MEDICAL LIENS - Burden of proof–Labor Code §5705–If the lien claimant claims it provided medical treatment to the injured worker, it is obligated to show that it is licensed by the Medical Board to provide such treatment or otherwise meets the requirements of Business and Professions Code §148.1. (See Zenith Ins. Co. v. Workers' Comp. Appeals Bd. (Capi) (2006) 138 Cal.App.4th 373, 8 WCAB Rptr. 10,094.) In addition, if the lien claimant provided medical treatment under a fictitious name, it also must show that it filed a fictitious business name statement with the county clerk and that it has a fictitious name permit from the Medical Board. (See Hand Rehabilitation Center v. Workers' Comp. Appeals Bd. (Obernier) (1995) 35 Cal.App.4th 1204.) [Writ Denied]

MEDICAL LIENS - Burden of proof–Labor Code §5705–If the lien claimant does not claim that it provided medical treatment, but that it only provided the "outpatient setting" where a licensed physician provided medical treatment, it must prove either that it operated under a license issued by the Medical Board or that it is properly accredited by an approved accreditation agency as such an "outpatient setting" at the time the services were provided. (See Hand Rehabilitation Center v. Workers' Comp. Appeals Bd. (Obernier) (1995) 35 Cal.App.4th 1204.) [Writ Denied]

MEDICAL LIENS - Burden of proof–Labor Code §5705–If the lien claimant provided services under a fictitious name, it must show that it filed a fictitious business name statement with the county clerk. (See Business and Profession Code §17910.) The lien claimant would not be obligated to prove that it had a fictitious name permit from the Medical Board if it did not provide medical treatment in its own name as a clinic. (See Business and Professions Code §2285(c).) Beach Cities Surgery Center v. Workers' Compensation Appeals Board, South Bay Union School District (Jose Mora) 10 WCAB Rptr. 10,100 [Writ Denied]

MEDICAL LIENS - Outpatient surgery center fees–Although the Official Medical Fee Schedule generally does not apply to outpatient surgery facility fees, such fees must nevertheless be reasonable. The lien claimant has the burden of proof that the fees charged were reasonable and necessary. (See Kunz v. Patterson Floor Coverings, Inc. (2003) 5 WCAB Rptr. 10,024 [en banc].) Beverly Hills Center for Arthroscopic and Outpatient Surgery, LLC v. Workers' Compensation Appeals Board, Pier Construction (Rafik Der Mehrabian) 10 WCAB Rptr. 10,065 [Writ Denied]

MEDICAL LIENS - Out patient surgery center fees–Although the Official Medical Fee Schedule generally does not apply to outpatient surgery facility fees,, such fees must nevertheless be reasonable. The lien claimant ahs the burden of proof that the fees charged were reasonable and necessary. (See Kunz v. Patterson Floor Coverings, Inc. (2003) 5 WCAB Rptr. 10,024.) Beverly Hills Center for Arthroscopic and Outpatient Surgery, LLC v. Workers' Compensation Appeals Board, Pier Construction (Rafik Der Mehrabian) 10 WCAB Rptr. 10,050 [Writ Denied]

MEDICAL LIENS - Labor Code §4906(a)–No claim for medical services is enforceable, valid or binding in excess of a reasonable amount. A WCJ may determine what constitutes a reasonable amount. (See Kaiser Foundation Hospitals v. Workmen's Comp. Appeals Bd.(1974) 13 Cal.3d 20.) [In this case, the arbitrator awarded a chiropractor $4,290 for physical therapy and found an additional $19,000 in physical therapy bills to be not necessarily or reasonably required to cure or relieve from the effects of the industrial injury.] JeffreyVallandinham, D.C. v. Workers' Compensation Appeals Board, Four Seasons Resort Aviara (Raymundo Rodriguez) 10 WCAB Rptr.10,013 [Writ Denied]

MEDICAL LIENS - In this case an ambulatory surgery center billed $15,000.00 for its services for surgically implanting a spinal cord stimulator and was paid. The aupplier of the stimulator later filed a line for $54,175.00 for the stimulator that had been implanted at the surgery center. The WCJ properly rejected the employer's argument that the facility charges for the procedure that requires implantation of durable medical equipment also covers the cost of the durable medical equipment. Ocean View School District v. Workers' Compensation Appeals Board, Pinnacle Lien Services (Dolores Holm) 10 WCAB Rptr. 10,014 [Writ Denied]

LIEN CLAIMS - Medical provider liens–In a workers' compensation case, the medical provider may not pursue an employer to recover payment for service rendered above and beyond the payment it had received from Medi-Cal. (See Olszewski v. Scripps Health (2003) 30 Cal.4th 798.) Recovery Resources, Inc. v. Workers' Compensation Appeals Board (Ramon Vasquez) 9 WCAB Rptr. 10,335 [Writ Denied]

