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PanelQMELienGranted in Part

Tony Ceasar — ADJ9874941

TONY CEASAR, Applicant vs. EXPRESS MESSENGER SYSTEMS, INC.; ONTRAC; ZURICH NORTH AMERICA, Defendants

ADJ number: ADJ9874941
Decision date: May 10, 2021
District office: San Bernardino
WCJ: —
Claim administrator: Zurich North America
Commissioners: DEIDRA E. LOWE, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR, CRAIG SNELLINGS, COMMISSIONER

Injury / body parts: back, leg, body system, excretory system, lumbar spine, hypertension (cardiovascular), sleep disorder

LC §4600LC §4610LC §4062LC §5705LC §3202.5CCR §9792.9.1

Summary

Lien claimant MH Express, a pharmacy, sought payment for prescription medications dispensed to applicant Tony Ceasar, who claimed a January 9, 2015 industrial injury that defendant initially denied. After the case in chief resolved by Compromise and Release, MH Express pursued a lien of $68,127.74 for dates of service from 3/27/2015 through 1/23/2018. The WCJ ordered defendant to conduct retrospective UR for numerous dates of service, but on reconsideration the Board found that MH Express produced only a single RFA dated May 8, 2015 (covering the 5/11/15 Zolpidem/Ambien date of service) and failed to meet its burden of proving entitlement for all other dates. The Board amended the F&O to limit retrospective UR to the 5/11/15 date of service and ordered MH Express to take nothing for all other outstanding dates of service.

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.