Liens and medical-legal cost petitions

• Author: David L. Pollak/Roger A. Tolman, Jr./Monika R. Reyes
• Pages: 547-596

LIENS, MEDICAL-LEGAL

COST PETITIONS

10-1

CHAPTER 10

LIENS AND MEDICALLEGAL

COST PETITIONS

I. ALLOWABLE LIENS

A. Overview

§10:01 Liens Allowed by LC §4903

§10:02 Independent Medical Review: LC §§139.5 & 4610.5

§10:03 Independent Bill Review: LC §§139.5 & 4603.6

B. Attorney’s Fees and Costs

§10:10 In General

§10:11 Compensation Services Only

§10:12 Against Other Lien Recoveries

C. Medical Treatment Liens

§10:20 Industrial Expense Only

§10:21 Medical Treatment Lien Limited to Reasonable Amount

§10:22 Medi-Cal Recoupment May Be Pursued

D. Living Expenses; “Consent Liens”

§10:30 Employee or Dependent Debts After Injury

§10:31 “Consent Liens”

§10:32 Monies Must Be Used as Living Expense

§10:33 Welfare Payments

E. Deserted or Neglected Dependents ’ Expenses; Spousal and Child Support

§10:40 Dependents’ Expenses

§10:41 Support Decrees

§10:42 Enforceable By County Assignee

§10:43 “Earnings Assignment” of 25% of TD Payments for Child/Spouse Support

F. EDD Liens: Unemployment Benef‌its

§10:50 SDI and UI Benef‌its; Determination of EDD Lien at Trial

§10:51 For Pre-1/1/94 Injuries, Against TD Only

§10:52 Post-1/1/94 Injuries Against TD & PD; Notice Requirements

§10:53 Amount of EDD Benef‌its Payable

§10:54 Payment of EDD Benef‌its During Pendency of WC Claim

§10:55 Lien for Regular Unemployment Benef‌its

§10:56 Credit for EDD Payments Against TPD

§10:57 Application of EDD Lien Against TD or PD: Double Recovery Against Public Policy

§10:58 EDD Recovery Can Include Interest and Penalty; Attorney’s Fees

§10:59 EDD Liens Not Payable by CIGA

G. Other Liens

§10:70 Group Disability Payments; CCPOA Liens

§10:71 CCPOA Liens

§10:72 Burial Expense

LIENS, MEDICAL-LEGAL

COST PETITIONS

California Workers’ Compensation 10-2

II. LIEN CLAIM PROCEDURES

§10:81 Filing Requirements

§10:82 Filing and Activation Fees

§10:83 Claimants Not Subject to Filing or Activation Fees

§10:84 Service of Lien Claims

§10:85 Statute of Limitations for Liens Filed Prior to January 1, 2013

§10:86 Statute of Limitations for Liens Filed after January 1, 2013

§10:87 Dismissal of Lien for Failure to Prosecute

§10:88 Petitions for Medical Information by Non-Physician Lien Claimants

§10:89 Assignment of Liens

§10:90 Notice of Representation of Lien Claimant

§10:91 Miscellaneous Procedural Issues

§10:92 Dismissal of Lien for Failure to Appear

§10:93 Orders Allowing Liens for Non-Appearing Defendants Not Permitted

§10:94 Dismissal for Failure to File Notice of Representation of Lien Claimant

§10:95 Lien Claimant’s Burden of Proof; Sanctions for Frivolous Claims; Special Lien Proceedings

III. NECESSITY AND REASONABLENESS OF MEDICAL TREATMENT EXPENSES

§10:99 Burden of Proof

§10:100 Licensing and Accreditation Requirements for Lien Claimants

§10:101 Retroactive Independent Medical Review

§10:102 “Minimum” Schedule

§10:103 “Off‌icial Medical Fee Schedule” — LC§5307.1

§10:104 Medical Fee Schedule

§10:105 Changes to Medical Fee Schedule

§10:106 Applicability of Fee Schedule

§10:107 Express Agreement — PPO Agreements

§10:108 Charging Patient With Excess — Bell

§10:109 Services Exempted from Fee Schedule

§10:110 No Usual and Customary Charges Allowed for Claimed Extraordinary Services