MEDICAL LIENS - Outpatient facility fees–In determining the reasonableness of an outpatient facility fee not subject to the Official Medical Fee Schedule, the Appeals Board may take into consideration a number of factors, including but not limited to the medical provider's usual fee, the usual fee of other medical providers in the geographical area in which the services are rendered, other aspects of the economics of the medical provider's practice that are relevant, and any unusual circumstances in the case. (See Gould v. Workers' Comp. Appeals Bd. (1992) 4 Cal.App.4th 1059.) Beach Cities Surgery Center v. Workers' Compensation Appeals Board, Truck Insurance Exchange (Maria Elena Flores) 9 WCAB Rptr. 10,282 [Writ Denied]

MEDICAL LIENS - In this case, the WCJ properly disallowed a nurse case manager's lien because the services were not authorized by the insurance carrier. The services were initially authorized for a period of time and then the insurance carrier notified the nurse that the services were no longer authorized. The nurse continued to provide medical management services for four years and asserted a lien for $55,160.79 Helen D. Garcia, R.N. v. Workers' Compensation Appeals Board (Reyna Lugo-Aviles), Pulitzer Publishing Company dba Napa Valley Register 9 WCAB Rptr. 10,268 [Writ Denied]

MEDICAL LIENS - Labor Code §3716(c)–The Uninsured Employers Benefits Trust Fund has no liability to pay for medical, surgical, chiropractic, hospital or other treatment, the liability for which treatment is imposed on the employer pursuant to Labor Code §4600, and which treatment has been provided or paid for by the State Department of Health Services pursuant to the California Medical Assistance Program. Rancho Los Amigos County Medical Rehabilitation Center v. Workers' Compensation Appeals Board (Hollis Wilkerson) 9 WCAB Rptr. 10,067 [Writ Denied]

MEDICAL LIENS-Outpatient surgery facility fees-Although outpatient surgery facility fees are not subject to the Official Medical Fee Schedule, any facility fee must be reasonable. In determining the reasonableness of a facility fee, the Appeals Board may take into consideration a number of factors, including but not limited to the medical provider's usual fee, the usual fee of other medical providers in the geographical area in which the services are rendered, other aspects of the economics of the medical provider's practice that are relevant, and any unusual circumstances in the case. (See Kunz v. Patterson Floor Coverings, Inc. (2003) 5 WCAB Rptr. 10,024 [en banc].) Universal Building Services v.Workers' Compensation Appeals Board, Bay Surgery Center (Roberto Yturbe) 8 WCAB Rptr. 10,159 [writ denied]

MEDICAL LIENS-Treatment must be reasonable and necessary for the lien to be approved. In this case, an MRI study showed a large posterior disc extrusion at C6-7, and the WCJ properly denied a chiropractor's lien because the chiropractic treatment was highly contraindicated and therefore not reasonably required to cure or relieve from the effects of the industrial injury. Susan Au-Yang, D.C. v. Workers' Compensation Appeals Board, Pan Pacific Hotels (Cortez Almazan) 8 WCAB Rptr. 10,196 [Writ Denied]

MEDICAL LIENS-Outpatient surgery center fees–Despite the fact that there is no Official Medical Fee Schedule for outpatient surgery center fees, the fees must be reasonable. One consideration when determining such fees is the usual fee of other medical providers in the same geographical area, which means the fee usually accepted, not the fee usually charged. (See Kunz v. Patterson Floors (2003) 5 WCAB Rptr. 10,054.) [In this case, the WCJ rejected the outpatient surgery center lien claim, which sought fees for carpal tunnel surgery that were the same fees charged by an acute care hospital.] San Antonio Ambulatory Surgical Center v. Workers' Compensation Appeals Board (Adolphe Alexander) 8 WCAB Rtpr. 10,181 [Writ Denied]

MEDICAL LIENS- Burden of proof–After an injured worker's case is settled by a compromise and release with a Thomas finding, the lien claimant has the burden of proof to show that the worker sustained an industrial injury and that the medical treatment was required to cure of relieve the effects of the industrial injury. (See The Permanente Medical Group v. Workers' Comp. Appeals Bd. (Williams) (1977) 73 Cal.App.3d 138.) Daryoush Amini, D.C. v. Workers' Compensation Appeals Board, On-Site Companies (Maricio Portillo) 8 WCAB Rptr. 10,128 [Writ Denied]

MEDICAL LIENS- Official Medical Fee Schedule–Labor Code §4603.2–Payment for medical treatment provided or authorized by the treating physician selected by the employee or designated by the employer shall be made at reasonable maximum amounts in the Official Medical Fee Schedule. (See Boehm & Associates v. Workers' Comp. Appeals Bd. (1999) 76 Cal.App.4th 513.) Thomas Hewko, D.C. v. Workers' Compensation Appeals Board, Select Machinery (Miguel Rojas) 8 WCAB Rptr. 10,131 [Writ Denied]

