Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, §§ 4600(a), 4903(b); Kunz v. Patterson Floor Coverings (2002) 67 Cal.Comp.Cases 1588, 1593 (en banc)
A lien for medical treatment is allowable only when the treatment rendered is reasonably required to cure or relieve an injured worker from the effects of an industrial injury. A defendant will not be liable for a medical treatment where there is no industrial injury.
Applied to deny lien for medical treatment where no industrial injury was found.
From the decision · page 2A lien for medical treatment is allowable only when the treatment rendered is reasonably
required to cure or relieve an injured worker from the effects of an industrial injury. (Lab. Code,
§ 4600(a), 4903(b).) A defendant will not be liable for a medical treatment where there is no
industrial injury. (Kunz v. Patterson Floor Coverings (2002) 67 Cal.Comp.Cases 1588, 1593
(en banc).) Therefore, where a lien claimant, rather than the injured worker, litigates the issue of
entitlement to payment for industrially-related medical treatment, the lien claimant stands in the
shoes of the injured worker and the lien claimant must establish injury by preponderance of
evidence. (Kaiser Foundation Hospitals v. Workers' Comp. Appeals Bd. (Martin) (1985) 39 Cal.3d
57, 67 [50 Cal.Comp.Cases 411]; Kunz, supra, 67 Cal.Comp.Cases at p. 1592.)
Kaiser Foundation Hospitals v. Workers' Comp. Appeals Bd. (Martin) (1985) 39 Cal.3d 57, 67 [50 Cal.Comp.Cases 411]; Kunz, supra, 67 Cal.Comp.Cases at p. 1592.
Lien claimant must establish injury by preponderance of evidence when litigating entitlement to payment for industrially-related medical treatment.
Applied to require lien claimant to prove industrial injury to recover on lien.
From the decision · page 2A lien for medical treatment is allowable only when the treatment rendered is reasonably
required to cure or relieve an injured worker from the effects of an industrial injury. (Lab. Code,
§ 4600(a), 4903(b).) A defendant will not be liable for a medical treatment where there is no
industrial injury. (Kunz v. Patterson Floor Coverings (2002) 67 Cal.Comp.Cases 1588, 1593
(en banc).) Therefore, where a lien claimant, rather than the injured worker, litigates the issue of
entitlement to payment for industrially-related medical treatment, the lien claimant stands in the
shoes of the injured worker and the lien claimant must establish injury by preponderance of
evidence. (Kaiser Foundation Hospitals v. Workers' Comp. Appeals Bd. (Martin) (1985) 39 Cal.3d
57, 67 [50 Cal.Comp.Cases 411]; Kunz, supra, 67 Cal.Comp.Cases at p. 1592.)
Honeywell v. Workers' Comp. Appeals Bd. (2005) 35 Cal.4th 24, 29 [70 Cal.Comp.Cases 97]
The 90 day period to deny a claim runs only from the date the worker files a claim form with the employer.
Applied to reject presumption of compensability where no evidence of claim form filing date was introduced.
From the decision · page 2If lien claimant intended to rely on an argument that the injury was presumed
compensable, lien claimant needed to introduce evidence of defendant's late denial including a
claim form. The 90 day period to deny a claim "runs only from the date the worker files a claim
form with the employer." (Honeywell v. Workers' Comp. Appeals Bd. (2005) 35 Cal.4th 24, 29
Lab. Code, § 4064(a)
The employer shall be liable for the cost of each reasonable and necessary comprehensive medical-legal evaluation obtained by the employee pursuant to Sections 4060, 4061, and 4062.
Applied to determine whether the evaluation qualified as a compensable medical-legal evaluation.
From the decision · page 3"The employer shall be liable for the cost of each reasonable and necessary comprehensive
medical-legal evaluation obtained by the employee pursuant to Sections 4060, 4061, and 4062."
(Lab. Code, § 4064(a).) Section 4060 addresses comprehensive medical-legal evaluations where
no body parts have been accepted and permits evaluations by a treating physician, a qualified
medical evaluator (QME) or an agreed medical evaluator (AME). Section 4061 addresses
medical-legal evaluations to determine the amount of permanent disability and allows the parties
to obtain an AME or a QME after "either the employee or employer objects to a medical
determination made by the treating physician." (Lab. Code, § 4061(b) and (c).) Section 4062
addresses medical-legal evaluations to determine medical treatment issues where the utilization
review/ independent medical review process does not apply.