CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. POM 0261983
Regular
Feb 08, 2009

SARA LARA vs. POMONA UNIFIED SCHOOL DISTRICT, CALIFORNIA COMPENSATION INSURANCE/BROADSPIRE

The lien claimant, Premier Outpatient Surgery Center, sought reconsideration of an administrative law judge's decision that reduced their billed costs for applicant's medical treatment. The Workers' Compensation Appeals Board denied the petition, upholding the judge's finding that the billed costs were unreasonable and that the lien claimant failed to present a persuasive case supporting their charges. The Board also found no evidence of a violation of Labor Code section 4603.2 regarding timely reimbursement.

Kunz v. PattersonWCABLien claimantAmended Findings of FactReasonable and necessary costsBilled costs unreasonableStipulations with Request for AwardIndustrial injuryBilateral upper extremitiesNeck injury
References
Case No. LBO 0355987
Regular
Jul 14, 2008

EDELMA D'TRINIDAD vs. LONG BEACH UNIFIED SCHOOL DISTRICT, Permissibly Self-Insured, Adjusted by SOUTHERN CALIFORNIA RISK MANAGEMENT ASSOCIATES (SCRMA)

This case involves a lien claim for surgical services where the applicant's insurer sought to reduce the billed amount. The Workers' Compensation Appeals Board denied reconsideration, upholding the administrative law judge's finding that only $3,100.00 was a reasonable charge for the services. This decision was based on credible testimony and evidence from a defense witness who presented a "Kunz study" demonstrating that the billed amount far exceeded usual and accepted fees in the area.

Workers Compensation Appeals BoardLien ClaimantReconsiderationFindings and OrderReasonable ValueSurgery CenterIndustrial InjuryLabor Code Section 3202.5Burden of ProofKunz Study
References
Case No. ADJ3820883 (SBR 0332538)
Regular
Dec 24, 2008

RUBY JONES vs. STATE DEPARTMENT OF MENTAL HEALTH, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted removal and rescinded the WCJ's orders compelling Randall Hollien's deposition and quashed the subpoena for records. The Board found the petition for removal timely and directed parties to identify the preparer of a disputed "Kunz" study before SCIF could properly subpoena the author. The matter was returned to the trial level for further proceedings.

RemovalHearing RepresentativeAttorney-Client PrivilegeSubpoenaDiscovery OrderCMS NetworkRandall HollienComparative Kunz StudyLien ClaimantWCJ
References
Case No. ADJ1194260 (ANA 0375551)
Regular
Jan 16, 2009

SERAFIN VASQUEZ vs. COASTAL MIRAGE LANDSCAPES, INC., STATE COMPENSATION INSURANCE FUND

"The Appeals Board grants the lien claimant's Petition for Reconsideration, rescinds the Findings and Order issued November 3, 2008, and returns the matter to the trial level to clarify whether the "Kunz Study" was admitted into evidence."

Lien claimantPetition for reconsiderationKunz v. Patterson Floor CoveringFindings and OrderWCJMedical servicesFee scheduleGeographical equivalent studyDRG valueAPC calculation
References
Case No. VNO 0435305
Regular
Dec 14, 2007

RENEE JACKSON vs. JEWISH FAMILY SERVICES OF LOS ANGELES, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded a prior award and returned the case to the trial level for further proceedings regarding the reasonable value of services provided by lien claimant Wilshire Surgicenter, Inc. The Board found that neither party presented sufficient evidence according to the precedent set in *Kunz v. Patterson Floor Coverings, Inc.* regarding usual fees accepted by providers. The case will be reheard to allow both parties to develop evidence regarding the usual fees accepted by providers in the geographic area for the services rendered.

Wilshire SurgicenterKunzComparative Study SummaryBill Review ExpertReasonable ValueOutpatient Surgery Facility FeesMedicare Reimbursement RatesLabor Code § 4903.1(c)Due ProcessRebuttal Evidence
References
Case No. ADJ8212510
Regular
Feb 19, 2013

SANTOS ARIN RODRIGUEZ vs. JK FARMS PARTNERSHIP, INSURANCE COMPANY OF THE WEST\EXPLORER

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration, rescinded the prior Findings and Award, and returned the case for further development of the record. The Board found that the second opinion physician's report was incomplete due to the defendant's refusal to authorize recommended diagnostic tests. This refusal prevented the physician from rendering a definitive opinion on the necessity of spinal surgery. The Board admonished the defendant for this delay and gamesmanship, emphasizing the need for authorized further testing.

Workers' Compensation Appeals BoardPetition for ReconsiderationSpinal SurgeryUtilization ReviewSecond OpinionNerve Conduction StudyEMG StudiesLumbar FusionDynamic Radiographic StudiesDeclaration of Readiness to Proceed
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. OAK 0314027
Regular
Jul 30, 2007

ANASTACIA MURELLA vs. DEPARTMENT OF INDUSTRIAL RELATIONS / STATE OF CALIFORNIA, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board rescinded a prior order disallowing a lien claim from Bay Surgery Center (BSC) for surgical services. The Board found that the administrative law judge incorrectly applied the *Kunz* standard for evaluating outpatient surgical facility fees and that the issue of BSC's licensure and fictitious-name permit requirements needed further consideration. The case is remanded to the trial level for a new decision that properly addresses these issues, ensuring compliance with *Stokes* and *Kunz*.

KunzFictitious-name permitBurden of proofLien claimantMedical BoardAmbulatory surgical centerMedicare rateLicensed physicianAccreditationUsual fee
References
Case No. MON 0292635
Regular
May 20, 2008

ZENA GARCIA vs. SANTA MONICA MALIBU UNIFIED SCHOOL DISTRICT

The Appeals Board denied the lien claimant's petition for reconsideration, upholding the administrative law judge's decision that the lien claimant failed to meet its burden of proving the reasonableness of its charges for surgery. Despite prior direction to develop the record regarding rebuttal evidence, the lien claimant presented no further evidence, leaving its charges appearing disproportionate. The Board affirmed the use of the 2004 fee schedule as a guide to establish the reasonable value of the services.

KunzOutpatient Surgery Fee ScheduleReconsiderationLien ClaimantReasonable ValueRebuttal EvidenceBurden of ProofGeographic ComparablesComparative StudyIndustrial Injury
References
Case No. LAO 0824281
Regular
Jan 28, 2008

LOY VOTAW vs. METRO FOURSLIDE MANUFACTURING, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant seeking reconsideration of a workers' compensation judge's decision regarding the reasonableness of a medical bill. The Appeals Board granted reconsideration, rescinded the prior order, and returned the case for further proceedings. The Board clarified that the lien claimant bears the burden of proving the reasonableness of their charges, and that further development of the record is necessary for a proper determination.

WCABLien ClaimantReconsiderationFacility FeeReasonablenessBurden of ProofKunzOutpatient SurgeryMedical SuppliesBilling Statement
References
Showing 1-10 of 573 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational