ADJ8290263 · May 5, 2025

Based on applicant's credible testimony and defendant's lack of rebuttal evidence, the WCJ's finding of unreasonable delay or refusal of medical treatment was upheld.

From the decision · page 7In the instant matter, based upon applicant's testimony, the passage of time since applicant's last date of treatment through defendant (over three years), and defendant's lack of rebuttal evidence, we agree with the WCJ that defendant unreasonably delayed or refused medical treatment. Per applicant's testimony, treatment was stopped in "late 2021" after the parties settled the claim via an August 18, 2020 Stipulations with Request for Award and "Medicare became aware that Zurich was supposed to be paying the bills." (Minutes Hearing and Summary of Evidence (MOH & SOE), January 14, 2025, p. 4.) Applicant further testified that despite discussions with Zurich's claims adjuster and multiple attempts at securing treatment with numerous providers, he was unable to secure a provider and "did not receive anything from Zurich regarding treatment until he was authorized by [Zurich] to see Dr. Mohamed." (Id. at p.

Applicant's credible testimony about lack of medical treatment and efforts to secure treatment.

Favours Applicant prevailed

Supported the finding of unreasonable delay or refusal of medical treatment by defendant.

From the decision · page 7In the instant matter, based upon applicant's testimony, the passage of time since applicant's last date of treatment through defendant (over three years), and defendant's lack of rebuttal evidence, we agree with the WCJ that defendant unreasonably delayed or refused medical treatment. Per applicant's testimony, treatment was stopped in "late 2021" after the parties settled the claim via an August 18, 2020 Stipulations with Request for Award and "Medicare became aware that Zurich was supposed to be paying the bills." (Minutes Hearing and Summary of Evidence (MOH & SOE), January 14, 2025, p. 4.) Applicant further testified that despite discussions with Zurich's claims adjuster and multiple attempts at securing treatment with numerous providers, he was unable to secure a provider and "did not receive anything from Zurich regarding treatment until he was authorized by [Zurich] to see Dr. Mohamed." (Id. at p.

Defendant's failure to provide rebuttal evidence to counter applicant's testimony.

Favours Applicant prevailed

Reinforced the credibility of applicant's testimony and supported the WCJ's finding.

From the decision · page 8find that based upon applicant's testimony and defendant's lack of rebuttal evidence, defendant unreasonably delayed or refused medical treatment.

Defendant failed to authorize Dr. Matthew Longacre as applicant's primary treating physician, contributing to the unreasonable delay or refusal of medical treatment.

Applicant alleged failure to authorize Dr. Longacre as PTP in petition for penalties; this was a key issue in the delay dispute.

From the decision · page 2On September 13, 2024, applicant filed a petition seeking penalties and attorney's fees pursuant to sections 5814 and 5814.5 for unreasonable delay or refusal of medical treatment. Applicant alleged that defendant failed to coordinate an initial evaluation with Big Island Pain Center and failed to authorize Dr. Matthew Longacre as his primary treating physician. (Petition for Penalties, September 13, 2024, p. 2.) Big Island Pain Center and Dr. Longacre were apparently listed within defendant's MPN.

Labor Code section 4600(a)

Employer must provide reasonable medical treatment to cure or relieve effects of industrial injury or be liable for reasonable medical expenses incurred.

Applied to find defendant liable for unreasonable delay or refusal of medical treatment.

From the decision · page 6III. Notwithstanding the above, we find it important to note that section 4600(a) requires the employer to provide reasonable medical treatment to cure or relieve from the effects of an industrial injury or be subject to liability for reasonable medical expenses incurred. Pursuant to section 4600(a): Medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatuses, including orthotic and prosthetic devices and services, that is reasonably required to cure or relieve the injured worker from the effects of the worker's injury shall be provided by the employer. In the case of the employer's neglect or refusal reasonably to do so, the employer is liable for the reasonable expense incurred by or on behalf of the employee in providing treatment.

Labor Code sections 5814 and 5814.5

Penalties and attorney's fees may be imposed for unreasonable delay or refusal of medical treatment.

Discussed as basis for penalties and fees deferred for further development.

From the decision · page 8In the event an employer is found to have unreasonably delayed or refused medical treatment, the injured worker may seek penalties under section 5814 and attorney's fees "incurred in enforcing the payment of compensation awarded" under section 5814.5. (Lab. Code, § 5814.5.) Pursuant to section 5814(a):

Applicant's credible testimony regarding lack of medical treatment and efforts to secure treatment.

From the decision · page 7In the instant matter, based upon applicant's testimony, the passage of time since applicant's last date of treatment through defendant (over three years), and defendant's lack of rebuttal evidence, we agree with the WCJ that defendant unreasonably delayed or refused medical treatment. Per applicant's testimony, treatment was stopped in "late 2021" after the parties settled the claim via an August 18, 2020 Stipulations with Request for Award and "Medicare became aware that Zurich was supposed to be paying the bills." (Minutes Hearing and Summary of Evidence (MOH & SOE), January 14, 2025, p. 4.) Applicant further testified that despite discussions with Zurich's claims adjuster and multiple attempts at securing treatment with numerous providers, he was unable to secure a provider and "did not receive anything from Zurich regarding treatment until he was authorized by [Zurich] to see Dr. Mohamed." (Id. at p.

Defendant's lack of rebuttal evidence to counter applicant's testimony.

From the decision · page 8find that based upon applicant's testimony and defendant's lack of rebuttal evidence, defendant unreasonably delayed or refused medical treatment.