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En BancLienRemanded

Luis Enriquez (Deceased)

LUIS ENRIQUEZ (DECEASED), Applicant vs. COUTO DAIRY and ZENITH INSURANCE COMPANY, Defendants

ADJ number: —
Decision date: Date unavailable
District office: Stockton
WCJ: —
Claim administrator: Zenith Insurance Company
Commissioners: —

Injury / body parts: fatal injury (gored by bull, resulting in death)

LC §5307.1LC §4600LC §3202.5LC §5705LC §115CCR §9789.70CCR §10341

Summary

Air ambulance provider Mercy Air Services airlifted a fatally injured worker (Luis Enriquez, gored by a bull) 26 miles to a Modesto hospital and billed Zenith $11,132.93, but Zenith paid only $4,756.42 (120% of the Medicare rate) under AD Rule 9789.70. The WCJ found the rule preempted by the federal Airline Deregulation Act (ADA) of 1978 and awarded Mercy the full billed amount. On reconsideration, the en banc Appeals Board held that (1) neither Article III, section 3.5 of the California Constitution nor Labor Code section 5307.1 prevents the Board from finding preemption of AD Rule 9789.70 (a regulation, not a statute); (2) the ADA preempts the rule if the lien claimant is an 'air carrier that may provide air transportation'; and (3) the air ambulance provider bears the burden of proving it is such a carrier, including authorization to provide interstate air transportation. Because the record was insufficient to determine Mercy's air carrier status, the Board rescinded the WCJ's decision and remanded for further development of the record.

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.