WCPanelIQ
PanelMed-legalLienGranted

Venegas, Maria

MARIA VENEGAS, Applicant vs. MARATHON PETROLEUM COMPANY, OCIP/BRINDERSON; ACE AMERICAN INSURANCE; administered by SEDGWICK CMS, Defendants

ADJ number
ADJ18498378
Decision date
Oct 26, 2025
District office
Long Beach
WCJ
—
Claim administrator
Sedgwick CMS (administering for ACE American Insurance)
Commissioners
CRAIG L. SNELLINGS, COMMISSIONER, KATHERINE WILLIAMS DODD, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR

Injury / body parts: psyche

LC §5909LC §5900LC §4600LC §4903LC §4060LC §4620LC §4621LC §4064LC §139.2LC §4628LC §4603.2LC §4662LC §5705LC §3202.5LC §5903LC §5952LC §4610.5LC §4610LC §4601.5CCR §10600CCR §9785CCR §9793CCR §10786CCR §10670CCR §10682CCR §10683CCR §10702

Summary

Lien claimant Premier Psychological Services sought reconsideration of a WCJ's take-nothing order finding it failed to sustain its burden of proof on its lien for both medical-legal expenses (January 29, 2024 evaluation) and medical treatment expenses (March 13, 2024 follow-up). The PTP, Dr. Mark Michaels, performed a medical-legal evaluation following defendant's denial of applicant's psyche claim and found injury AOE/COE was predominantly industrial (greater than 50%), diagnosing adjustment disorder and anxiety. The WCJ denied the lien on grounds the report was untimely under section 139.2(j), incomplete due to lack of record review, failed to identify the interpreter under section 4628(b), and lacked applicant testimony. The Appeals Board granted reconsideration, holding that lien claimant met its initial burden showing a contested claim, that the section 4628 interpreter deficiency was curable through notice and opportunity to amend, that the 30-day report timeframe does not bar reimbursement where no replacement evaluator was sought, and that Dr. Michaels' report constituted substantial evidence on AOE/COE. The Board rescinded the F&O and remanded for further proceedings, including an opportunity to cure the report and consideration of whether updated utilization review is necessary.

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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