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

Case No. SBR 0332538
Regular
Mar 28, 2009

RUBY JONES vs. STATE OF CALIFORNIA / DEPARTMENT OF MENTAL HEALTH, STATE COMPENSATION INSURANCE FUND, PREMIER OUTPATIENT SURGERY CENTER, INC.

The Appeals Board granted reconsideration, rescinded the prior order, and returned the case for further proceedings on the reasonableness of Premier Outpatient Surgery Center's (POSC) $\$16,578.00$ lien claim for surgical services. While POSC was properly licensed as a surgical clinic and did not require a fictitious-name permit, the Appeals Board found the record insufficient to establish the reasonableness of the charged fee, noting a significant disparity between the billed amount and what was paid based on Medicare rates. The Board also rescinded the award of attorney's fees to POSC's counsel, finding no basis for such an award under Labor Code sections 5811 or 5813.

Workers' Compensation Appeals BoardRuby JonesState Compensation Insurance FundPremier Outpatient Surgery Centerfictitious-name permitMedical Board of CaliforniaDepartment of Health Servicessurgical clinic licenseoutpatient settingreasonable fee
References
Case No. RIV 0047694, RIV 0063415 RIV 0063416, RIV 0063417
Regular
Jul 19, 2007

DEADRA FRANKLIN vs. STATE OF CALIFORNIA / DEPARTMENT OF MENTAL HEALTH / PATTON STATE HOSPITAL, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

This case concerns a lien claim by Premier Outpatient Surgery Center for unpaid services. The WCAB rescinded a previous order disallowing the lien due to Premier's lack of a fictitious-name permit, finding that the distinction between providing medical treatment versus an "outpatient setting" was not adequately addressed. The matter is returned to the trial level to determine if Premier, as an outpatient facility, was required to obtain a fictitious-name permit from the Medical Board.

Workers' Compensation Appeals BoardPremier Outpatient Surgery Centerfictitious-name permitBusiness and Professions CodeMedical Boardlien claimantoutpatient facilitycliniclicensureaccreditation
References
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. RIV 047525
Regular
Jan 31, 2008

THERESA CASTELLO vs. STATE OF CALIFORNIA / DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

This case involves a lien claim for facility services provided by Premier Outpatient Surgery Center. The Workers' Compensation Appeals Board rescinded the prior ruling disallowing the lien, finding Premier was properly licensed as a "surgical clinic" by the Department of Health Services and thus not required to possess a fictitious-name permit from the Medical Board. The case is remanded for further proceedings to determine the reasonableness of Premier's billed amount and whether Premier rendered professional services requiring separate licensure.

Workers' Compensation Appeals BoardPremier Outpatient Surgery Centerlien claimantfictitious name permitMedical Board of Californiasurgical clinic licenseDepartment of Health Servicesoutpatient settingfacility feelicensure
References
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
Case No. SBR 0303770 SBR 0313222
Regular
Jun 09, 2008

TIM STOKES vs. STATE OF CALIFORNIA / CALIFORNIA HIGHWAY PATROL, STATE COMPENSATION INSURANCE FUND

The Appeals Board rescinded the prior decision and returned the case for further development of the record on the reasonableness of Premier Outpatient Surgery Center's (POSC) lien claim for services rendered to the applicant. While POSC was correctly deemed licensed and not required to obtain a fictitious-name permit for its outpatient setting services, it bears the burden of proving the reasonableness of its charges. The Appeals Board also found that the award of attorney fees under LC § 5813 was unsupported by the record as no findings of bad faith were made.

Workers' Compensation Appeals BoardState Compensation Insurance FundPremier Outpatient Surgery Centerepidural corticosteroid injectionsfluoroscopic guidancefictitious-name permitMedical Board of CaliforniaDepartment of Health Servicessurgical clinic licenseoutpatient setting
References
Case No. VNO 0396976
Regular
Feb 01, 2008

MARIA MARTINEZ vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, rescinded the prior order, and returned the case to the trial level. The WCJ erred by applying the 2004 Outpatient Surgery Center Fee Schedule; instead, the court must determine a reasonable fee based on the *Kunz* precedent. This requires developing the record to consider factors like the provider's usual fees and geographic area rates, not solely the fee schedule.

KunzSB Surgery Centerlien claimantreasonable feeoutpatient surgery center fee scheduleprima facie evidenceWCJAppeals Boardpermanent disabilityfuture medical treatment
References
Case No. ADJ 4564224
Regular
Sep 17, 2008

MARIA TAPIA vs. SKILL MASTER STAFFING, LIBERTY MUTUAL INSURANCE COMPANY

The Appeals Board affirmed the WCJ's decision on a lien claim for outpatient surgery services, finding the claimant's billing unreasonable despite the defendant's lack of evidence of fees accepted by other surgery centers in the same geographic area.

WCABEn BancLien ClaimantSB Surgery CenterLiberty Mutual Insurance CompanyKunz v. PattersonReasonable ValueOutpatient Surgery CenterBurden of ProofRebuttal Evidence
References
Case No. AHM 074034
Regular
Jul 20, 2007

JAMES C. SKIDMORE vs. STATE OF CALIFORNIA / CALIFORNIA HIGHWAY PATROL, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to determine if Premier Outpatient Surgery Center, Inc. (Premier) met its burden to prove proper licensing and accreditation for its lien claim. The original ruling disallowed the lien because Premier failed to provide a fictitious-name permit from the Medical Board, which was deemed necessary by the administrative law judge. The WCAB rescinded the initial decision and returned the case for further proceedings to fully address whether Premier provided services as a facility or directly as a medical treatment provider requiring specific permits.

Workers' Compensation Appeals BoardPremier Outpatient Surgery CenterMedical Boardfictitious-name permitlicensingaccreditationlien claimantfacility feessurgical clinicStokes v. Patton State Hospital
References
Case No. OAK 263916
Regular
Jun 04, 2008

JEFFREY HONEYWELL vs. SAFEWAY STORES

The Workers' Compensation Appeals Board denied lien claimant Bay Surgery Center's petition for reconsideration, upholding the administrative law judge's decision to award partial payment for medical services. The Board also dismissed Safeway Stores' petition for reconsideration as untimely filed. Additionally, the Board admonished the lien claimant's representative for unprofessional comments made about the judge.

Bay Surgery Centerdiscographypump proceduresitemized billsLabor Code section 4603.2substantial evidencereasonableness of chargespenalty assessmentpenalty for unreasonable delayfictitious name permit
References
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