What the panel ordered
July 29, 2024 Findings and Order rescinded; matter returned to trial level for further proceedings consistent with this opinion.
Petition for reconsideration of the July 29, 2024 Findings and Order granted; matter returned to WCJ for further proceedings.
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The WCAB found that the lien claimant met the burden to show a contested claim existed and that the medical-legal report by Dr. Haghighinia was relevant to proving the cumulative injury claim. The WCAB also found that the issue of whether the medical-legal expenses and treatment were reasonable and necessary must be considered by the WCJ in the first instance. The WCAB granted reconsideration and remanded the matter for further proceedings.
From the decision · page 5On December 8, 2022, Medland Medical filed a lien on behalf of Dr. Haghighinia. On July 11, 2024, lien claimant and defendant proceeded to trial. The issues in dispute were: 1. Parts of the body injured: Lumbar spine, neck, left wrist, left hand, left knee, left index and middle fingers;
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant's attorney designated Dr. Haghighinia as Primary Treating Physician on February 15, 2022, and Dr. Haghighinia issued a medical-legal report on March 7, 2022, addressing the cumulative injury claim.
Favours Applicant prevailed
This report was considered substantial evidence of a contested claim and causation, supporting the lien claimant's entitlement to medical-legal expenses.
From the decision · page 8Here, on January 14, 2022, applicant filed an amended Application claiming a cumulative injury from April 1, 2011 to October 15, 2021. Also on January 14, 2022, defendant denied liability for applicant's claimed injury of "October 13, 2021."4 On March 7, 2022, PTP, Dr. Haghighina, examined applicant and issued a medical-legal report for the purpose of proving applicant's cumulative injury claim. Moreover, on October 24, 2024, the parties entered into a C&R, which stated that "There is a serious and legitimate dispute regarding AOE/COE." Based on the record before us, we believe that lien claimant met its burden to show that the claim is a "contested claim," however, again we will return the matter to the WCJ to consider in the first instance. As explained above, once lien claimant has met its burden of proof pursuant to sections 4620 and 4621, and the analysis then shifts to the reasonable value of the services pursuant to section 4622.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Applicant sustained industrially related injuries to left shoulder, lumbar spine, and left knee with pain radiating to hand and fingers; ongoing medical care needed; causation linked to cumulative trauma from April 1, 2011 to October 15, 2021; job duties involved heavy lifting and repetitive concrete finishing tasks.
The medical-legal report was issued pursuant to Labor Code sections and California Code of Regulations, addressing disputed medical facts and proving the contested claim; the report was considered substantial evidence relevant to the cumulative injury claim.
From the decision · page 2Haghighinia examined applicant and issued a medical-legal report for applicant's claimed injury of April 1, 2011 to October 15, 2021. (Lien Claimant's Exhibit 6, 3/7/2022.) The report is addressed to applicant's attorney and defendant American Claims Management. The report begins by saying that: This Medical-Legal report is issued pursuant to Labor Code § 4620, et seq. and 5307.6, and California Code of Regulations § 9793(c)(2), which defines a comprehensive medical- legal evaluation as an evaluation of an injured worker which results in the preparation of a narrative medical report, and is performed by the primary treating physician for the purpose of proving or disproving a
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code Sections 4060, 4064
Employer is liable for reasonable and necessary medical-legal reports performed by the treating physician under Labor Code sections 4060 and 4064.
The Board held that a medical-legal evaluation by the treating physician is a medical-legal expense for which the employer is liable, consistent with prior en banc authority.
From the decision · page 7Section 4060(b) allows a medical-legal evaluation by the treating physician. Section 4620(a) defines medical-legal expense as "any costs and expenses...for the purpose of proving or disproving a contested claim." Section 4064(a) provides that the employer is liable for the cost of a comprehensive medical evaluation that is authorized by section 4060.
What proof carried it
The evidence the panel weighed, by kind.
Medical-legal report by Dr. Haghighinia establishing contested claim and causation for cumulative injury claim
From the decision · page 8Here, on January 14, 2022, applicant filed an amended Application claiming a cumulative injury from April 1, 2011 to October 15, 2021. Also on January 14, 2022, defendant denied liability for applicant's claimed injury of "October 13, 2021."4 On March 7, 2022, PTP, Dr. Haghighina, examined applicant and issued a medical-legal report for the purpose of proving applicant's cumulative injury claim. Moreover, on October 24, 2024, the parties entered into a C&R, which stated that "There is a serious and legitimate dispute regarding AOE/COE." Based on the record before us, we believe that lien claimant met its burden to show that the claim is a "contested claim," however, again we will return the matter to the WCJ to consider in the first instance. As explained above, once lien claimant has met its burden of proof pursuant to sections 4620 and 4621, and the analysis then shifts to the reasonable value of the services pursuant to section 4622.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
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