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PanelQMEMed-legalLienDenied

Ye, Gang

GANG YE, Applicant vs. AQUATIC GEARS INC; OAK RIVER INSURANCE COMPANY C/O BERKSHIRE HATHAWAY HOMESTATE COMPANIES, Defendants

ADJ number: ADJ11681317
Decision date: Jul 23, 2023
District office: Pomona
WCJ: —
Claim administrator: Berkshire Hathaway Homestate Companies (administering Oak River Insurance Company)
Commissioners: KATHERINE WILLIAMS DODD, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER, JOSÉ H. RAZO, COMMISSIONER

Injury / body parts: back, stress/nervous, digestive, psyche, internal, neurological, headaches, sleep

LC §3202.5LC §5705LC §4600

Summary

Optimal Health Institute, a lien claimant, sought reconsideration of a WCJ's Findings and Award that limited its lien recovery to $9,532.91 for treatment rendered during the delay period in two consolidated cases involving applicant Gang Ye. The lien claimant argued it was entitled to additional payment for treatment after the claims were denied on January 18, 2019, contending that the PQME Dr. Mummaneni's reporting and other medical evidence established industrial causation. The WCAB found the PQME's reporting was incomplete and not substantial medical evidence on causation, as Dr. Mummaneni's bare conclusion of 'at least 1% causation' lacked supporting reasoning. Because the lien claimant bore the burden of proving injury AOE/COE and failed to do so, there was no legal basis for the disputed treatment to be reasonably required under Labor Code section 4600. The Board denied 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.