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PanelIBRLienRemanded

Steven Brow — ADJ12210104

STEVEN BROW, Applicant vs. SEPRAGEN CORPORATION and THE HARTFORD, Defendants

ADJ number: ADJ12210104
Decision date: Feb 8, 2021
District office: San Jose
WCJ: —
Claim administrator: The Hartford
Commissioners: —

Injury / body parts: left thumb

LC §5307.1LC §4603.2LC §4603.3LC §4603.6LC §4622LC §4600LC §4604LC §4903LC §5304LC §5705LC §3202.5LC §132aLC §3751LC §5900CCR §9789.10CCR §9789.20CCR §9789.24CCR §9789.12.1CCR §9789.19CCR §9789.70CCR §9789.111CCR §10451.2

Summary

Steven Brow sustained an industrial left thumb injury in February 2018 while working as a machinist for Sepragen Corporation, insured by The Hartford. The U.S. Department of Veterans Affairs (V.A.) provided treatment (including outpatient nerve repair) and filed a lien seeking $100,169.65, claiming federal law preempts California's Official Medical Fee Schedule (OMFS). The WCJ rejected the preemption argument and awarded only $11,591.57 based on the OMFS reasonableness standard supported by defendant's billing expert. On reconsideration, the Appeals Board identified two unresolved threshold issues: whether the WCAB even has jurisdiction given the primacy of Independent Bill Review (IBR), and whether the WCAB has authority to find federal preemption based on 'an extensive body of federal or state case law.' The Board rescinded the WCJ's decision and remanded for further briefing and a new decision.

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.