Serrano v. Nova Commercial Co., Inc. (2024 Cal. Wrk. Comp. P.D. LEXIS 123)

The applicant received treatment, including treatment for hip pain, and was seen by a QME who reported that she needed an evaluation of a lateral hip mass to rule out pathology.

After objections to that treatment by an MPN treating physician and after receiving second and third opinion evaluations under LC §4616.3, the applicant was evaluated by a medical provider network independent medical reviewer (MPN IMR), who reported that she required an excision on a nonindustrial basis of a lipoma on the left hip by an orthopedic oncologist.

The WCAB held that a MPN IMR’s evaluation could be used to assess whether an applicant was entitled to a left hip biopsy surgery to remove a hip mass.

The WCAB stated that the physician’s opinion could not address the issue of causation or be sent to the QME. LC §4616.4(b) is clear that an MPN IMR evaluation pertains only to “disputed treatment or diagnostic service still in dispute.”