Updated Daily

Case Law Database

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

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The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award, remanding the case to the trial level.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. 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. 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The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case to the trial level for further proceedings.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. SDO 313688

Regular

May 06, 2008

CRESENCIO BARRERA vs. HNR FRAMING, AMERICAN HOME ASSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded a prior decision because the administrative law judge (WCJ) failed to apply the *Kunz* standard for determining reasonable facility fees for medical services. The WCJ's decision was found to be internally inconsistent and unsupported by the evidence, particularly regarding the consideration of contractually negotiated rates and usual fees accepted by other providers. The case is remanded for further proceedings and a new decision by a different WCJ.

WCABReconsiderationFacility FeesCPT CodesReasonablenessKunz v. PattersonAmbulatory Surgery CenterMedicareOfficial Medical Fee ScheduleGeographical Area

References

Case No. ADJ2579439 (VNO 0448908)

Regular

Dec 04, 2008

HAYLEY PURECE vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board denied the lien claimant's petition for reconsideration, upholding the administrative law judge's award of $7,500 for facility fees and $1,189.73 per procedure. The Board found that the lien claimant failed to meet its burden of proving its charges were reasonable, while the defendant provided persuasive evidence suggesting the billed amount was excessive. Consequently, the WCAB affirmed the WCJ's decision to rely on the defendant's evidence to determine reasonable compensation.

Lien ClaimantFacility FeeProcedure FeePetition for ReconsiderationKunzTapiaReasonableness of FeeGeographic AreaOutpatient Surgery CenterAmbulatory Surgical Centers

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. GOL 0090664, GOL 0090665

Regular

Jul 14, 2008

CLIAZAR CARDENAS vs. WEST COAST HARVESTING, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, rescinding the prior award to the lien claimant for outpatient surgery center fees and anesthesiology. The Board found that the lien claimant bore the burden to prove the reasonableness of its charges, and the WCJ erred in favoring the lien claimant's evidence over the defendant's rebuttal evidence. The matter is remanded for further proceedings to determine a reasonable fee based on all evidence presented.

WCABSCIFlien claimantreasonableness of chargesoutpatient surgery center feeanesthesiologist feesOMFSKunz v. Patterson Floor Coveringfacility feebill reviewer testimony

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. ANA 0390307

Regular

Jul 24, 2007

MARCIA HOELKER vs. SADDLEBACK VALLEY UNIFIED SCHOOL DISTRICT, KEENAN & ASSOCIATES

The Appeals Board reconsidered the WCJ's award to a lien claimant for surgical facility charges. The Board found the lien claimant's initial billing of $12,225 was not fully reasonable. Consequently, the Board modified the award to $7,440, less amounts already paid by the defendant, and denied penalty and interest.

Workers Compensation Appeals BoardPetition for ReconsiderationLien ClaimantFacility FeesReasonableness of ChargesKunz v. Patterson Floor CoveringsOfficial Medical Fee ScheduleBurden of ProofComparative StudyUsual Fee

References

Case No. MON 0304414

Regular

Sep 17, 2007

SHEENA WILSON vs. BEVERLY HILLS, LTD., THE ZENITH

This case involves a lien claimant, Wilshire Surgicenter, Inc., challenging a Workers' Compensation Appeals Board (WCAB) decision that limited their recovery for outpatient services. The WCAB granted reconsideration solely to correct the lien claimant's name, affirming the administrative law judge's (ALJ) finding that the reasonable value of the services was $3,843.74, despite the invoiced amount of $19,165.00. The WCAB determined that while the fee schedule implemented after the services were rendered did not directly apply, it served as relevant evidence for determining the reasonableness of the facility fee.

Wilshire SurgicenterOutpatient Surgical Facility Fee SchedulePetition for ReconsiderationFindings of FactOrderCompromise and Releasecumulative injuryreasonable valuefacility feeWCJ

References

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Updated Daily

Case Law Database

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

Case No. LAO 0832662

Regular

Mar 18, 2008

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

References

Case No. FRE 0222651

Regular

Jul 15, 2008

CHRISTOPHER HUNT vs. MADERA COUNTY ROAD DEPARTMENT

KunzOfficial Medical Fee Scheduleoutpatient surgery facility feeslien claimantreconsiderationen banc decisionreasonableness of feesusual feegeographical areacontractually negotiated fees

References

Case No. LAO 0807776

Regular

Jan 08, 2008

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

References

Case No. SDO 313688

Regular

May 06, 2008

CRESENCIO BARRERA vs. HNR FRAMING, AMERICAN HOME ASSURANCE COMPANY

WCABReconsiderationFacility FeesCPT CodesReasonablenessKunz v. PattersonAmbulatory Surgery CenterMedicareOfficial Medical Fee ScheduleGeographical Area

References

Case No. ADJ2579439 (VNO 0448908)

Regular

Dec 04, 2008

HAYLEY PURECE vs. CITY OF LOS ANGELES

Lien ClaimantFacility FeeProcedure FeePetition for ReconsiderationKunzTapiaReasonableness of FeeGeographic AreaOutpatient Surgery CenterAmbulatory Surgical Centers

References

Case No. ADJ4673406 (ANA 0403334) ADJ4233924 (ANA 0376527)

Regular

Sep 29, 2009

Joseph Vella vs. Hitchcock Automotive, State Compensation Insurance Fund

Kunz doctrinelien claimantreasonable feerebuttal evidenceTapiabillingmedical treatmentoutpatient surgeryinpatient hospitalDRG

References

Case No. GOL 0090664, GOL 0090665

Regular

Jul 14, 2008

CLIAZAR CARDENAS vs. WEST COAST HARVESTING, STATE COMPENSATION INSURANCE FUND

WCABSCIFlien claimantreasonableness of chargesoutpatient surgery center feeanesthesiologist feesOMFSKunz v. Patterson Floor Coveringfacility feebill reviewer testimony

References

Case No. ADJ2340102 (LAO 0751270) ADJ4406096 (LAO 0784412)

Regular

Apr 27, 2017

JOSE MORFIN vs. WHITE MEMORIAL MEDICAL CENTER, ADVENTIST HEALTH

References

Case No. ANA 0390307

Regular

Jul 24, 2007

MARCIA HOELKER vs. SADDLEBACK VALLEY UNIFIED SCHOOL DISTRICT, KEENAN & ASSOCIATES

References

Case No. MON 0304414

Regular

Sep 17, 2007

SHEENA WILSON vs. BEVERLY HILLS, LTD., THE ZENITH

Wilshire SurgicenterOutpatient Surgical Facility Fee SchedulePetition for ReconsiderationFindings of FactOrderCompromise and Releasecumulative injuryreasonable valuefacility feeWCJ

References

Showing 1-10 of 2,601 results

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