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

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The Appeals Board rescinded the prior decision and returned the case for further development of the record on the reasonableness of Premier Outpatient Surgery Center's (POSC) lien claim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. 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The Appeals Board granted reconsideration, rescinded the prior order, and returned the case for further proceedings on the reasonableness of Premier Outpatient Surgery Center's (POSC) $\$16,578.00$ lien claim for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. ANA 0357324
Regular
Aug 20, 2007

ANDRES QUINONES vs. AN'S WORLD SERVICE INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted SCIF's petition for removal to reconsider a prior order regarding a lien claimant's (LC) right to payment. SCIF argued LC lacked standing because it failed to prove it held a required fictitious name permit from the Medical Board, while LC contended it was an "outpatient setting" exempt from such a permit. The Board rescinded the original order and returned the case for the WCJ to determine if LC is an "outpatient setting" or a "clinic" to assess its compliance with licensing and fictitious name requirements.

Workers' Compensation Appeals BoardRemovalLien ClaimantFictitious Name PermitMedical BoardOutpatient SettingClinicLicensureBusiness and Professions CodeStokes v. Patton State Hospital
References
Case No. OAK 0293725
Regular
May 22, 2008

MARGARITA CHAVEZ vs. WESTERN NATIONAL PROPERTIES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded the initial denial of the lien claim by Bay Surgery Center (BSC). BSC's claim for facility fees was initially denied because it allegedly failed to prove it operated as an "outpatient setting" and thus was exempt from needing a fictitious business name permit. The Board found that BSC presented sufficient evidence of its "surgical clinic" license to meet its initial burden, thereby establishing it as an "outpatient setting" for purposes of the lien claim, and remanded the case for further proceedings on the reasonableness of the fees.

Workers' Compensation Appeals BoardLien claimantOutpatient settingFictitious Business Name permitSurgical clinic licenseDepartment of Health ServicesFacility feeMedical BoardLicensed physicianReasonable 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 267164
Regular
Aug 13, 2007

VALERIE ALLEN vs. STATE OF CALIFORNIA / DEPARTMENT OF DEVELOPMENTAL SERVICES / LANTERMAN DEVELOPMENTAL CENTER, STATE COMPENSATION INSURANCE FUND

This case involves a dispute over whether a lien claimant, Premier Outpatient Surgery Center, Inc. (Premier), was properly licensed to provide medical services to the applicant, Valerie Allen. The defendant argues Premier failed to obtain a required fictitious-name permit from the Medical Board. The Appeals Board rescinded the prior finding that Premier was properly licensed and remanded the case for further proceedings to determine compliance with licensure and permit requirements, distinguishing between providing medical treatment and operating as an "outpatient setting."

Workers' Compensation Appeals BoardLien ClaimantFictitious Name PermitMedical BoardBusiness and Professions CodeLicensed ProfessionalOutpatient SettingClinicBurden of ProofLicensure Requirements
References
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
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. SFO 0481476
Regular
Jan 24, 2008

JEANNE MANN vs. AEROVENTURE CLUB, INC., STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration to Marin Surgery Center (MCSC) and rescinded the trial judge's denial of MCSC's lien. The Board found that MCSC, as an "outpatient setting," was not required to obtain a license or fictitious-name permit from the Medical Board. However, the case is returned to the trial level to further address MCSC's accreditation by the AAAASF at the time of the procedure and the reasonableness of its claimed fee.

Workers' Compensation Appeals BoardLien ClaimantMarin Surgery CenterMarin Cosmetic Surgery CenterMedical Board of CaliforniaAAAASFFictitious Name PermitAccreditationOutpatient SettingLicensed
References
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