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PanelMed-legalLienDenied

Eustolia Lopez — ADJ10839476

EUSTOLIA LOPEZ, Applicant vs. MONARCH LITHO; EVEREST NATIONAL INSURANCE COMPANY, administered by SEDGWICK CMS, Defendants

ADJ number: ADJ10839476
Decision date: Mar 24, 2022
District office: Oxnard
WCJ: Michael K. Greenberg
Claim administrator: Sedgwick Claims Management Services (Sedgwick CMS)
Commissioners: —

Injury / body parts: psyche, head, nervous system

LC §4060LC §4601LC §4062LC §4628LC §4903.05CCR §9785CCR §9793CCR §9795CCR §10964

Summary

Applicant Eustolia Lopez filed a denied psychiatric injury claim that was resolved by Compromise and Release in October 2020. The lien dispute centered on the lien of Southern California Mental Health for medical-legal reports by Dr. David Krauss, Ph.D., for dates of service 2/21/2019, 10/7/2019, and 12/12/2019, totaling $9,758.08 billed and nothing paid. The WCJ found Dr. Krauss was the primary treating physician who performed valid comprehensive medical-legal evaluations after the claim was denied, and awarded payment. Defendant petitioned for reconsideration arguing Dr. Krauss was not a QME, AME, or treating physician and that the reports were not valid medical-legal evaluations. The WCAB adopted and incorporated the WCJ's report and 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.

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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.