ADJ8948890 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied; WCJ's disallowance of lien affirmed.

Lien claimant Reliable Medical Supply petitioned for reconsideration of the WCJ's July 24, 2025 Findings and Order disallowing its lien for medical treatment services.

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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.

LiensDefendant prevailedlow back

Lien claimant failed to prove by a preponderance of the evidence that the medical treatment services provided were reasonable and necessary, as required by Labor Code and Board precedent. No evidence was submitted showing the treatment was supported by MTUS or other guidelines.

From the decision · page 6Accordingly, we agree with the WCJ that lien claimant did not meet its burden to prove that the medical treatment services provided to applicant were reasonable and necessary. As such, we deny lien claimant's Petition for Reconsideration.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Lab. Code §§ 4600, 4610.5(c)(2), 5705; Kunz v. Patterson Floor Coverings, Inc. (2002) 67 Cal.Comp.Cases 1588 (en banc); Tapia v. Skill Masters Staffing (2008) 73 Cal.Comp.Cases 1338 (en banc)

Lien claimant must prove by preponderance of the evidence all elements necessary to establish its lien, including that the treatment was reasonable and necessary.

Applied to require Reliable Medical Supply to prove the necessity and reasonableness of the medical treatment provided.

From the decision · page 5Turning now to the merits of the Petition, it is well established that "[w]here a lien claimant (rather than the injured employee) is litigating the issue of entitlement to payment for industrially- related medical treatment, the lien claimant stands in the shoes of the injured employee and the lien claimant must prove by preponderance of the evidence all of the elements necessary to the establishment of its lien." (Kunz v. Patterson Floor Coverings, Inc. (2002) 67 Cal.Comp.Cases 1588, 1592 (Appeals Bd. en banc).) Section 5705 provides that "[t]he burden of proof rests upon the party or lien claimant holding the affirmative of the issue." Accordingly, the lien claimant carries the "affirmative burden of proving that its lien is reasonable, and it must carry this burden by a preponderance of the evidence. (Lab. Code, § 5705; 3202.5; Tapia v. Skill Masters Staffing (2008) 73 Cal.Comp.Cases 1338, 1342§ 1343 (Appeals Bd. en banc).)

Lab. Code §§ 4600(b), 5307.27, 4604.5(a); Cal. Code Regs., tit. 8, §§ 9792.20 et seq., 9792.21(c)-(d)

Medical treatment must be based on guidelines adopted by the administrative director (MTUS) and is presumptively correct; may be rebutted in limited situations.

Applied to evaluate whether Dr. Shah's prescription was supported by MTUS or other evidence-based guidelines.

From the decision · page 6Further, pursuant to section 4600(b), "medical treatment that is reasonably required to cure or relieve the injured worker from the effects of the worker's injury means treatment that is based upon the guidelines adopted by the administrative director pursuant to Section 5307.27." (Lab. Code, § 4600(b); see also Lab. Code, § 4610.5(c)(2) [defining "medically necessary" and "medical necessity" as treatment based on certain standards].) Section 5307.27 specifies that these guidelines refer to the medical treatment utilization schedule (MTUS). (Lab. Code, § 5307.27(a); see also Cal. Code Regs., tit. 8, § 9792.20 et seq.) The MTUS is presumptively correct on the extent and scope of treatment and is the primary source of guidance for physicians. (Lab. Code, § 4604.5(a); Cal. Code Regs., tit. 8, § 9792.21(c).) The MTUS, however, may be rebutted, and treatment may be warranted based on recommendations outside the MTUS in limited situations. (Cal. Code Regs., tit. 8, § 9792.21(d); see also Lab. Code, § 4604.5(d).)

What proof carried it

The evidence the panel weighed, by kind.

expert methodologyfavours Defendant prevailed

Dr. Shah's May 10, 2013 report and prescription did not include citations to MTUS or other evidence-based guidelines supporting the need for the LSO brace.

From the decision · page 6Here, in contravention to section 5307.27, Dr. Shah's May 10, 2013 report (Lien Claimant Exhibit 6) and corresponding prescription (Lien Claimant Exhibit 2), do not include citations to the MTUS or other evidence-based treatment guidelines which support the need for the specified treatment. Further, there are no other medical reports in the evidentiary record which support the need for the LSO brace or any other medical treatment requested by Dr. Shah during applicant's May 10, 2013 visit.

Medical recordsfavours Defendant prevailed

No other medical reports in the evidentiary record supported the need for the LSO brace or other medical treatment requested by Dr. Shah.

From the decision · page 6Here, in contravention to section 5307.27, Dr. Shah's May 10, 2013 report (Lien Claimant Exhibit 6) and corresponding prescription (Lien Claimant Exhibit 2), do not include citations to the MTUS or other evidence-based treatment guidelines which support the need for the specified treatment. Further, there are no other medical reports in the evidentiary record which support the need for the LSO brace or any other medical treatment requested by Dr. Shah during applicant's May 10, 2013 visit.

Other evidencefavours Defendant prevailed

Lien claimant was offered a continuance to address the necessity issue but declined and proceeded with existing evidence.

From the decision · page 6Lastly, we underscore that although the WCJ provided lien claimant at trial the opportunity to continue the matter to amend the PTCS and supplement their proposed exhibits in order to address the issue of reasonableness and necessity of the subject medical treatment, they declined to do so and elected instead to proceed with their existing evidence.

ADJ8948890 · October 7, 2025

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

What proof carried it

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