What the panel ordered
Petition for reconsideration denied; lien claimant takes nothing on the lien.
Lien claimant filed a timely petition for reconsideration of the WCJ's Findings and Order denying the lien, but the Appeals Board failed to act within 60 days due to administrative error, leading to equitable tolling of the time to act on the petition.
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.
Lien claimant failed to prove that the treatment rendered was within the nature and extent of the accepted injury and failed to prove the reasonableness and necessity of the treatment, thus failing to meet its burden of proof.
From the decision · page 5II. A lien claimant has a duty to know or discover the facts regarding the compensability of its lien prior to submitting its lien for trial. (Cal. Code. Regs., tit. 8, § 10880(a)(1).) Here, the WCJ denied lien claimant's recovery on the grounds that lien claimant failed to prove causation of injury. In its petition, lien claimant correctly points out that causation of injury was stipulated. However, lien claimant fails to recognize two important elements to its burden of proof. First, defendant disputed the nature and extent of injury. (Lien Claimant's Exhibit 2.) Causation was stipulated as to a head laceration only. (Ibid.) Lien claimant argues that all treatment rendered in its emergency room was industrial. However, arguments are not evidence. (Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal. Comp. Cases 473, 476 (Appeals Board en banc).) Where liability is disputed, lien claimant was required to establish that its treatment was encompassed within the nature and extent of injury. Absent such evidence, lien claimant failed to meet its burden of proof.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Causation was stipulated only for a head laceration injury, not for all treatment rendered by lien claimant.
Favours Defendant prevailed
Lien claimant failed to prove treatment was within the nature and extent of the accepted injury, failing burden of proof.
From the decision · page 5II. A lien claimant has a duty to know or discover the facts regarding the compensability of its lien prior to submitting its lien for trial. (Cal. Code. Regs., tit. 8, § 10880(a)(1).) Here, the WCJ denied lien claimant's recovery on the grounds that lien claimant failed to prove causation of injury. In its petition, lien claimant correctly points out that causation of injury was stipulated. However, lien claimant fails to recognize two important elements to its burden of proof. First, defendant disputed the nature and extent of injury. (Lien Claimant's Exhibit 2.) Causation was stipulated as to a head laceration only. (Ibid.) Lien claimant argues that all treatment rendered in its emergency room was industrial. However, arguments are not evidence. (Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal. Comp. Cases 473, 476 (Appeals Board en banc).) Where liability is disputed, lien claimant was required to establish that its treatment was encompassed within the nature and extent of injury. Absent such evidence, lien claimant failed to meet its burden of proof.
Lien claimant provided no evidence that the treatment rendered was reasonable and necessary to cure or relieve the effects of the industrial injury.
Favours Defendant prevailed
Without such evidence, lien claimant failed to meet burden of proof on reasonableness and necessity of treatment.
From the decision · page 6Second, even where a claim is accepted, lien claimant must prove that the treatment rendered was reasonable and necessary to cure or relieve from the effects of the industrial injury. (Lab. Code4, § 4600, 4610.5(c)(2); 5705.) Lien claimant provided no evidence as to the reasonableness of the treatment rendered. Lien claimant could have submitted the treatment it provided as a request for authorization of retrospective medical treatment. (§ 4610, 4610.5; Cal. Code Regs., tit. 8, § 9792.9.1.) Then defendant could have either approved the treatment, or submitted it for retrospective utilization review. This did not happen. Furthermore, lien claimant submitted no other medical reports establishing the reasonableness and necessity of the treatment rendered. Instead, it appears that lien claimant simply sent its billing to defendant on the assumption that reasonableness was not in dispute. (Lien Claimant's Exhibit 1.) Defendant responded to the billing by denying liability to all body parts outside of a head laceration. At that point, lien claimant was on notice that a dispute existed and should have obtained evidence to establish its burden of proof.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Cal. Code Regs., tit. 8, 10880(a)(1)
Lien claimant has a duty to know or discover facts regarding compensability of its lien prior to trial.
Lien claimant failed to meet burden of proof on causation and reasonableness of treatment.
