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

Case No. ADJ1700793 (SAC 0307437) ADJ3714832 (SAC 0307399)
Regular
Jun 13, 2011

JUANITA BRADLEY (Deceased) vs. COUNTY OF PLACER

This case involves a dispute over liability for a medical-legal report cost. The defendant seeks reconsideration of a prior award holding them responsible for Dr. Adelberg's $4,237.50 report. The defendant argues the judge ignored a prior order for an Agreed Medical Evaluation (AME) and that the applicant's attorney improperly proceeded with Dr. Adelberg's exam. The Board granted reconsideration, preliminarily finding it may be inequitable to place the full cost on the defendant, and intends to split the expense between the defendant and applicant's attorney. A dissenting opinion argues the defendant's own correspondence shows an ongoing dispute regarding the AME, supporting the original award of liability.

Workers' Compensation Appeals BoardReconsiderationMedical-Legal ReportAgreed Medical EvaluationQualified Medical EvaluatorJoint Findings and AwardLabor Code Section 4062(a)Stipulation and OrderEquitable PowersLien Claimant
References
1
Case No. MISSING
Regular Panel Decision

Wood v. Firestone Tire & Rubber Co.

Anthony N. Wood, severely injured while employed by the Town of Stillwater Highway Department, settled a third-party action against Firestone Tire and Rubber Company for $1.1 million. The workers' compensation carrier, Saratoga County Self-Insured Plan, had a lien of over $63,000 for compensation and medical payments. Wood moved to apportion legal fees and expenses against the carrier's lien, arguing that the carrier's equitable share should consider the present value of estimated future benefits it would no longer have to pay, citing *Matter of Kelly v State Ins. Fund*. The Saratoga County Self-Insured Plan opposed, disputing the calculation of future benefits and arguing for consideration of potential future death benefits. The court, guided by *Kelly*, found the respondent's arguments lacked merit and applied a formula that included the lien amount plus the discounted value of future payments saved by the carrier. The court determined an equitable apportionment of $114,112.67, concluding that the offset exceeded the carrier's lien due to the substantial benefits the carrier received from the extinguishment of future obligations.

ApportionmentLegal FeesThird-Party ActionLien OffsetFuture Benefits CalculationEquitable ApportionmentSettlement ProceedsEconomist Expert WitnessPermanent DisabilityCarrier Liability
References
10
Case No. ADJ6484208
Regular
Aug 21, 2018

ERIK LOPEZ vs. SERFIN CONSTRUCTION, INC., STATE COMPENSATION INSURANCE FUND

The WCAB granted reconsideration and rescinded the prior order, finding that lien claimant South Bay Neurological Diagnostic Center was not entitled to reimbursement for a sleep study. The Board determined the sleep study and associated reports were not valid medical-legal expenses because they were not requested by a medical-legal evaluator and were not incidental to the production of a medical-legal report capable of proving or disproving a disputed medical fact. Therefore, the lien claim was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderAdministrative Law Judgeindustrial injurysleep disorderlien claimantmedical-legal expenseAgreed Medical Evaluator (AME)Report and Recommendation
References
1
Case No. ADJ9101616
Regular
Feb 20, 2018

MARIA MENCITAR vs. JESUS EDGARDO PACHECO, STAR INSURANCE CO., Administered by MEADOWBROOK INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted removal and rescinded a WCJ's order that dismissed a medical-legal provider's petition for determination of non-IBR medical-legal dispute for lack of jurisdiction. The WCAB found the WCJ erred by not holding a hearing, as no procedural rule required the provider to file a lien first. This decision allows the provider to pursue its claim for medical-legal expenses at the trial level.

WCABPetition for RemovalPetition for ReconsiderationPetition for Determination of Non-IBR Medical-Legal DisputeWCJMinute OrderFinal OrderInterlocutory OrderMedical-Legal ExpensesLien Claimant
References
12
Case No. ADJ15742808
Regular
Apr 03, 2023

DENISE RICO vs. STARCREST PRODUCTS OF CALIFORNIA, INC., ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of the Findings and Orders regarding a lien trial. The defendant, Zenith Insurance Company, contested the compensability of a medical-legal report from Dr. Haghighinia, arguing it was not from a qualified medical evaluator. The Board adopted the WCJ's report, which found that a report from a treating physician addressing disputed issues like causation in a denied claim is compensable as a medical-legal expense under Labor Code 4620(a). The petition for reconsideration was denied as no new evidence or compelling legal arguments were presented.

WCABPetition for ReconsiderationDeniedMedical-Legal ReportPrimary Treating PhysicianPanel QMELabor Code 4060Labor Code 4062.2Labor Code 4064Contested Claim
References
2
Case No. ADJ8677592
Regular
Aug 27, 2018

LINDA DAVIES vs. SECURITAS SECURITY SERVICES USA, INC.

