ROSA HERNANDEZ, Applicant vs. FEDEX SUPPLY CHAIN DISTRIBUTION SYSTEM, INC.; ACE AMERICAN INSURANCE COMPANY, Administered by Sedgwick Claims Management Services, Inc., Defendants
ADJ number
ADJ16774509
Decision date
Nov 27, 2023
District office
Van Nuys
WCJ
David L. Pollak
Claim administrator
Sedgwick Claims Management Services, Inc. (administering ACE American Insurance Company)
Commissioners
—
Injury / body parts: cervical spine, lumbar spine, both shoulders, both arms, both hands
LC §4062LC §4604.5LC §4610CCR §9792.9
Summary
Lien claimant Medland Medical, Inc. filed a lien for $3,448.48 for medical and medical-legal services rendered to applicant Rosa Hernandez, whose underlying claim resolved by C&R for $15,000. At a lien trial, the WCJ found the medical treatment was not reasonable, found the medical-legal services were reasonable, and noticed intent to appoint an independent bill review expert (Milt Kyle) to value the medical-legal reimbursement, while deferring penalties and interest. Medland sought reconsideration arguing the treatment complied with the MTUS, that an IBR expert was unnecessary, and that it was entitled to penalties and interest. The WCAB adopted and incorporated the WCJ's report and denied reconsideration, finding the lien claimant failed to meet its burden of proving the treatment's reasonableness under Labor Code § 4604.5, that the WCJ had authority to appoint a bill review expert, and that deferred penalty/interest issues were not yet ripe for reconsideration.
Issues
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Holding
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Analysis
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Applicant takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Defense takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Provider takeaway
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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Similar decisions
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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The panel considered the record, the applicable statutes, and the arguments of the parties.
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