ADJ9336762 · March 17, 2025

Basso Pharmacy was found not to be properly licensed and therefore not entitled to payment for their lien.

From the decision · page 7Lien claimant argues that Basso and A&R are one in the same and that as A&R was licensed that that imputes licensing to Basso because they say so. The corporate By-Laws appear to have been fluid and per lien claimant support an argument of proper licensing. For example, the fictitious business statement lists Basso is owned and operated by A&R but in 2013 the fictitious business name was A&R not Basso and that A&R was owned and operated by Basso. (Exhibit 27, EAMS doc 33976253) the 2008 By-Laws offered by lien claimant indicate that wherever it says A&R that should be changed to read Basso. Basso was not licensed. All of the billing was under Basso and per California Business Code Section 4110(a) a license is required for each pharmacy owned or operated by a specific person and a separate license is required for each of the premises.

The Appeals Board found that a medical-legal evaluation performed by the employee's primary treating physician (PTP) is a medical-legal expense for which the employer is liable, even if there is an AME or PQME, and that RMS Medical Group's medical-legal services were reasonable and necessary.

From the decision · page 9II. Section 4060(b) allows for a medical-legal evaluation by a treating physician and section 4620(a) defines medical legal expense as "any costs and expenses...for the purpose of proving or disproving a contested claim." Section 4064(a) provides that an employer is liable for the cost of any comprehensive medical evaluations authorized under section 4060. The regulations provide that the "primary treating physician shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation..." (Cal. Code Regs., tit. 8, § 9785(d).) AD Rule 9793(h) states: (h) "Medical-legal expense" means any costs or expenses incurred by or on behalf of any party or parties, the administrative director, or the appeals board for X-rays, laboratory fees, other diagnostic tests, medical reports, medical records, medical testimony, and as needed, interpreter's fees, for the purpose of proving or disproving a contested claim. The cost of medical evaluations, diagnostic tests, and interpreters is not a medical-legal expense unless it is incidental to the production of a comprehensive medical-legal evaluation report, follow-up medical-legal evaluation report, or a supplemental medical-legal evaluation report and all of the following conditions exist:

RMS Medical Group was designated as the Primary Treating Physician and provided medical-legal reports requested by applicant's attorney.

Favours Applicant prevailed

Supports entitlement to payment for medical-legal services as PTP under Labor Code and regulations.

From the decision · page 2BACKGROUND We will briefly review the relevant facts. Applicant claimed injury to his back, [lower] extremities and psyche while employed by defendant as a laborer, at Riverside, California by Riverside Landscape during the period from June 5, 2012 to June 5, 2013. An Application for Adjudication (Application) was filed on January 27, 2014, indicating the Application was being filed due to a disagreement regarding liability for all claimed benefits. On March 1, 2017, Applicant's Attorney issued a letter to Guy Gottschalk, M.D. designating him as taking over as applicant's Primary Treating Physician (PTP) pursuant to Labor Code2 section 4600. The letter further requests that Dr.

Basso Pharmacy was not properly licensed to dispense prescriptions under California Business and Professions Code Section 4110(a).

Favours Defendant prevailed

Licensing failure bars entitlement to payment for lien.

From the decision · page 7Lien claimant argues that Basso and A&R are one in the same and that as A&R was licensed that that imputes licensing to Basso because they say so. The corporate By-Laws appear to have been fluid and per lien claimant support an argument of proper licensing. For example, the fictitious business statement lists Basso is owned and operated by A&R but in 2013 the fictitious business name was A&R not Basso and that A&R was owned and operated by Basso. (Exhibit 27, EAMS doc 33976253) the 2008 By-Laws offered by lien claimant indicate that wherever it says A&R that should be changed to read Basso. Basso was not licensed. All of the billing was under Basso and per California Business Code Section 4110(a) a license is required for each pharmacy owned or operated by a specific person and a separate license is required for each of the premises.

Diagnosed chronic sprain/strain of thoracolumbosacral spine; opined applicant was most probably permanent and stationary but needed MRI and Panel QME reports to determine nature, extent, disability level, and future treatment.

From the decision · page 4Dr. Gottschalk diagnosed chronic sprain/strain of thoracolumbosacral spine and

Labor Code

Labor Code section 4060(b)

Allows medical-legal evaluation by treating physician.

From the decision · page 9II. Section 4060(b) allows for a medical-legal evaluation by a treating physician and section 4620(a) defines medical legal expense as "any costs and expenses...for the purpose of proving or disproving a contested claim." Section 4064(a) provides that an employer is liable for the cost of any comprehensive medical evaluations authorized under section 4060. The regulations provide that the "primary treating physician shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation..." (Cal. Code Regs., tit. 8, § 9785(d).) AD Rule 9793(h) states: (h) "Medical-legal expense" means any costs or expenses incurred by or on behalf of any party or parties, the administrative director, or the appeals board for X-rays, laboratory fees, other diagnostic tests, medical reports, medical records, medical testimony, and as needed, interpreter's fees, for the purpose of proving or disproving a contested claim. The cost of medical evaluations, diagnostic tests, and interpreters is not a medical-legal expense unless it is incidental to the production of a comprehensive medical-legal evaluation report, follow-up medical-legal evaluation report, or a supplemental medical-legal evaluation report and all of the following conditions exist:

Labor Code

Labor Code section 4064(a)

Employer liable for cost of comprehensive medical evaluations authorized under section 4060.

