ADJ16626738 — California WCAB decision

What the panel ordered

Petition for Reconsideration GRANTED; final decision deferred pending further review of the merits and the record.

Lien claimant sought reconsideration of the WCJ's Findings and Order denying its lien for failure to prove industrial injury and reasonableness/necessity of treatment. WCAB granted reconsideration and deferred a final decision pending further review.

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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.

LiensRemandedhead · back · chest · shoulders · knee · headaches

The WCJ denied the lien for failure to prove industrial injury and reasonableness/necessity of treatment, but the WCAB found the record required further review and development, and that the Compromise and Release's good-faith dispute was not binding on the lien claimant. The WCAB granted reconsideration and deferred a final decision.

From the decision · page 1Lien claimant, FMR Interventional Quality Pain Management, APC, seeks reconsideration of the "Findings and Order" (F&O) issued on December 24, 2025, by the workers' compensation administrative law judge (WCJ). The WCJ found, in pertinent part, that lien claimant failed its burden to prove industrial injury and to prove reasonableness and necessity of its treatment and ordered lien claimant to take nothing on its lien.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

The Compromise and Release's stipulation as to a good-faith dispute between applicant and defendant is not binding on the lien claimant, as the lien claimant was not a party to the settlement.

Favours Applicant prevailed

This fact allowed the WCAB to disregard the WCJ's reliance on the C&R's good-faith dispute stipulation in denying the lien, supporting reconsideration and further review.

From the decision · page 6seeking settlement approval. (Cal. Code Regs., tit. 8, § 10789(b)(1), ["[A]ll supporting medical reports and other supporting documents not previously filed, shall be filed directly with the workers' compensation judge at the date and time of the walk-through[.]"]; Cal. Code Regs., tit. 8, § 10700(a), ["When filing a Compromise and Release or a Stipulations with Request for Award, the filing party shall file all agreed medical evaluator reports, qualified medical evaluator reports, treating physician reports, and any other that are relevant to a determination of the adequacy of the Compromise and Release or Stipulations with Request for Award that have not been filed previously."].) None of the medical records, which existed at the time of the Compromise and Release appear to have been filed for review when the settlement was submitted. This includes medical records indicating that applicant uses a walker. It is unclear why the parties failed to file any medical records for the WCJ to review when determining whether the proposed settlement in this matter was adequate. In any event, the stipulation between applicant and defendant as to a good-faith dispute is not binding upon lien claimant as they were not a party to the Compromise and Release.

No testimony or evidence contradicted applicant's reported mechanism of injury in the record; arguments are not evidence.

Favours Applicant prevailed

This fact undermined the WCJ's finding that applicant's statements were unreliable and supported the need for further review of the record.

From the decision · page 6Contrary to the WCJ's conclusion, the documentary evidence does not appear to create a dispute as to applicant's reported mechanism of injury. No testimony was submitted by either party contradicting the paper record. We could find no statement or testimony in the record contradicting applicant's version of events. To the extent that defendant argues that applicant's description of injury is not reliable, arguments are not evidence. (See Hamilton v. Lockheed Corporation (2001) 66 Cal. Comp. Cases 473 (Appeals Board en banc).)

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Kunz v. Patterson Floor Company, Inc. (2002) 67 Cal.Comp.Cases 1588 (en banc); Tapia v. Skill Master Staffing (2008) 73 Cal.Comp.Cases 1338 (en banc)

Lien claimant must prove by a preponderance of the evidence all elements necessary to establish its lien, including industrial injury in a denied case.

Applied to require lien claimant to prove industrial injury and reasonableness/necessity of treatment for entitlement to payment.

From the decision · page 4II. We highlight several legal principles that may be relevant to our review of this matter. When a lien claimant is litigating the issue of entitlement to payment for industrially-related medical treatment, the lien claimant must prove by a preponderance of the evidence all of the elements necessary to the establishment of its lien, including establishing that applicant sustained an industrial injury in a denied case. (Kunz v. Patterson Floor Company, Inc. (Kunz) (2002) 67 Cal.Comp.Cases 1588 (Appeals Bd. en banc); see also, Tapia v. Skill Master Staffing (2008) 73 Cal.Comp.Cases 1338 (Appeals Bd. en banc).)

Lab. Code § 3600; South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291

Employer is liable for workers' compensation benefits only if employee sustains an injury arising out of and in the course of employment; connection between work and injury must be a contributing cause.

Applied to determine whether applicant's injury was industrial.

From the decision · page 5Section 3600 imposes liability on an employer for workers' compensation benefits only if its employee sustains an injury "arising out of and in the course of employment." It is sufficient if the connection between work and the injury is a contributing cause of the injury. (South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 298 [188 Cal. Rptr. 3d 46, 349 P.3d 141, 80 Cal.Comp.Cases 489].) An employee necessarily acts within the "course of employment" when "performing a duty imposed upon him by his employer and one necessary to perform before the terms of the contract [are] mutually satisfied." (Maher v. Workers' Comp. Appeals Bd. (1983) 33 Cal.3d 729 [190 Cal. Rptr. 904, 661 P.2d 1058, 48 Cal.Comp.Cases 326, 328].)

E.L. Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (en banc); Zemke v. Workmen's Comp. Appeals Bd. (1968) 68 Cal. 2d 794; Hegglin v. Workmen's Comp. Appeals Bd.

Substantial medical evidence must be based on reasonable medical probability, accurate history, examination, and reasoning; not on speculation or incorrect legal theory.

Applied to evaluate whether medical reporting constituted substantial evidence of industrial causation.

From the decision · page 5Lien claimant has the burden of proving reasonable probability of industrial causation based on substantial medical evidence. To be substantial evidence, expert medical opinion must be framed in terms of reasonable medical probability, be based on an accurate history and an examination, and set forth reasoning to support the expert conclusions reached. (E.L. Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).) "A medical report predicated upon an incorrect legal theory and devoid of relevant factual basis, as well as a medical opinion extended beyond the range of the physician's expertise, cannot rise to a higher level than its own inadequate premises." (Zemke v. Workmen's Comp. Appeals Bd. (1968) 68 Cal. 2d 794 [69 Cal. Rptr.

ADJ16626738 · March 30, 2026

What the panel ordered

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