WCPanelIQ
PanelQMEMed-legalLienGranted

Antonio Gomez — ADJ10233926

ANTONIO GOMEZ, Applicant vs. G&M OIL, INC.; INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, administered by Gallagher Bassett Insurance Services, Defendants

ADJ number
ADJ10233926
Decision date
Apr 17, 2022
District office
Santa Ana
WCJ
—
Claim administrator
Gallagher Bassett Insurance Services (administering for Insurance Company of the State of Pennsylvania)
Commissioners
KATHERINE WILLIAMS DODD, COMMISSIONER, CRAIG SNELLINGS, COMMISSIONER, ANNE SCHMITZ, DEPUTY COMMISSIONER

Injury / body parts: left leg, left ankle, left knee, lumbar spine

LC §4600LC §4061LC §4062LC §4062.2LC §4620LC §4621LC §4903.8LC §5313CCR §9795

Summary

Lien claimant RMS Medical Group sought reconsideration of a WCJ's Findings and Order disallowing its $6,560.70 medical treatment lien. The WCJ had found that lien claimant's services occurred after applicant was discharged from care by the primary treating physician, that Dr. Guy Gottschalk was not the applicant's PTP, and that RMS did not conduct a valid medical-legal evaluation. The Board granted reconsideration but, on different grounds, rescinded the F&O and substituted new findings that the lien claimant failed to meet its burden of proof. The treating and consulting physician reports (Drs. Gottschalk, Shamlou, and Green) were excluded from evidence and not challenged in the petition, and the billing ledger was likewise excluded; without admitted evidence of what services were rendered or their medical necessity, the lien could not be established. The lien was disallowed and all other issues deemed moot.

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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