WCPanelIQ
PanelMed-legalLienGranted in Part

Kharel, Alexis

ALEXIS KHAREL, Applicant vs. EASTRIDGE WORKFORCE SOLUTIONS; AMERICAN HOME ASSURANCE administered by BROADSPIRE, Defendants

ADJ number
ADJ16497715
Decision date
Jul 7, 2024
District office
Los Angeles
WCJ
—
Claim administrator
Broadspire (administering for American Home Assurance / AIG Claims)
Commissioners
JOSÉ H. RAZO, COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER

Injury / body parts: right foot, fourth toe, fifth toe, multiple body parts (cumulative trauma)

LC §4060LC §4064LC §4620LC §5307.6LC §139.2LC §3209.3LC §5904CCR §9793CCR §10964

Summary

Lien claimant Spectrum Medical Group sought reconsideration of a WCJ's finding that defendant had no liability for self-procured medical treatment or for a comprehensive medical-legal evaluation performed by Dr. Amin Nia, D.C. (applicant's primary treating physician) on August 26, 2022, where applicant's claim of injury to the right foot and cumulative trauma had been denied and resolved by a $12,000 Compromise and Release. The WCJ concluded no treatment was actually furnished and there was no evidence of a request for a medical-legal evaluation. The Appeals Board granted reconsideration and held that the WCJ improperly applied AD Rule 9793(h) without considering Labor Code sections 4060(b), 4064(a), and 4620(a), which authorize medical-legal evaluations by treating physicians. The Board deferred the issue of whether defendant is liable for the medical-legal evaluation while affirming the disallowance of the self-procured treatment lien, which lien claimant failed to challenge on AOE/COE grounds.

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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