Hines, Amaud

Applicant Amaud Hines, a psychiatric technician, sustained an industrial injury and his claim resolved by Compromise and Release. Lien claimant Integrated Pain Care, acting as alter ego for primary treating physician Dr. Gary Martinovsky, filed a lien for $10,130.10 seeking rates exceeding those paid under a Blue Cross Prudent Buyer Plan agreement. SCIF, administering the legally uninsured Department of State Hospitals, argued the WCAB lacked jurisdiction under Labor Code section 5304 because a chain of contracts (Dr. Martinovsky-Blue Cross and Blue Cross-SCIF) formed an express agreement fixing reimbursement amounts. The WCJ had found WCAB jurisdiction existed because the treatment was rendered under SCIF's MPN rather than the Knox-Keene Act, but the Appeals Board rescinded that decision. The Board held that the Prudent Buyer Plan expressly contemplated workers' compensation treatment and other payors, creating an express agreement under section 5304 that divested the WCAB of jurisdiction, consistent with Tri-City Medical Center v. WCAB (Streeter).