Fresno, Bakersfield, Stockton, Bishop,
Oakland, Sacramento, Salinas, San Jose,
San Luis Obispo, Santa Barbara
YRULEGUI & ROBERTS PREVAILS AGAINST LIEN CLAIMANTS
By Matthew Bowden
On April 23, 2012, Matthew Bowden had the opportunity and pleasure to obtain his first take nothing in the matter of Carlos Ortiz v. Fresno Lexus.
The matter was originally decided in favor of the lien claimants, RS Medical, Premier Physical Therapy, and Santa Teresa Medical Clinic, but Mr. Bowden filed a Petition for Reconsideration, and the WCAB agreed with his arguments ordering a take nothing from the appellate level.
Mr. Bowden's Petition for Reconsideration contended that the workers' compensation judge erred in allowing said liens, arguing that the medical reports, upon which the liens were based, were not substantial evidence, also arguing that the lien claimants did not meet their burdens of proof, and that the treatment they provided was not reasonable and necessary to cure the applicant from the effects of an industrial injury.
The Workers' Compensation Appeals Board, in granting the Petition for Reconsideration, relied on the fact that the WCAB may determine and allow lien claims from medical treatment expenses that are reasonable and necessary to cure or relieve the injured worker for the effects of an industrial injury, based on Labor Code § 4600(a) and § 4903(b).
The WCAB then said that lien claimants are required to meet the evidentiary burden of proof by a preponderance of the evidence on the issues of which it holds the affirmative, based on Labor Code § 3202.5, § 5705 and Kaiser Foundation Hospitals v. Workers' Compensation Appeals Board (Martin) (1985) 39 Cal. 3d. 57, 67. [50 Cal. Comp. Cases 411]; Kuntz v. Patterson Floor Covering (2002) 67 Cal. Comp. Cases 1588, 1592 (Appeals Board en banc).) Lastly, the court relied on the fact that payments shall not, in the absence of any agreement, be an admission of liability for compensation on the part of the employer, based on Labor Code § 4909.
The court held that the medical reports that were submitted into the record made mention of some of the treatments provided by the lien claimants, but did not delineate specifically the reason for those treatments and the length of time that the treatments were intended to extend. This led the court to agree with our office, and hold that there was no substantial medical evidence establishing the reasonableness and necessity of the treatment in question. Therefore, our client was granted exemption from making any additional payments on the remaining three liens.
If you would like a copy of the WCAB Opinion, or would like to discuss your liens further, please contact YRULEGUI & ROBERTS.
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• Jaime Simmons v. Just Wingin’ It, Inc.
• Maxham v. SCIF
• Senate Bill 11/60/Lien Anti-Fraud Provisions and Utilization Review Changes
• The Post-Termination Defense
• Penalties Assessed Under Labor Code Section 5814
• New California Law Establishes Shared Liability Between Employer & Labor Contractor
• Rulings Concerning Medical Treatment Disputes
• Cannon Appellate Decision and The Cannon Ball Effect It Will Have
• The Beginning and Ending of Temporary Disability
• Medical Provider Network Changes
• New Lien Regulations
• Y&R Prevails Against Lien Claimants
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• New En banc decision from WCAB allows Defendant's more Discovery
• A First-Year Associate's Perspective on Workers' Compensation in California
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• Labor Code 4658(d)(3)(A)
• Y&R Obtains Take-Nothing from WCAB