & Associates (Rita Sharp) 6 WCAB Rptr. 10,009

MEDICAL TREATMENT– Labor Code §4600– An injured worker is entitled to all medical treatment reasonably required to cure or relieve the worker from the effects of the injury. But the employer is liable only for the reasonable value of the services provided. When a lien claimant seeks reimbursement for medical treatment, services or equipment reasonably required for an industrial injury, it stands in the shoes of the injured worker and must prove by a preponderance of the evidence all of the elements necessary to establish the defendant's liability for the amount claimed. (See Beverly Hills Multispecialty Group Inc. v. Workers' Comp. Appeals Bd. (Pinkeny) (1994) 26 Cal.App.4th 789.) Electronic Waveform Lab, Inc. v. Workers' Compensation Appeals Board (Denise Beatty), Department of Corrections. 5 WCAB Rptr. 10,359

MEDICAL TREATMENT– Labor Code §4600– In this case, the treating physician providing psychotherapy recommended as future medical treatment the purchase of a computer, payment of application fees and the payment of school fees and provision of materials to allow applicant to become a private investigator. These were determined not to be medical care but rather vocational rehabilitation expenses. [The Rehabilitation Bureau had determined that applicant had completed an approved rehabilitation plan before the treating physician prescribed these items as part of future medical care.] Melissa Clerkin v. Workers' Compensation Appeals Board, City of Los Angeles. 5 WCAB Rptr 10,230

MEDICAL TREATMENT– Enrollment in a heath care organization (HCO) –Labor Code §4600.3–When an injured worker has properly enrolled in a health care organization program, the employer has control of the medical treatment and the worker must be treated by an HCO physician. Mirana Chen v. Workers' Compensation Appeals Board, Grand National Bank, Everest Insurance Company 5 WCAB Rptr. 10,214

MEDICAL TREATMENT– Future Medical Treatment– A recommendation for over-the-counter medication does not amount to need for future medical treatment. (See Rodriguez v. Workers' Comp. Appeals Bd. (1994) 21 Cal.App.4th 1747.) [In this case, the treating physician stated that applicant "should be advised to take over-the-counter analgesics should she experience her minimal symptoms" and also stated that "instruction in a home exercise program would also be appropriate."] Mary Bradley v. Workers' Compensation Appeals Board, Accountants, Inc. 5 WCAB Rptr. 10,180

MEDICAL TREATMENT– Labor Code §4600– Home care services provided by spouse– Generally speaking, a family member may be entitled to compensation for personal services rendered at home while caring for an injured worker. (See Henson v. Workers' Comp. Appeals Bd. (1972) 27 Cal.App.3d 452.) [In this case, the injured worker was 100% disabled and his paralyzed and debilitated state required constant monitoring, medication and other supportive services. The only issue in the case was the proper calculation of the hourly rate to be paid the spouse, which the WCJ concluded was the midpoint of the hourly rate for an LVN plus the hourly rate for a Certified Nurse Aide for 16 hours per day.] Los Angeles County Metropolitan Transportation Authority v. Workers' Compensation Appeals Board (Delbert Puckett) 5 WCAB Rptr. 10,114

MEDICAL TREATMENT– Labor Code §4600– There is no apportionment of the expenses of the medical treatment between the employer and the employee. If an injury has any industrial causation, the employer is liable for the payment of all the employee's reasonable medical expenses, without apportionment to any nonindustrial causes. (See Grando v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 399, Tanenbaum v. Industrial Acc. Com. (1935) 4 Cal.3d 615.) An employee who suffers from a pre-existing condition and who is disabled by a subsequent industrial injury, is entitled to medical treatment at the employer's expense, to cure or relieve applicant from the effects of the injury, which may include treatment of a nonindustrial condition so that an industrial injury can be properly treated. (See Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159.) U.S. Airways v. Workers' Compensation Appeals Board (Andrew Diaz) 5 WCAB Rptr. 10,071

MEDICAL TREATMENT– Labor Code §4600– Home health care provided by a relative– In this case, there was no reasonable basis for requiring the WCJ to order home health services be provided by a licensed health care professional instead of the applicant's mother. [The defendant failed to provide such services to the applicant for more than a year after his release from a rehabilitation facility. There also was no showing that the services provided by the mother were either unnecessary or inadequate.] Ellegaaard Custom Finishing v. Workers' Compensation Appeals Board (Juan Jimenez) 5 WCAB Rptr. 10,054

MEDICAL TREATMENT– Labor Code §4600– An employer must provide reimbursement for medical, surgical, chiropractic, and other medical treatment that is reasonably required to cure or relieve from the effects of the applicant's industrial injury. An employer is required to treat an applicant's nonindustrial injury if such treatment is necessary to treat the applicant's industrial condition. (See Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159; Vela v. Workers' Comp. Appeals Bd. (1972) 22 Cal.App. 3d 573.) [In this case, the Appeals Board found that the employee was in need of medical treatment to cure and relieve the effects of her injury, including psychiatric treatment for her orthopedic injury. Because the Board expressly found that the applicant did not sustain any industrial psychiatric injury, the compensability threshold of Labor Code §3208.3(b)(1) did not apply. Compare Lockheed Martin Corp. v. Workers' Comp. Appeals Bd. (McCullough) (2002) 96 Cal.App.4th 1237, 4 WCAB Rptr. 10,100 that held the compensability threshold applies to a psychiatric injury that is a compensable consequence of an industrial physicial injury.] Simi Valley Hospital v. Workers' Compensation Appeals Board (Sheila Neira) 5 WCAB Rptr. 10,020

