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

Case No. AHM 0082920
Regular
Mar 10, 2008

RAUL REYES vs. DUDDY DRYWALL COMPANY, STATE COMPENSATION INSURANCE FUND

This Workers' Compensation Appeals Board decision denies a lien claimant's petition for reconsideration. The WCAB affirmed the trial judge's disallowance of a medical lien, finding the claimant failed to prove either the reasonableness of its charges or proper licensure for the services provided under the name "SB Surgery Center" on the date of service. The Board held the lien claimant bore the burden of proving licensure and did not meet that burden.

Lien claimantSB Surgery CenterS&B Surgery Centerlicensingreasonableness of chargesburden of proofsubstantial evidenceLabor Code sections 59025904Zenith Insurance Company v. Workers' Comp. Appeals Bd.
References
2
Case No. LAO 0794643
Regular
May 07, 2008

FRANCISCO CHAPA vs. GIBSON OVERSEAS, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinding the initial denial of a lien claim by S&B Surgery Center. The Board found the record insufficient regarding S&B's licensure and proper business naming, remanding the case for further development. This includes proving proper licensure as an "outpatient setting" and addressing the necessity of filing a fictitious business name statement, followed by a determination of the reasonableness of the billed fees.

Lien claimantreconsiderationlicensurefictitious business name statementoutpatient settingsurgical clinicMedical Boardcounty clerkreasonableness of feesburden of proof
References
9
Case No. ADJ1004728 (OAK 0312941)
Regular
Dec 31, 2008

MARTHA HASSLER vs. FUTURE EXPLORE, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to address the WCJ's award to a lien claimant for surgical services. The Board found the WCJ erred in determining licensure and accreditation requirements, specifically regarding a fictitious business name permit, and in awarding a fee without sufficient evidence per established precedent. The case is remanded for further proceedings to develop the record on the lien claimant's proper licensure and the reasonableness of their claimed fee.

Workers' Compensation Appeals BoardFictitious Business Name PermitLien ClaimantLicensed ProfessionalOutpatient SettingSurgical ClinicMedical BoardReasonable FeeLicensureAccreditation
References
9
Case No. ADJ680519 (VNO 0523537)
Regular
Oct 03, 2008

BENJAMIN MARTINEZ vs. SPRINGER TERMITE & PEST, INC., CALIFORNIA INSURANCE COMPANY, APPLIED RISK SERVICES, INC.

The Appeals Board granted reconsideration for lien claimants California Pharmacy Management and Long Beach Prescription Pharmacy, rescinding the administrative law judge's disallowance of their liens. The Board found that while lien claimants bear the burden of proving licensure, they were not afforded a full and fair opportunity to do so when the judge raised the issue for the first time at trial. The case is remanded to the trial level for further proceedings and a decision after the record regarding licensure is fully developed.

Lien claimantsOffer of proofLicensureAccreditationPharmaceuticalsRepackaged drugsDue processReconsiderationRescindedTrial level
References
12
Case No. RIV 0037205, RIV 0070473
Regular
Jul 24, 2007

LORRIE AVERETTE vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior ruling that Premier Outpatient Surgery Center was properly licensed and not required to have a fictitious name permit for services rendered. The defendant argued Premier lacked proper licensure and a fictitious name permit, but the Board found Premier met its burden of proof by submitting evidence of its licensure and accreditation. Premier was determined to be an "outpatient setting" rather than a "clinic," thus not requiring a fictitious name permit from the Medical Board.

Workers' Compensation Appeals BoardLien claimantFictitious name permitMedical Board of CaliforniaOutpatient surgery servicesLicensureAccreditationAmbulatory surgical centersZenith Ins. Co. v. Workers' Comp. Appeals Bd. (Capi)Stokes v. Patton State Hospital
References
2
Case No. WCK 0063425
Regular
Jul 30, 2007

JACQUELINE SYLVESTER vs. EASTBAY MUNICIPAL UTILITY DISTRICT, OCTAGON RISK SERVICES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address the defendant's contention that the lien claimant, Webster Surgery Center, failed to prove proper licensure and accreditation for services rendered to the applicant. The WCAB rescinded the prior award and remanded the case for further proceedings to determine if Webster met the necessary licensing or accreditation requirements to provide the claimed medical services. This decision aligns with recent appellate court rulings placing the burden on lien claimants to demonstrate compliance with applicable licensure or accreditation standards.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and OrderMedical TreatmentReasonable ValueLicensureAccreditationBurden of ProofAmbulatory Surgical Centers
References
2
Case No. ADJ3344729 (OAK 309365)
Regular
Mar 26, 2009

Richard Faria vs. GHILOTTI BROTHERS, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a previous award to lien claimant Bay Surgery Center (BSC). The Board found the record deficient regarding BSC's licensure and the reasonableness of its charges. The case is returned to the trial level for further proceedings to develop evidence on whether BSC was properly licensed to operate as an outpatient setting and to determine the reasonable value of services rendered. Specifically, the Board clarified that BSC is not required to have a fictitious-name permit if it operated as an outpatient facility, but must prove proper licensure as such.

Workers' Compensation Appeals BoardLien ClaimantFictitious Name PermitLicensureOutpatient SettingSurgical ClinicReasonable FeeMedical TreatmentAdministrative Law JudgeStipulated Award
References
9
Case No. ANA 0356755
Regular
Aug 22, 2007

YAZMINA VERDUZCO vs. EXECUTIVE AIR WASH, INC., STATE COMPENSATION INSURANCE FUND

This case involves a lien claim by Outpatient Spine & Surgery Center (OSSC) for over $74,000 in surgical services. The original ruling disallowed the lien, finding OSSC failed to prove it had a fictitious name permit from the Medical Board. The Appeals Board rescinded this decision, remanding the case for further proceedings to determine OSSC's compliance with licensure and accreditation requirements and the reasonableness of its charges.

Fictitious Name PermitMedical BoardLien ClaimantOutpatient SettingAccreditationBusiness and Professions CodeLicensureBurden of ProofRescindReturn to Trial Level
References
3
Case No. ADJ10430501
Regular
Aug 05, 2019

MARCO ESTRADA vs. INCA ONE CORP, REPUBLIC INDEMNITY COMPANY OF AMERICA

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration. The claimant failed to prove it possessed a valid fictitious business name permit at the time services were rendered, a requirement for maintaining its lien. While the claimant argued they cured the defect, the Board found they did not meet their burden of proof and the FNP status remained canceled. The decision upholds that lien claimants must demonstrate compliance with applicable licensure and permit requirements.

Fictitious Business Name PermitBusiness and Professions Code Section 2415Burden of ProofLien ClaimantMedical Board of CaliforniaSecretary of StateFictitious Name PermitComplianceCurable DefectPetition for Reconsideration
References
13
Case No. AHM 0084758
Regular
Mar 06, 2008

STEVEN POOL vs. CALIFORNIA HIGHWAY PATROL, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, rescinded the prior decision disallowing S&B Surgery Center's lien in its entirety, and returned the case for further proceedings. The WCJ improperly raised and decided issues not identified for trial, specifically regarding Labor Code section 139.3. The Appeals Board found SB possessed a valid surgical clinic license and remanded to determine the true name of SB, its licensure, and the reasonableness of its lien claim.

Lien claimantReconsiderationFindings and OrdersLabor Code section 139.3LicensureSurgical clinicDepartment of Health ServicesReasonable chargesFictitious business name statementOutpatient setting
References
34
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