Hunter, Margaret Joanne

Lien claimants David Silver, M.D., and David Bresler, Ph.D., L.Ac., who treated applicant Margaret Hunter for industrial fibromyalgia (injury date 2/24/1997), sought reconsideration of a WCJ finding that defendant satisfied their liens at OMFS rates with nothing additional owed. The lien claimants argued that because they treated on what was effectively a denied claim, they were entitled to usual and customary charges rather than discounted OMFS rates, and that the WCJ exceeded the submitted issues by finding actual payment had been made. The Board affirmed the WCJ's determination that the OMFS applies and that lien claimants failed to establish the 'extraordinary circumstances related to the unusual nature of the services rendered' required under AD Rule 9792(c) to justify fees in excess of OMFS. However, the Board found that whether defendant actually issued and lien claimants actually received the OMFS payments was a colorable issue not submitted for trial, so it rescinded the WCJ's finding that the liens were paid and deferred that issue for informal adjustment. Reconsideration was granted and the decision affirmed as amended.