Hines, Amaud

Applicant Amaud Hines, a psychiatric technician, claimed injury to his head, cervical spine, lumbar spine, brain, and psyche on February 2, 2016, and resolved the claim by Compromise and Release approved December 28, 2017. Lien claimant Integrated Pain Care (treated as an alter ego of treating physician Dr. Gary Martinovsky) filed a lien for $10,130.10 for medical treatment. The dispute centered on whether the WCAB had jurisdiction over the value of those services under Labor Code section 5304, or whether an 'express agreement' (a chain of contracts between Dr. Martinovsky and Blue Cross via the Prudent Buyer Plan, and between Blue Cross and SCIF via a Managed Care Services Agreement) fixed the rates and ousted WCAB jurisdiction. The Board, in its prior ODAR, found such an express agreement existed and rescinded the WCJ's finding of jurisdiction. On reconsideration, the Board reaffirmed that the chain of contracts constituted an express agreement under section 5304, precluding WCAB jurisdiction, and denied the petition.