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PanelLienGranted

Alan Lopez — ADJ1128094

ALAN LOPEZ, Applicant vs. GABRIEL VERON doing business as GLA ELECTRIC; NORGUARD INSURANCE COMPANY, Defendants

ADJ number: ADJ1128094
Decision date: Mar 4, 2021
District office: Santa Ana
WCJ: —
Claim administrator: NorGuard Insurance Company
Commissioners: KATHERINE WILLIAMS DODD, COMMISSIONER, ANNE SCHMITZ, DEPUTY COMMISSIONER

Injury / body parts: legs, thighs, knees, lower extremities, nervous system, psyche

LC §4603.2LC §4603.4CCR §9792.5.2

Summary

PCT Medical Services, a lien claimant seeking reimbursement for six shock wave treatments provided to applicant Alan Lopez in November and December 2018, petitioned for reconsideration of a WCJ's F&O that disallowed its lien in its entirety. The WCJ denied the lien on two grounds: failure to submit an NPI number under Labor Code section 4603.2(b)(1)(C), and failure to provide bills on a CMS 1500 Health Insurance Claim Form under AD Rule 9792.5.2(a). The Board found the NPI requirement inapplicable because that statutory provision (added by SB 537) only became effective January 1, 2020, after the 2018 treatments. The Board further found the CMS 1500 form objection should have been raised by defendant at the MSC or trial and was potentially waived, while raising it sua sponte implicated lien claimant's due process rights. The Board granted reconsideration, rescinded the F&O, and returned the matter to the trial level for further proceedings on the merits.

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.