This case involves a dispute over reimbursement for medical-legal expenses incurred by a lien claimant, Dr. Kauss, who was designated as the applicant's primary treating physician. The Workers' Compensation Appeals Board (WCAB) rescinded the initial award, finding that the WCJ erred in determining the compensability of Dr. Kauss's reports. The WCAB remanded the case for further proceedings to evaluate compliance with specific statutory requirements regarding objections to medical-legal bills and the distinction between IBR and non-IBR disputes. A dissenting opinion argued Dr. Kauss did not fulfill the duties of a primary treating physician and should not be reimbursed.

Workers' Compensation Appeals BoardReconsiderationMedical-Legal ExpensesPrimary Treating PhysicianLabor Code Section 4060Labor Code Section 4061Lien ClaimantIndependent Bill ReviewExplanation of ReviewDefense Attorney
References
3
Case No. ADJ18498378
Regular
Oct 27, 2025

MARIA VENEGAS vs. MARATHON PETROLEUM COMPANY, ACE AMERICAN INSURANCE

Lien claimant, Premier Psychological Services, sought reconsideration of a Findings and Order from July 30, 2025, which denied its lien for medical-legal and medical treatment expenses. The Workers' Compensation Appeals Board (WCAB) granted the petition for reconsideration, rescinded the original F&O, and returned the matter to the trial level for further proceedings. The Board found that the medical-legal expenses were incurred for a contested claim and that the medical report from Dr. Mark Michaels constituted substantial medical evidence for an injury arising out of and in the course of employment, despite some curable deficiencies regarding interpreter information. The WCAB ordered further consideration of the medical treatment expenses and a potential updated utilization review.

Premier Psychological ServicesAdjudication Number ADJ18498378Opinion and Order Granting Petition for ReconsiderationDecision After ReconsiderationLien ClaimantPrimary Treating Physician (PTP)Dr. Mark MichaelsInjury Arising Out of and In the Course of Employment (AOE/COE)PsycheMedical-Legal Report
References
21
Case No. LAO 0807689
Regular
Mar 24, 2008

CHARLES CASTRO vs. ALPHA THERAPEUTIC CORPORATION, UNITED STATES FIRE INSURANCE COMPANY

This case concerns a lien claimant's award for medical-legal services after the applicant's primary industrial injury claim was settled. The Appeals Board granted reconsideration to allow the defendant credit for any sums already paid to the lien claimant. The Board affirmed the original decision awarding the lien claimant $\$ 3,486.00$ plus penalties and interest for reasonable medical-legal expenses, finding the reports capable of proving a disputed medical fact.

Workers' Compensation Appeals BoardSupplemental Findings and AwardLien TrialIndustrial InjuryCompensable Psychiatric InjuryMedical-Legal ServicesUnreasonable DenialCompromise and ReleaseSubstantial EvidenceQualified Medical Examiner
References
1
Case No. MISSING
Regular Panel Decision

Claim of Cummins v. North Medical Family Physicians

A claimant sustained a work-related back injury and sought continued medical treatment, which was initially authorized. Disputes over authorization led the claimant to retain an attorney. A Workers’ Compensation Law Judge authorized continued medical treatment but denied counsel fees, stating no "money passing" occurred. The Workers' Compensation Board upheld this decision. The claimant appealed, arguing the Board unconstitutionally applied Workers’ Compensation Law § 24, misinterpreted the statute regarding fee payment from medical benefits, and abused its discretion. The appellate court affirmed the Board's decision, ruling that counsel fees must be paid from "compensation," defined as a money allowance, and medical benefits are not considered "compensation" for this purpose, thus finding no abuse of discretion.

Workers' CompensationCounsel FeesAttorney FeesMedical TreatmentStatutory InterpretationConstitutional LawLienCompensation DefinitionAppellate ReviewBoard Decision
References
3
Case No. ADJ8060110, ADJ8060106
Regular
Sep 28, 2018

VICTOR SANTOYO vs. WEST CENTRAL PRODUCE, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of a lien claim for medical-legal expenses. The claimant failed to prove a contested claim existed at the time the expenses were incurred, a prerequisite for employer liability under Labor Code sections 4620 and 4621. Copy service fees for medical records are considered medical-legal expenses, but the claimant bore the burden of proving their necessity and the existence of a contested claim. The Board adopted the WCJ's report, excluding discussion on the "existence of contested claim" from their specific reasoning.

Workers' Compensation Appeals BoardVictor SantoyoWest Central ProduceZenith Insurance CompanyPetition for ReconsiderationDenyLabor Code Section 4622Medical-Legal ExpensesLien ClaimantContested Claim
References
5
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