Lisa Henry — ADJ8077330

The Dental Trauma Center, a lien claimant providing self-procured dental treatment to applicant Lisa Henry, sought reconsideration of a WCJ's Findings and Order disallowing its lien based on a finding that applicant did not sustain injury AOE/COE to her back, jaw, teeth, respiratory system, psyche, or in the form of sleep disorder. The lien claimant argued the medical record was substantial evidence of a specific lumbar and dental injury and that defendant had waived the AOE/COE issue. The WCAB rejected the waiver argument, finding no statutory or case law support, and held that the reports of Drs. Schames and Benarroch were not substantial evidence because they relied on inaccurate histories (failing to account for a prior gunshot wound to the jaw), incorrectly assumed the claim had been accepted, referenced a cumulative trauma not established by the QME, and used impermissible 'and/or' causation language. The Board also found the billing exhibits internally inconsistent and not substantial evidence. Rather than affirm the disallowance, the Board rescinded the F&O and remanded for development of the record, noting settlement may be in the parties' interest given the evidentiary difficulties.