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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ8658755
Regular
Mar 22, 2018

JOSE ALCAIDE SIERRA vs. MARK BOWERS DRYWALL, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of an order awarding interpreter fees. The Board found that the award did not violate Rule 10451.3 because the interpreter services were rendered during a hearing, allowing the WCJ to assess their necessity and qualifications directly. Unlike situations requiring a formal petition for costs, the WCJ's personal observation and lack of objection from the defendant at the hearing supported the award. The Board also found the order sufficiently supported by the facts presented.

Petition for ReconsiderationAppeals Board Rule 10451.3Petition for CostsInterpreter feesLabor Code section 5710(b)(5)Administrative Director Rule 9795.3(a)(5)WCJHearingInterpreter qualificationsUnsupported order
References
Case No. FRE 0222651
Regular
Jul 15, 2008

CHRISTOPHER HUNT vs. MADERA COUNTY ROAD DEPARTMENT

The Appeals Board granted reconsideration of a WCJ's decision that limited a lien claimant's facility fees to the Official Medical Fee Schedule. The Board found the WCJ erred by not applying the correct *Kunz* standard for determining the reasonableness of outpatient surgery facility fees, which considers factors beyond the fee schedule. The case is remanded for further proceedings to properly develop the record according to *Kunz*.

KunzOfficial Medical Fee Scheduleoutpatient surgery facility feeslien claimantreconsiderationen banc decisionreasonableness of feesusual feegeographical areacontractually negotiated fees
References
Case No. ADJ4673406 (ANA 0403334) ADJ4233924 (ANA 0376527)
Regular
Sep 29, 2009

Joseph Vella vs. Hitchcock Automotive, State Compensation Insurance Fund

This case concerns a dispute over the reasonableness of a lien claimant's billing for outpatient surgery services. The Workers' Compensation Appeals Board granted reconsideration and rescinded the original award, finding the Administrative Law Judge (ALJ) erred by concluding the lien claimant met its burden based solely on its usual billing practices without a proper analysis of reasonableness. The Board remanded the case to the ALJ to determine a reasonable fee considering all evidence, including the lien claimant's and defendant's submissions, as outlined in *Kunz* and *Tapia*. The decision emphasizes that the lien claimant bears the affirmative burden to prove the reasonableness of its fee.

Kunz doctrinelien claimantreasonable feerebuttal evidenceTapiabillingmedical treatmentoutpatient surgeryinpatient hospitalDRG
References
Case No. ADJ2340102 (LAO 0751270) ADJ4406096 (LAO 0784412)
Regular
Apr 27, 2017

JOSE MORFIN vs. WHITE MEMORIAL MEDICAL CENTER, ADVENTIST HEALTH

This case involves an award of additional attorney's fees for applicant's counsel in the California Court of Appeal. The court remanded the matter for supplemental fees after the defendant's unsuccessful Petition for Writ of Review. While applicant's attorney sought $11,480.00 in fees, the Board found this excessive and awarded $8,000.00 based on a review of the appellate work and the contentious history of the litigation. The Board also awarded the requested costs of $67.58, totaling $8,067.58 in additional appellate attorney's fees and costs.

Workers' Compensation Appeals BoardSupplemental Attorney's FeesPetition for Writ of ReviewLabor Code § 5801Labor Code § 5811Appellate Attorney's FeesItemization of Attorney's FeesExcessive Fee RequestReasonable Fee DeterminationCase-by-Case Basis
References
Case No. LAO 0807776
Regular
Jan 08, 2008

Mason Dow vs. COMMERCIAL INTERIOR RESOURCES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case to the trial level for further proceedings. The Board found that the Administrative Law Judge erred by improperly applying the Official Medical Fee Schedule to a lien claimant's surgical facility fees incurred prior to its adoption. The case is remanded for the judge to determine the reasonableness of the lien claimant's charges, considering factors outlined in *Kunz v. Patterson Floor Coverings*.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and AwardSurgical Facility FeesKunz v. Patterson Floor CoveringsReasonable FeeOfficial Medical Fee Schedule (OMFS)Outpatient Surgery CenterUsual Fee
References
Case No. LAO 0832662
Regular
Mar 18, 2008

RIVALDO CASTILLO vs. BENTLEY-SIMONSON, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award, remanding the case to the trial level. The WCJ erred by applying the Official Medical Fee Schedule to a 2003 surgery and failing to consider the *Kunz* factors for reasonableness when determining the lien claimant's facility fees. The Board will allow the WCJ to determine the reasonableness of the lien claimant's charges under *Kunz*, with the OMFS as one factor.

