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Out-of-Network Medical Records Admissible in California Workers’ Comp

Posted on Dec 11, 2013

This November, the state Supreme Court affirmed a ruling stating that medical records from out-of-network doctors must be considered admissible evidence in California workers’ compensation claims. The ruling is being seen as a victory for injured workers throughout the state.

According to court records, Elayne Valdez first filed for workers’ comp after sustaining an injury from a fall in October 2009, while she was working for Warehouse Demo Services, Inc.

She was unhappy with the care she received from a physician inside of her employer’s Medical Provider Network (MPN), so she sought help from a different physician—one recommended by her attorney. Valdez used medical records from her independently hired physician when she filed for temporary disability.

Valdez’s employer and insurance provider, Zurich North America, contested the records, saying that the opinion of an out-of-network doctor couldn’t be used in workers’ compensation hearings. The judge didn’t agree, ruling that medical records from treating physicians have always been admissible.

The Workers’ Compensation Appeals Board (WCAB) initially reversed the ruling in appeal claiming that the records show that only MPN can be used in workers’ compensation cases; that ruling was later overturned by the California Court of Appeal and ultimately the Supreme Court, which said “comprehensive medical evaluations obtained by any party shall be admissible in any proceedings before the appeals board.”

The case was remanded to the WCAB for reconsideration.

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Thomas Ledgerwood
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