What the panel ordered
Petition for Reconsideration granted, Findings and Order of October 7, 2024 rescinded, matter returned to WCJ for further proceedings
Petition for Reconsideration granted, Findings and Order of October 7, 2024 rescinded, matter returned to WCJ for further proceedings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 WCJ erred in disallowing the lien for medical-legal services because the lien claimant met its burden to show the services were reasonable and necessary for a contested claim, and the PTP's medical-legal report was valid under Labor Code and regulations. The matter is remanded for further proceedings on the reasonable value of the lien.
From the decision · page 1Lien claimant Medland Medical seeks reconsideration of the Findings and Order (F&O), issued by the workers' compensation administrative law judge (WCJ) on October 7, 2024, wherein the WCJ found in pertinent part that applicant while employed during the period of January 4, 2022 through January 4, 2023, as a caregiver for defendant and claims to have sustained injury arising out of and occurring in the course of employment (AOE/COE) to her neck, back, shoulders, and hernia. The WCJ found that lien claimant failed to meet its burden of proving that its medical treatment and medical-legal services were reasonable or necessary and disallowed its lien.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Defendant denied applicant's claim for cumulative injury on March 8, 2023, creating a contested claim for medical-legal services.
Favours Applicant prevailed
This denial established the existence of a contested claim, making the medical-legal services reasonable and necessary for proving the claim.
From the decision · page 2BACKGROUND We will briefly review the relevant facts. In Case No. ADJ17166141, applicant filed an Application for Adjudication (Application) on January 10, 2023, claiming a cumulative injury to her neck, right shoulder, back, and hernia while employed by defendant as a caregiver, during the period of January 4, 2022 to January 4, 2023. On March 8, 2023, defendant issued a Notice Regarding Denial of Workers Compensation Benefits to applicant denying all liability for her claim of injury to her neck, shoulders, back, and hernia, "... because there is no substantial legal, medical or factual evidence to indicate that your alleged injury for a continuous trauma for dates 1-4-22 to 1-4-23 that may be resulted from your employment at Atria Senior Living." (Exhibit 5, March 8, 2023.) On March 29, 2023, applicant and her attorney designated Omid Haghighinia, D.C., as applicant's primary treating physician (PTP) pursuant to Labor Code section 4600. (Exhibit 2, March 29, 2023.) Also, enclosed was a letter indicating that applicant's attorney intended to seek a medical-legal evaluation from Dr. Haghighinia. (Exhibit 2, March 29, 2023 and Exhibit E, March 29, 2023.) On April 13, 2023, Dr.
Dr. Omid Haghighinia, the applicant's primary treating physician, issued a medical-legal report supporting the claim of industrial injury and need for ongoing care.
Favours Applicant prevailed
The report was requested to prove a contested claim and was found reasonable and necessary, supporting the lien claimant's entitlement to payment.
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 neck, back, shoulders, and hernia from continuous trauma during employment period January 4, 2022 to January 4, 2023, and ongoing medical care was needed.
Dr. Haghighinia's medical-legal report was requested by applicant's attorney to prove a contested claim and was found reasonable and necessary by the Appeals Board.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code sections 4060, 4063.2, 4064, 4600, 4620, 4621, 4622 and California Code of Regulations sections 9785(d), 9793(b)(1), 9793(h)(2) govern medical-legal evaluations and expenses liability.
The Board applied these statutes and regulations to determine that a medical-legal evaluation by a PTP is a medical-legal expense for which the employer is liable if reasonable and necessary.
From the decision · page 10II. Section 4060(b) allows for a medical-legal evaluation by a treating physician and 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 an employer is liable for the cost of any comprehensive medical evaluations authorized under section 4060. The regulations provide that the "primary treating physician shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation..." (Cal. Code Regs., tit. 8, § 9785(d).) AD Rule 9793(h) states: (h) "Medical-legal expense" means any costs or expenses incurred by or on behalf of any party or parties, the administrative director, or the appeals board for X-rays, laboratory fees, other diagnostic tests, medical reports, medical records, medical testimony, and as needed, interpreter's fees, for the purpose of proving or disproving a contested claim. The cost of medical evaluations, diagnostic tests, and interpreters is not a medical-legal expense unless it is incidental to the production of a comprehensive medical-legal evaluation report, follow-up medical-legal evaluation report, or a supplemental medical-legal evaluation report and all of the following conditions exist:
What proof carried it
The evidence the panel weighed, by kind.
Defendant denied applicant's claim for cumulative injury on March 8, 2023, creating a contested claim for medical-legal services.
From the decision · page 2BACKGROUND We will briefly review the relevant facts. In Case No. ADJ17166141, applicant filed an Application for Adjudication (Application) on January 10, 2023, claiming a cumulative injury to her neck, right shoulder, back, and hernia while employed by defendant as a caregiver, during the period of January 4, 2022 to January 4, 2023. On March 8, 2023, defendant issued a Notice Regarding Denial of Workers Compensation Benefits to applicant denying all liability for her claim of injury to her neck, shoulders, back, and hernia, "... because there is no substantial legal, medical or factual evidence to indicate that your alleged injury for a continuous trauma for dates 1-4-22 to 1-4-23 that may be resulted from your employment at Atria Senior Living." (Exhibit 5, March 8, 2023.) On March 29, 2023, applicant and her attorney designated Omid Haghighinia, D.C., as applicant's primary treating physician (PTP) pursuant to Labor Code section 4600. (Exhibit 2, March 29, 2023.) Also, enclosed was a letter indicating that applicant's attorney intended to seek a medical-legal evaluation from Dr. Haghighinia. (Exhibit 2, March 29, 2023 and Exhibit E, March 29, 2023.) On April 13, 2023, Dr.
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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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