What the panel treated as outcome-determinative, and which side it favoured.
WCJ found no substantial medical evidence to sustain a finding of injury to the psyche and disallowed the lien of Nogales Psychological Counseling, Inc.
Favours Defendant prevailed
This finding was the basis for disallowing the lien and denying treatment charges, but was challenged on reconsideration.
From the decision · page 51. the applicant born on [ ] while employed on 01/22/2004
as a library aide at North Hollywood, California, by Los Angeles Unified School
District, claimed to have sustained injury arising out of and occurring in the course
of employment to her head, neck upper extremities, shoulders, bilateral lower
extremities, psyche, cardiovascular system and dental.
2. Accordingly Defendant's Exhibits A through K are admitted in evidence herein.
3. There is no substantial medical evidence to sustain a finding of injury to the
psyche.
4. The lien of Nogales Psychological is disallowed.
5. In light of the foregoing there is no basis to award statutory increase and interest
or reimbursement of the filing fee.
All reporting physicians found industrial causation for applicant's psychological injury but differed on apportionment of resulting disability.
Favours neutral
This conflicting medical evidence created a dispute over causation and apportionment, leading to reconsideration.
From the decision · page 7Judge Carrero indicates that the lien claimant cannot meet it[s] burden of
proof as to psyche injury due to the differing opinions as to the percentage of
causation assigned by different providers. The interesting thing in this particular
matter is that all physicians find industrial injury. The question is not if the
employment contributed to the cause of the psychological injury, rather to what
degree.
Defendant denied injury to the psyche, making applicant entitled to self-procure psychiatric treatment and medical-legal expenses were reasonably incurred to prove or disprove the contested claim.
Favours Applicant prevailed
This justified reconsideration of the lien claim and medical-legal expenses under Labor Code sections 4620 and 4621.
From the decision · page 8The expenses at issue are medical-legal expenses within the meaning of
Labor Code § 4620 and § 4621 because they were reasonably, actually, and
necessarily incurred for the purpose of proving or disproving a contested claim. As
indicated above, Defendant's denied the Applicant's psyche component to her
injury. Medical-Legal expenses are "any costs or expenses incurred by or on behalf
of any party, the administrative director, or the board...for the purpose of proving
or disproving a contested claim". LC§ 4620(a); see also CCR§ 9793. Defendants are
liable for medical-legal expenses that are "reasonably, actually, and necessarily
incurred"LC§ 4621(a). "The reasonableness of and necessity for, incurring these
expenses shall be determined with respect to the time when the expenses were
actually incurred.