§10:111 Reasonableness of Medical Interpreting Services

IV. REIMBURSEMENT OF MEDICALLEGAL EXPENSES

A. General Points

§10:120 The Basic Right of Recovery

§10:121 Treating Physicians May Incur Medical-Legal Expenses

§10:122 Administrative Director Rules

§10:123 Medical-Legal Costs Def‌ined

§10:124 Three Types of Medical-Legal Costs

B. The Medical-Legal Fee Schedule

§10:130 Introduction

§10:131 Comprehensive Medical-Legal Evaluation

§10:132 Follow-Up Medical-Legal Evaluation — ML202

§10:133 Fees for Supplemental Medical-Legal Evaluations — ML203

§10:134 Fees for Medical-Legal Testimony — ML204

§10:135 Fees for Review of Sub Rosa Recordings — ML205

§10:136 Fees for Excessive Record Review — ML-PRR

§10:137 Fees for Missed Appointment for a Comprehensive or Follow-Up Medical-Legal Evaluation — ML200

§10:138 Modif‌iers — (Primary Treating Physician; Interpreter Needed, Etc.)

§10:139 Application of Current Schedule

§10:140 Record Review Requirements

C. Procedures for Recovery of Medical-Legal Costs

§10:150 Time for Payment/Objections

§10:151 Administrative Procedures for Medical-Legal Expense Reimbursement — ADR §9794

§10:152 Lab Fees; X-Rays; Diag. Tests — ADR §9794(a) (1), LC §5307(1)

§10:153 Required Billing Procedure — ADR §9794(a)(2)

§10:154 Objections

LIENS, MEDICAL-LEGAL

COST PETITIONS

10-3 Liens and Medical-Legal Cost Petitions

§10:155 Objections to Necessity

§10:156 Specif‌ic Grounds of Objection

§10:157 Objections Based on Violation of LC §4628

§10:158 Data to Be Returned by Physicians and Claims Administrators — ADR §9794(i)

§10:159 [Reserved]

§10:160 [Reserved]

§10:161 Medical-Legal Lien Claims

§10:162 Penalty and Interest on Unpaid Portion Only

§10:163 Penalty and Interest Payable to Lien Claimant Provider — Not Employee

§10:164 LC §4622 Penalty and Interest Applicable to Litigation Expense, Not Self-Procured Treatment Expense

§10:165 Compare Jurisdictional Objections

§10:166 Provider’s Rights Against Employee — Spalenka; Zepeda

§10:167 Medical-Legal Costs Recoverable Only By Employee/Dependents

§10:168 Right of Reimbursement or Restitution of Invalid Medical-Legal Costs

D. Unsuccessful Litigants’ Rights

§10:180 Employee or Dependent Status Unquestioned, But Compensation Denied on Other Grounds

§10:181 Compare Fraud

§10:182 Compare Independent Contractors and Non-Dependents

V. INDEPENDENT BILL REVIEW

§10:190 Disputes Resolved through IBR BR §§9792.5.4-9792.5.15

§10:191 IBR Procedures

VI. COST PETITIONS

§10:200 Non-Independent Bill Review Disputes

§10:201 Petition for Reimbursement of Medical-Legal Expenses

§10:202 [Reserved]

§10:203 Waiver by a Defendant

§10:204 Waiver by a Medical-Legal Provider

§10:205 Suspended Physicians or Medical Providers

§10:206 Petition for Costs

§10:207 Reimbursement for Interpreters for Medical-Legal Purposes

§10:208 Limitations on an Applicant’s Selection of Interpreters at Depositions

§10:209 Reimbursement for Copy Services for Medical-Legal Purposes

§10:210 Copy Services Contacted by Attorneys for Injured Workers Need Not Be Registered or Bonded

FORMS (ON DIGITAL ACCESS ONLY)

10.1 Notice and Request for Allowance of Lien

10.2 Supplemental Lien Form and Section 4903.05(c) Declaration

10.3 Provider’s Request for Second Bill Review

10.4 Request for Independent Bill Review

10.5 Petition for Costs for Interpreting Services (Labor Code §5811) (WCAB Rule 10545)

10.6 Notice of Intention to Order Payment of Labor Code §5811 Costs (Interpreting Services)

10.7 Order to Pay Labor Code §5811 Costs (Interpreting Services)