ADJ3739681 · June 6, 2025

The Board found that a contested claim existed at the time the services were rendered, the expenses were necessary to prove the contested claim, and the services were reasonable and necessary. Therefore, the lien claimant is entitled to payment under Labor Code section 4622, but the amount of payment is deferred to the WCJ.

From the decision · page 6Accordingly, we rescind the F&O and substitute a new F&O that finds that a contested claim existed at the time services were rendered; that the expenses were necessary to prove a contested claim; that the services were reasonable and necessary; and that lien claimant is entitled to payment under section 4622. We award payment, but we defer the issue of the amount of the payment and return the matter to the WCJ to determine the amount of payment, including interest, costs, and penalties.

A contested claim existed at the time the services were rendered, as the defendant continued to dispute liability for benefits throughout the case.

Favours Applicant prevailed

This fact established the lien claimant's initial burden of proof under Labor Code section 4620(a).

From the decision · page 4continued to dispute liability for benefits throughout the pendency of applicant's case. The WCJ conceded that issues such as parts of body were disputed by defendant but concluded that lien claimant had not provided a sufficient "reason" for the purpose of the subpoenas. We disagree with the WCJ's finding as to whether a contested claim existed because the WCJ appears to construe the meaning of "for the purpose of proving or disproving a contested claim" very narrowly. There is nothing in the statutory language that requires that the copy services lien claimant demonstrate "a reason" for each individual subpoena as part of its burden of proof because as explained in Allison, supra, the public policy favoring liberal pre-trial discovery that may reasonably lead to relevant and admissible evidence is applicable in workers' compensation cases. (Id. at p. 663.) Thus, lien claimant met its burden that a contested claim existed pursuant to section 4620.

The subpoenas requested records that had been continually served on the applicant's attorney throughout the case.

Favours Applicant prevailed

Despite this, the Board found the subpoenas were reasonable and necessary for proving the contested claim, contrary to the WCJ's finding.

From the decision · page 5Defendant's Exhibit E1 is 93 pages of transmittal letter indicating that the records in this case had been continually served on the Applicant Attorney throughout this case. There has been no showing that the subpoenas requested records that had not been previously served. If fact, it is the opposite, the subpoenas are for records that had already been served on Applicant Attorney.

The defendant failed to serve a timely and compliant explanation of review within 60 days to object to the medical-legal invoices.

Favours Applicant prevailed

This failure resulted in the defendant waiving objections other than compliance with sections 4620 and 4621, making them liable for payment plus penalties and interest under section 4622.

From the decision · page 6The defendant is deemed to have waived all objections to a medical-legal provider's billing other than compliance with sections 4620 and 4621 if they either fail to serve a timely and compliant explanation of review within 60 days, fail to make payment consistent with the EOR, fail to serve a final written determination after a timely request for second review, or fail to make payment consistent with a final determination. (Cal. Code Regs., tit. 8, § 10786; see Colamonico, supra.) Defendant is then liable for the reasonable value of the medical-legal services, as well as a 10 percent penalty and 7 percent per annum interest. (Lab. Code, § 4622(a)(1)).

Labor Code sections 4620, 4621

A lien claimant must prove that a contested claim existed at the time the expenses were incurred, and that the services were reasonably, actually, and necessarily incurred, under Labor Code sections 4620 and 4621.

The Board applied these standards to find that the lien claimant met its burden of proof for entitlement to payment.

From the decision · page 3(Appeals Board en banc), a lien claimant holds the initial burden of proof pursuant under sections

Labor Code section 4622; Cal. Code Regs., tit. 8, 10786

A defendant must serve a timely and compliant explanation of review within 60 days to object to a medical-legal invoice, or else waive objections other than compliance with sections 4620 and 4621, under Labor Code section 4622 and California Code of Regulations, title 8, section 10786.

The Board noted that the defendant's failure to properly object within 60 days results in liability for the reasonable value of the services plus penalties and interest.

From the decision · page 6The defendant is deemed to have waived all objections to a medical-legal provider's billing other than compliance with sections 4620 and 4621 if they either fail to serve a timely and compliant explanation of review within 60 days, fail to make payment consistent with the EOR, fail to serve a final written determination after a timely request for second review, or fail to make payment consistent with a final determination. (Cal. Code Regs., tit. 8, § 10786; see Colamonico, supra.) Defendant is then liable for the reasonable value of the medical-legal services, as well as a 10 percent penalty and 7 percent per annum interest. (Lab. Code, § 4622(a)(1)).

The lien claimant met its burden to show a contested claim existed at the time the services were rendered, contrary to the WCJ's initial finding.

From the decision · page 4continued to dispute liability for benefits throughout the pendency of applicant's case. The WCJ conceded that issues such as parts of body were disputed by defendant but concluded that lien claimant had not provided a sufficient "reason" for the purpose of the subpoenas. We disagree with the WCJ's finding as to whether a contested claim existed because the WCJ appears to construe the meaning of "for the purpose of proving or disproving a contested claim" very narrowly. There is nothing in the statutory language that requires that the copy services lien claimant demonstrate "a reason" for each individual subpoena as part of its burden of proof because as explained in Allison, supra, the public policy favoring liberal pre-trial discovery that may reasonably lead to relevant and admissible evidence is applicable in workers' compensation cases. (Id. at p. 663.) Thus, lien claimant met its burden that a contested claim existed pursuant to section 4620.

The defendant had continually served the records requested by the subpoenas throughout the case, but this did not negate the reasonableness or necessity of the subpoenas for proving the contested claim.

From the decision · page 5Defendant's Exhibit E1 is 93 pages of transmittal letter indicating that the records in this case had been continually served on the Applicant Attorney throughout this case. There has been no showing that the subpoenas requested records that had not been previously served. If fact, it is the opposite, the subpoenas are for records that had already been served on Applicant Attorney.