MEDICAL TREATMENT– Labor Code §4600– An award of medical care and treatment on an "as needed" basis, is synonymous with active past, present and future on-going medical treatment. As a consequence, the Appeals Board would have continuing jurisdiction to enforce an aqard as opposed to rescinding, altering or amending an award. (See Barnes v. Workers' Comp. Appeals Bd. (2000) 23 Cal.4th 679, 2 WCAB Rptr. 10,267.) County of Los Angeles v. Workers' Compensation Appeals Board, (John Malast) 4 WCAB Rptr. 10,318

MEDICAL EXPENSE– Labor Code §4600– In this case the cost of a seven-by-seven foot Jacuzzi ($7,537.13) was found to be a reasonable medical expense to cure or relieve the effects of the applicant's industrial injury. [The defendant failed to offer any admissible evidence in rebuttal to establish the amount of the expenditure was unreasonable.] City of Manteca v. Workers' Compensation Appeals Board (Jonathan Shaefer) 4 WCAB Rptr. 10,301

MEDICAL TREATMENT– In this case involving a Petition for Contribution for medical expenses paid by one insurance carrier for extensive orthopedic treatment, the arbitrator properly found that the orthopedic injury had no connection to decedent's death due to cardiac arrest. The cardiac arrest did not imply an underlying heart condition, but simply meant that the heart stopped. The medical evidence in this case showed the heart stopped due to the underlying liver disease due to alcohol abuse. R&S Carpet Service v. Workers' Compensation Appeals Board (Jimmy Martinez) 4 WCAB Rptr. 10,286

MEDICAL TREATMENT– Reasonable geographic area– Cal.Code Regs. §9780(e)– Reasonable geographic area within the context of providing medical treatment is determined by giving consideration to: (1) the employee's domicile, place of employment and place where injury occurred; (2) the availability of physicians in the fields of practice, and facilities offering treatment reasonably required to cure or relieve the employee from the effects of the injury; (3) the employee's medical history; and (4) the employee's primary language. [In this case the WCJ found following a 15 month regmin of epidural treatments, the applicant's returning every 45 days for further evaluations by the treating orthopedist driving 130 miles each time was reasonable since the applicant waived any mileage or per diem claim for the trips and the applicant's condition over the course of treatment had improved and there was no persuasive basis to interrupt what appeared to be a successful course of treatment.] McFarland Unified School District v. Workers' Compensation Appeals Board (Kathy Couch) 4 WCAB Rptr. 10,075

MEDICAL TREATMENT– Labor Code §4600– An employer is required to provide medical treatment that is reasonably required to treat an industrial injury. The treatment of a non-industrial condition may be required, where it is essential in relieving from the effects of the industrial injury. Under these circumstances, the medical treatment is not apportionable. (See Grando v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 399.) [In this case the applicant injured his right knee. The treating physician performed surgery which included a diagnostic arthroscopy, debridement of the patella, and a ACL reconstruction. The treating physician testified that the ACL was in a weakened condition from a non-industrial injury. The WCAB panel found that it was reasonable for the treating physician to treat the ACL because without the treatment a fall would case further problems to the knee and the cost of the ACL reconstruction surgery was so inextricably linked to the patella repair that the cost of the surgery to the ACL was compensable.] Butterball Turkey Company v. Workers' Compensation Appeals Board (Beverly Dickinson) 4 WCAB Rptr. 10,045

MEDICAL TREATMENT– Labor Code §4600– It is reasonable to include within the definitions of medical treatment in Labor Code §3209.3 and 4600, psychotherapy performed by a Licensed Clinical Social Worker, who treated applicant within the scope of her license and the treatment was seen by other psychologists and psychiatrists as reasonable and helpful in relieving the effects of applicant's injury. Cypress Insurance Company v. Workers' Compensation Appeals Board (Debra Paget) 4 WCAB Rptr. 10,044

MEDICAL TREATMENT– Labor Code §4600– Further medical treatment provided to cure and relieve the effects of the industrial injury– The employer is liable for the direct treatment to cure or relieve from the effects of the industrial injury, and, in addition, the employer is also liable for medical treatment for nonindustrial conditions when treatment becomes essential to cure and relieve from the effects of the industrial injury. (See Granado v. Workers' Comp. Appeals Bd. (1968) 69 Cal.2d 399.) [In this case substantial evidence supported the finding of an award of future medical treatment of the applicant's coronary artery disease following an industrial heart attack was necessary to prevent further injury to the heart muscle. During the course of treatment of the coronary artery disease, applicant underwent at least two multiple artery bypass grafting surgeries, as well as separate artery cautherizations, to remove artery obstructions so that proper blood flow could be maintained to the injured heart muscle.] City of San Diego v. Workers' Compensation Appeals Board (Richard Ehmann) 3 WCAB Rptr. 10,341