Wilshire SurgicenterOpinion and Order Granting ReconsiderationFindings and AwardLien ClaimantOutpatient Surgery Facility FeesOfficial Medical Fee ScheduleKunz v. Patterson Floor CoveringLabor Code section 4600Reasonableness of Facility FeeUsual Fee
References
Case No. ADJ8361822
Regular
Aug 03, 2015

LORENA CHAVEZ vs. ABM JANITORIAL SERVICES, ESIS

This case concerns ABC Interpreting, Inc.'s petition for reconsideration of a WCJ's decision awarding them $180.00 for interpreter services. ABC Interpreting sought $250.00, claiming entitlement to the pre-established market rate, plus interest and penalties for late payment. The Board denied the petition, affirming the WCJ's award because ABC Interpreting failed to provide adequate documentation of market rate, their qualifications as an interpreter, and because Labor Code section 5811 does not authorize penalties and interest. The Board found the $180.00 award consistent with the reasonable and customary rate for interpreter services in the applicable geographic area.

Petition for ReconsiderationInterpreter FeesLabor Code Section 5811Market RateSuperior Court Fee ScheduleQualified InterpreterDeposition ServicesUntimely PaymentInterest and PenaltyAmended Order
References
Case No. ADJ1972276 (LAO 0862108) ADJ2914408 (LAO 0889233)
Regular
Mar 07, 2011

AMANDA CORONADO vs. BALLY'S TOTAL FITNESS, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant, E&M Interpreting, seeking payment for alleged interpretation services during the applicant's medical treatment. The Workers' Compensation Appeals Board denied reconsideration, upholding the administrative law judge's decision that E&M failed to meet its burden of proof. Specifically, E&M did not demonstrate the qualifications of its interpreters or the necessity of the services provided. The Board affirmed that lien claimants must prove both the reasonableness and necessity of services, as well as the qualifications of the individuals providing them, to be entitled to payment.

Workers' Compensation Appeals BoardLien claimantReconsiderationQualified interpretersBurden of proofInterpretation servicesMedical treatment appointmentsAdministrative law judgeFindings and OrderBilling
References
Case No. ADJ4124563
Regular
May 29, 2009

MARIO HERNANDEZ vs. WESLAR, INC., STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant attorney challenging an arbitrator's award of withheld attorney fees. The lien claimant argued they were not properly notified of proceedings concerning the fee distribution. The Appeals Board granted reconsideration, rescinded the arbitrator's prior award, and returned the matter for a full determination on the merits of how the withheld attorney fees should be disbursed. This ensures both attorneys involved will have their claims fairly considered.

Workers' Compensation Appeals BoardLien ClaimantAttorney FeesReconsiderationArbitratorWithheld FeesPetition for ReconsiderationNotice of IntentionAward of Attorney FeesDisbursement
References
Case No. ADJ1781281 (MON 0350482) ADJ4191242 (MON 0350483)
Regular
Aug 11, 2011

ANGEL ACOSTA vs. GUILDCRAFT FURNITURE MANUFACTURING COMPANY, AMERICAN CASUALTY

This case involves a lien claimant seeking payment for interpreting services provided to an injured worker. The Workers' Compensation Appeals Board affirmed the WCJ's decision to disallow the lien claimant's claim for $25,573.00. The Board found that the lien claimant failed to meet its burden of proof to establish that the interpreting services were reasonably necessary, that the interpreters were qualified, and that the fees were reasonable. Crucially, no evidence was presented demonstrating a need for an interpreter for effective doctor-patient communication or that the interpreters were certified as required by law.

Lien claimantInterpreting servicesQualified interpreterBurden of proofReasonableness of feesIndustrial injuryMedical treatmentLabor Code section 4600(f)Compensable servicesWorkers' compensation administrative law judge
References
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