From the decision · page 5II. A lien claimant has a duty to know or discover the facts regarding the compensability of its lien prior to submitting its lien for trial. (Cal. Code. Regs., tit. 8, § 10880(a)(1).) Here, the WCJ denied lien claimant's recovery on the grounds that lien claimant failed to prove causation of injury. In its petition, lien claimant correctly points out that causation of injury was stipulated. However, lien claimant fails to recognize two important elements to its burden of proof. First, defendant disputed the nature and extent of injury. (Lien Claimant's Exhibit 2.) Causation was stipulated as to a head laceration only. (Ibid.) Lien claimant argues that all treatment rendered in its emergency room was industrial. However, arguments are not evidence. (Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal. Comp. Cases 473, 476 (Appeals Board en banc).) Where liability is disputed, lien claimant was required to establish that its treatment was encompassed within the nature and extent of injury. Absent such evidence, lien claimant failed to meet its burden of proof.
Lab. Code 4600, 4610.5(c)(2), 5705
Treatment must be reasonable and necessary to cure or relieve effects of industrial injury.
Lien claimant provided no evidence of reasonableness and necessity of treatment rendered.
From the decision · page 6Second, even where a claim is accepted, lien claimant must prove that the treatment rendered was reasonable and necessary to cure or relieve from the effects of the industrial injury. (Lab. Code4, § 4600, 4610.5(c)(2); 5705.) Lien claimant provided no evidence as to the reasonableness of the treatment rendered. Lien claimant could have submitted the treatment it provided as a request for authorization of retrospective medical treatment. (§ 4610, 4610.5; Cal. Code Regs., tit. 8, § 9792.9.1.) Then defendant could have either approved the treatment, or submitted it for retrospective utilization review. This did not happen. Furthermore, lien claimant submitted no other medical reports establishing the reasonableness and necessity of the treatment rendered. Instead, it appears that lien claimant simply sent its billing to defendant on the assumption that reasonableness was not in dispute. (Lien Claimant's Exhibit 1.) Defendant responded to the billing by denying liability to all body parts outside of a head laceration. At that point, lien claimant was on notice that a dispute existed and should have obtained evidence to establish its burden of proof.
Hamilton v. Lockheed Corporation (2001) 66 Cal. Comp. Cases 473
Arguments are not evidence; burden of proof requires evidence.
Lien claimant's argument that all treatment was industrial was rejected for lack of evidence.
From the decision · page 5II. A lien claimant has a duty to know or discover the facts regarding the compensability of its lien prior to submitting its lien for trial. (Cal. Code. Regs., tit. 8, § 10880(a)(1).) Here, the WCJ denied lien claimant's recovery on the grounds that lien claimant failed to prove causation of injury. In its petition, lien claimant correctly points out that causation of injury was stipulated. However, lien claimant fails to recognize two important elements to its burden of proof. First, defendant disputed the nature and extent of injury. (Lien Claimant's Exhibit 2.) Causation was stipulated as to a head laceration only. (Ibid.) Lien claimant argues that all treatment rendered in its emergency room was industrial. However, arguments are not evidence. (Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal. Comp. Cases 473, 476 (Appeals Board en banc).) Where liability is disputed, lien claimant was required to establish that its treatment was encompassed within the nature and extent of injury. Absent such evidence, lien claimant failed to meet its burden of proof.
What proof carried it
The evidence the panel weighed, by kind.
Lien claimant failed to provide evidence of causation for treatment beyond the accepted head laceration injury and failed to prove reasonableness and necessity of treatment.
From the decision · page 5II. A lien claimant has a duty to know or discover the facts regarding the compensability of its lien prior to submitting its lien for trial. (Cal. Code. Regs., tit. 8, § 10880(a)(1).) Here, the WCJ denied lien claimant's recovery on the grounds that lien claimant failed to prove causation of injury. In its petition, lien claimant correctly points out that causation of injury was stipulated. However, lien claimant fails to recognize two important elements to its burden of proof. First, defendant disputed the nature and extent of injury. (Lien Claimant's Exhibit 2.) Causation was stipulated as to a head laceration only. (Ibid.) Lien claimant argues that all treatment rendered in its emergency room was industrial. However, arguments are not evidence. (Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal. Comp. Cases 473, 476 (Appeals Board en banc).) Where liability is disputed, lien claimant was required to establish that its treatment was encompassed within the nature and extent of injury. Absent such evidence, lien claimant failed to meet its burden of proof.
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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.
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