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PanelQMEMed-legalIBRLienGranted

Garcia, Frances

FRANCES GARCIA, Applicant vs. MONTE VISTA CHILD CARE CENTER; CYPRESS INSURANCE COMPANY; ADMINISTERED BY BERKSHIRE HATHAWAY, Defendants

ADJ number: ADJ13556902
Decision date: Date unavailable
District office: Pomona
WCJ: —
Claim administrator: Berkshire Hathaway (administering for Cypress Insurance Company)
Commissioners: KATHERINE A. ZALEWSKI, CHAIR, CRAIG SNELLINGS, COMMISSIONER, JOSEPH V. CAPURRO, COMMISSIONER

Injury / body parts: neck, lumbar spine, back

LC §4600LC §4610LC §4603.2LC §4603.3LC §4603.6LC §5307.1

Summary

Lien claimant Medland Medical sought reconsideration of a WCJ's Joint Findings and Order that found Medland's reporting did not qualify as medical-legal reporting and its treatment was not reasonable or necessary, ordering the lien claimant take nothing. The WCJ relied primarily on the QME reports to deny the lien. The Board found this analysis incomplete because the proper mechanism for a defendant to dispute reasonableness/necessity of treatment is utilization review (UR), and defendant submitted no UR evidence despite Medland having submitted RFAs. The Board also noted the WCJ failed to address AOE/COE despite stipulations and a C&R establishing injury to the neck and back. The Board granted reconsideration, rescinded the decision, and remanded for further proceedings to develop the record.

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.

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.