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PanelQMEMed-legalIBRDenied

Lisa Hill Sanders — ADJ11998519

LISA HILL SANDERS, Applicant vs. KAISER PERMANENTE, Permissibly Self-Insured; Administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, Defendants

ADJ number: ADJ11998519
Decision date: Jun 26, 2022
District office: Los Angeles
WCJ: Karinneh Aslanian
Claim administrator: Sedgwick Claims Management Services (administering for Kaiser Permanente, Permissibly Self-Insured)
Commissioners: —

LC §5813LC §5811LC §4903LC §5710LC §5801LC §5814LC §5814.5CCR §10451.1CCR §10561CCR §10421

Summary

Cost petitioner Dr. Konstat (a PQME), through attorney Kapelnikov, sought reimbursement of attorney's fees in connection with a medical-legal billing dispute against Kaiser Permanente (PSI), administered by Sedgwick. The dispute originated from a clerical 'unit error' (7 vs. 74 units) that caused an underpayment, which the defendant discovered only when a non-IBR petition was filed in March 2019, after which it settled the bill in full plus penalties and interest within about 30 days. The WCJ found the defendant did not act in bad faith and that no sanctions or attorney's fees could issue, because attorney's fees for med-legal providers require sanctionable conduct under Labor Code section 5813 and are not allowable as 'costs' under section 5811. The WCAB adopted and incorporated the WCJ's report, denied reconsideration, and clarified that an attorney's fee is not allowable under section 5813 absent a finding of sanctionable conduct.

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.