WCPanelIQ
PanelMed-legalLienGranted in Part

Davis, Chriselda

CHRISELDA DAVIS, Applicant vs. PREMIER SENIOR CARE LIMITED LIABILITY COMPANY; STATE INSURANCE COMPENSATION FUND, Defendants

ADJ number
ADJ10914834
Decision date
Aug 28, 2025
District office
Anaheim
WCJ
—
Claim administrator
State Compensation Insurance Fund (SCIF)
Commissioners
JOSÉ H. RAZO, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR, ANNE SCHMITZ, DEPUTY COMMISSIONER

Injury / body parts: psyche, stress, digestive system, head, back

LC §3208.3LC §4620LC §4621LC §4622LC §4603.3LC §4603.6LC §5813CCR §10421CCR §10786CCR §10964

Summary

Cost petitioner Matrix Document Imaging subpoenaed and copied Kaiser medical records on behalf of applicant's attorney after defendant SCIF denied the claim. SCIF had denied the psychiatric claim based on the six-month employment threshold of Labor Code section 3208.3(d), and argued the records did not prove or disprove that threshold issue, so the copy service was not a valid medical-legal expense. The WCJ found the services constituted a valid medical-legal expense, ordered SCIF to pay $645.70 plus a 10% penalty and interest, and imposed $500 in sanctions against SCIF and its adjuster for bad-faith failure to timely contest the invoice. On reconsideration, the Board affirmed liability for the copy costs, penalty, and interest, finding the cost petitioner met its burden under sections 4620, 4621, and 4622, but reversed the sanctions, holding that merely being late in paying an invoice after issuing an EOR does not rise to the level of bad faith under section 5813.

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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