MEDICAL TREATMENT BENEFTS– Date of commencement– The date of commencement of medical benefits is the date on which the defendant was placed on notice of the nature of the medical services that were performed on an industrial basis.] Beverly Bass v. Workers' Compensation Appeals Board, City of Lynwood. 3 WCAB Rptr. 10,290

MEDICAL TREATMENT– MEDICAL BILLS– Proper procedure for objections to medical bills– Cal.Code. Regs, Title 8 §9792.5– When a medical provider submits a statement for services using a CPT code which does not have a unit value assigned, such an unlisted service or one that is rarely provided, unusual or variable , may require a report that demonstrates the medical appropriateness of the service. Bloch Medical Clinic v. Workers' Compensation Appeals Board (Bernice Lowery) 3 WCAB Rptr. 10,243

MEDICAL TREATMENT– Change of physicians– Labor Code §4603– Once the defendant's request for change of physician was granted by the Administrative Director, and then appealed by applicant, applicant cannot select a new physician outside the panel provided by the defendant. Lucrecia Cardenas v. Workers' Compensation Appeals Board, Leslie Building Products. 3 WCAB Rptr. 10,239

MEDICAL TREATMENT– Change of treating physician– In this case the applicant was unrepresented at the time the treating physician issued a permanent and stationary report. Applicant was unaware of her rights and obligations under Labor Code §§4061 & 4062 and sought treatment from another physician. The defendant failed to provide the necessary notices after the defendant received the P&S report and this failure estopped the defendant from raising the issue of the improper change of treating physician. Owens-Illinois, Incorporated v. Workers' Compensation Appeals Board (Maria Araiza) 3 WCAB Rptr. 10,124

MEDICAL TREATMENT– Labor Code §4600– An injured worker exercising his or her won control over medical treatment is entitled to an unlimited number of changes of physicians subject to the reasonableness test. If the employer believes that the injured worker is abusing its right to exercise control over his or her own medical treatment, the employer may petition the Administrative Ditector under Labor Code §4603 to regain control of treatment or may request a hearing before the WCJ on the matter. (See Ralph's Grovery v. Workers' Comp. Appeals Bd.(Lara) (1995) 38 Cal.App.4th 820.) American Medical Response v. Workers' Compensation Appeals Board (Shirley McNamara) 3 WCAB Rptr. 10,109

MEDICAL TREATMENT– Labor Code §4600– When an injured worker is found permanent and stationary and released from further medical care and the injured worker disagrees with the treating physician's findings, the injured worker is not entitled to immediately seek a new primary treating physician. Before the injured worker may seek treatment with a new primary treating physician, the parties must seek resolution of the disputed issues through compliance with the procedures set forth in Labor Code §§ 4061 and 4062. (See Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing) (2000) 80 Cal.App. 4th 1041, 2 WCAB Rptr. 10,205.) American Medical Response v. Workers' Compensation Appeals Board (Shirley McNamara) 3 WCAB Rptr. 10,109

MEDICAL TREATMENT– Employer right to control for first 30 days– Labor Code §4600– The employer has the right to control medical treatment for the first 30 days after the injury. In this case the injured worker represented by experienced counsel was found to have attempted to deny the employer's right to control medical treatment during this initial period. Daniel Ordorica v. Workers' Compensation Appeals Board, Lance Campers Manufacturing Company. 3 WCAB Rptr. 10,099

MEDICAL TREATMENT– Labor Code §4600– Psychiatric treatment may be awarded as a compensable consequence of an orthopedic injury, even where there is no stipulation to such treatment and the need arises more than five years after the date of injury. [In San Juan Unified School District v. Workers' Comp. Appeals Bd. (1999) 1 WCAB Rptr. 10,069 [writ den.], the Appeals Board held that a stipulated award which included further medical treatment for applicant's back and leg injuries compelled the employer to pay for treatment for a psychiatric condition which resulted in part from orthopedic injuries, even though applicant dismissed her psychiatric claim with prejudice. County of Santa Barbara v. Workers' Compensation Appeals Board. 3 WCAB Rptr. 10,094

MEDICAL TREATMENT– Enforcement of an award for future medical treatment– The Appeals Board retains jurisdiction to determine whether particular medical treatment is attributable to the original industrial injury where there is an outstanding award of further medical treatment. (See Barnes v. Workers' Comp. Appeals Bd. (2000) 23 Cal.4th 679, 2 WCAB Rptr. 10,267.) Richard Beeman v. Workers' Compensation Appeals Board. 3 WCAB Rptr. 10,030

MEDICAL TREATMENT– Home health care– In determining the defendant's liability for home health care, the test is whether household services are medically necessary and reasonable. An admissible medical report is necessary to establish the expenses for housekeeping are recoverable as medical treatment. (See Smyers v. Workers' Comp. Appeals Bd. (1984) 157 Cal.App.3d 36.) Douglas Scott v. Workers' Compensation Appeals Board, Southern California Edison 5 WCAB Rptr. 10,260