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PanelMed-legalLienDenied

Lira, Antonio

ANTONIO LIRA, Applicant vs. A.G. PRODUCTION COMPANY; CYPRESS INSURANCE COMPANY, adjusted by BERKSHIRE HATHAWAY HOMESTATE COMPANIES, Defendants

ADJ number: ADJ11777176
Decision date: Feb 10, 2026
District office: Stockton
WCJ: —
Claim administrator: Berkshire Hathaway Homestate Companies
Commissioners: KATHERINE WILLIAMS DODD, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR, JOSÉ H. RAZO, COMMISSIONER

Injury / body parts: teeth

LC §4610LC §3209.3LC §4600LC §4620LC §4621LC §4603.2

Summary

Applicant Antonio Lira sustained an admitted dental injury on June 28, 2017. Defendant authorized lien claimant Dental Trauma Center to conduct a consult evaluation and provide treatment, and the provider performed diagnostic testing (photographs, ultrasonic doppler analysis) to develop a treatment plan, generating a ten-page report. Defendant later contested liability for the diagnostic services, arguing they required separate RFA/utilization review authorization. The WCAB affirmed the WCJ's F&A, holding that diagnostic testing is a medical-legal expense governed by sections 4620-4621, not treatment subject to UR, and that defendant produced no evidence the services were unreasonable nor any proper objection. The Board affirmed the award of the lien balance with penalties and interest.

Issues

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Holding

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Analysis

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Applicant takeaway

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Defense takeaway

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Provider takeaway

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Similar decisions

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Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.

Full case search with summaries, PDFs, holdings, and filters is included with Member. This block is a decorative placeholder so the page layout is visible without exposing restricted text. Sign in or subscribe to Member to read the complete decision. The panel considered the record, the applicable statutes, and the arguments of the parties. Member is $25/month or $250/year and includes the weekly email digest, full case search, and bookmarks.