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PanelQMEMed-legalIBRGranted

Langford, Derrick

DERRICK LANGFORD, Applicant vs. ARIZONA DIAMONDBACKS; FAIRMONT PREMIER INSURANCE COMPANY, Administered by ZENITH INSURANCE COMPANY; ATLANTA BRAVES; ALLIANZ INSURANCE, Defendants

ADJ number: ADJ8671084
Decision date: May 30, 2024
District office: Santa Ana
WCJ: —
Claim administrator: Zenith Insurance Company (administering Fairmont Premier Insurance Company); Allianz Insurance
Commissioners: KATHERINE WILLIAMS DODD, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR, JOSÉ H. RAZO, COMMISSIONER

Injury / body parts: brain, face, head, neck, multiple

LC §4603.3LC §4603.6LC §4622LC §4063.6LC §4903LC §4903.5LC §5813LC §5909CCR §10451.1CCR §9794CCR §9795CCR §10940CCR §10964

Summary

Dr. Myron Nathan, retained as a defense QME in psychiatry, billed $4,687.50 for his March 27, 2018 report under code ML 104. After three EORs, defendant (Zenith) ultimately paid $937.50 under ML 103. Dr. Nathan filed a Petition to Resolve Medical-Legal Dispute (Non-IBR) with the WCAB, arguing defendant waived objections because its EORs did not comply with Labor Code section 4603.3. The WCJ agreed and ordered full payment plus penalties and interest. On reconsideration, the Appeals Board rescinded the WCJ's decision, finding the essence of the dispute was the reasonable value of services (ML 103 vs. ML 104), which is subject to Independent Bill Review rather than WCAB jurisdiction. The Board allowed Dr. Nathan to still pursue IBR, with the 30-day time limit running from the date of the Decision After Reconsideration.

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.