From the decision · page 9II. Section 4060(b) allows for a medical-legal evaluation by a treating physician and section 4620(a) defines medical legal expense as "any costs and expenses...for the purpose of proving or disproving a contested claim." Section 4064(a) provides that an employer is liable for the cost of any comprehensive medical evaluations authorized under section 4060. The regulations provide that the "primary treating physician shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation..." (Cal. Code Regs., tit. 8, § 9785(d).) AD Rule 9793(h) states: (h) "Medical-legal expense" means any costs or expenses incurred by or on behalf of any party or parties, the administrative director, or the appeals board for X-rays, laboratory fees, other diagnostic tests, medical reports, medical records, medical testimony, and as needed, interpreter's fees, for the purpose of proving or disproving a contested claim. The cost of medical evaluations, diagnostic tests, and interpreters is not a medical-legal expense unless it is incidental to the production of a comprehensive medical-legal evaluation report, follow-up medical-legal evaluation report, or a supplemental medical-legal evaluation report and all of the following conditions exist:

California Code of Regulations

Cal. Code Regs., tit. 8, 9785(d)

Primary treating physician shall render opinions on all medical issues necessary to determine eligibility for compensation.

From the decision · page 9II. Section 4060(b) allows for a medical-legal evaluation by a treating physician and section 4620(a) defines medical legal expense as "any costs and expenses...for the purpose of proving or disproving a contested claim." Section 4064(a) provides that an employer is liable for the cost of any comprehensive medical evaluations authorized under section 4060. The regulations provide that the "primary treating physician shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation..." (Cal. Code Regs., tit. 8, § 9785(d).) AD Rule 9793(h) states: (h) "Medical-legal expense" means any costs or expenses incurred by or on behalf of any party or parties, the administrative director, or the appeals board for X-rays, laboratory fees, other diagnostic tests, medical reports, medical records, medical testimony, and as needed, interpreter's fees, for the purpose of proving or disproving a contested claim. The cost of medical evaluations, diagnostic tests, and interpreters is not a medical-legal expense unless it is incidental to the production of a comprehensive medical-legal evaluation report, follow-up medical-legal evaluation report, or a supplemental medical-legal evaluation report and all of the following conditions exist:

California Code of Regulations

Cal. Code Regs., tit. 8, 9793(h)

Defines medical-legal expense and conditions for medical-legal evaluation reports.

From the decision · page 9II. Section 4060(b) allows for a medical-legal evaluation by a treating physician and section 4620(a) defines medical legal expense as "any costs and expenses...for the purpose of proving or disproving a contested claim." Section 4064(a) provides that an employer is liable for the cost of any comprehensive medical evaluations authorized under section 4060. The regulations provide that the "primary treating physician shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation..." (Cal. Code Regs., tit. 8, § 9785(d).) AD Rule 9793(h) states: (h) "Medical-legal expense" means any costs or expenses incurred by or on behalf of any party or parties, the administrative director, or the appeals board for X-rays, laboratory fees, other diagnostic tests, medical reports, medical records, medical testimony, and as needed, interpreter's fees, for the purpose of proving or disproving a contested claim. The cost of medical evaluations, diagnostic tests, and interpreters is not a medical-legal expense unless it is incidental to the production of a comprehensive medical-legal evaluation report, follow-up medical-legal evaluation report, or a supplemental medical-legal evaluation report and all of the following conditions exist:

CA-WCAB

Warren Brower v. David Jones Construction (2014) 79 Cal.Comp.Cases 550 (Appeals Board en banc)

Held that injured worker is entitled to request a medical-legal report from their PTP and that the report is a medical-legal expense for which defendant is liable, even if there is an AME.

From the decision · page 10(Cal. Code Regs., tit. 8, § 9793(h).) Read together, these sections provide that a medical-legal evaluation performed by an employee's treating physician is a medical-legal evaluation obtained pursuant to section 4060 and that an employer is liable for the cost of reasonable and necessary medical-legal reports that are performed by the treating physician. The Appeals Board has previously held that there was no legal authority to support the proposition that an injured worker is not entitled to request a medical- legal report from their PTP, and in turn, the report from that PTP is a medical-legal expense for which the defendant is liable. (Warren Brower v. David Jones Construction (2014) 79 Cal.Comp.Cases 550, 556 (Appeals Board en banc).)

Medical-legal report from PTP Dr. Gottschalk was reasonable and necessary for proving contested claim.

From the decision · page 10In the instant case, medical reporting from the agreed medical evaluator and a treating physician is relevant and admissible and could provide a basis for a decision. If lien claimant demonstrates that PTP Dr. Gottschalk's medical-legal report was reasonable and necessary, it is entitled to recover on that basis.

Basso Pharmacy was not properly licensed to dispense prescriptions, affecting entitlement to payment.

From the decision · page 7Lien claimant argues that Basso and A&R are one in the same and that as A&R was licensed that that imputes licensing to Basso because they say so. The corporate By-Laws appear to have been fluid and per lien claimant support an argument of proper licensing. For example, the fictitious business statement lists Basso is owned and operated by A&R but in 2013 the fictitious business name was A&R not Basso and that A&R was owned and operated by Basso. (Exhibit 27, EAMS doc 33976253) the 2008 By-Laws offered by lien claimant indicate that wherever it says A&R that should be changed to read Basso. Basso was not licensed. All of the billing was under Basso and per California Business Code Section 4110(a) a license is required for each pharmacy owned or operated by a specific person and a separate license is required for each of the premises.