MEDICAL LIENS- Outpatient Surgery Facility Fees–Although the Official Medical Fee Schedule generally does not apply to outpatient surgery facility fees, such fees must nevertheless be reasonable. In order to determine the reasonableness of an outpatient surgery facility fee, the Appeals Board may take into consideration a number of factors, including but not limited to: (1) the medical provider's usual fee and the usual fee of other medical providers in the same geographical area, which means the fee usually accepted, not the fee usually charged, (2) the fee the outpatient surgery center usually accepts for the same or similar services, and (3) the fee usually accepted by other providers in the same geographical area. (See Kunz v. Patterson Floor Covering (2002) 4 WCAB Rptr. 10,124.) City of Los Angeles v. Workers' Compensation Appeals Board, Bohm Medical Group Ambulatory Surgery Center, Inc., (Bernita Boney) 8 WCAB Rptr. 10,130 [Writ Denied]

MEDICAL LIENS- An ambulatory surgical center must be properly licensed or accredited to bill or collect a facility fee. Zenith Insurance Company v. Workers' Compensation Appeals Board, Pain Intervention Therapy of San Diego and Beach Cities Surgery Center (Gilberto Capi) 8 WCAB Rptr. 10,094 ___Cal.App.4th___

MEDICAL LIENS– Welfare and Institutions Code §14124.791– Until a medical provider fully reimburses Medi-Cal, it may not recoup expenses paid since the provider has made an election of remedies to accept payment from Medi-Cal as payment in full. (See Boehm & Associates v. Workers' Comp. Appeals Bd. (Brower) (2003) 108 Cal.App.4th 137, 5 WCAB Rptr. 10,141.) St. Joseph's Hospital v. Workers' Compensation Appeals Board, California Insurance Guarantee Association (Cheryl Martin) 7 WCAB Rptr. 10,343 [Writ Denied]

MEDICAL LIEN– A medical lien is properly rejected when the physician fails to discuss the injury, the date of the injury, the cause of the condition he was treating, a diagnosis or treatment plan. David Silver, M.D. v. Workers' Compensation Appeals Board, Prudential Capital Group (Pamela Fagan) 7 WCAB Rptr. 10,317 [Writ Denied]

MEDICAL LIENS– Must an ambulatory surgical center be properly licensed or accredited to bill or collect a facility fee? Zenith Insurance Company v. Workers' Compensation Appeals Board, Pain Intervention Therapy of San Diego and Beach Cities Surgery Center (Gilberto Capi) 7 WCAB Rptr. 10,282 [Writ Granted]

MEDICAL LIENS– Medical-legal expenses– If the employer admits the employee's entitlement to all claimed benefits and is currently providing those benefits, there is no contested claim that would require medical-legal reporting. (See White v. Workers' Comp. Appeals Bd. (1960) 270 Cal.App.2d 447.) Reinherz Chiropractic, Inc. v. Workers' Compensation Appeals Board, Universal Bias & Trimming (Floridalma Castaneda) 7 WCAB Rptr. 10,267 [Writ Denied]

MEDICAL LIENS– Restitution for amounts paid for medical-legal expenses– Labor Code §4622 provides for restitution of medical-legal expenses when (1) the employer pays the medical provider that portion of his or her charges that do not exceed the amount deemed reasonable, and (2) the Appeals Board sustains the employer's position in contesting the reasonableness or necessity for incurring the expenses. Reinherz Chiropractic, Inc. v. Workers' Compensation Appeals Board, Universal Bias & Trimming (Floridalma Castaneda) 7 WCAB Rptr. 10,267 [Writ Denied]

MEDICAL LIENS– When the primary treating physician finds the employee permanent and stationary and releases the employee to return to work without restrictions, with no requirement for continuing care except for flareups, the applicant is deemed discharged from care within the meaning of California Code of Regulations, Title 8, §9785(b), and is not entitled to seek medical treatment from another physician without complying with the provisions of Labor Code §§4061 and 4062. [In this case, the attorney's letter indicating the employee was dissatisfied with current medical treatment was written 4½ months after being discharged from medical treatment by the treating physician and long after the 20-day objection period granted by Labor Code §4062(a) from the date of receipt of the permanent and stationary report of the primary treating physician.] Reinherz Chiropractic, Inc. v. Workers' Compensation Appeals Board, Universal Bias & Trimming (Floridalma Castaneda) 7 WCAB Rptr. 10,267 [Writ Denied]

MEDICAL LIENS– Reasonableness of medical provider charges–Once the lien claimant submits his or her lien as evidence, the burden of proof shifts to the defendant to provide evidence that the charges are not reasonable. (See Kunz v. Patterson Floor Coverings (2002) 3 WCAB Rptr. 10,024[en banc].) [In this case, the defendant failed to produce any evidence on which the WCJ could determine whether the surgical charges were reasonable.] Labor Ready Inc. v. Workers' Compensation Appeals Board (L.C. Johnson) 7 WCAB Rptr. 10,156

MEDICAL LIENS– When considering the reasonableness of non-scheduled medical charges, consideration must be given to a reasonable charge as the fee accepted by the medical provider, not as billed. (See Kunz v. Patterson Floor Covering (2002) 5 WCAB Rptr. 10,024 [en banc].) [In this case, a chiropractor sought a surgical assistant's fee for a spinal manipulation under anesthesia, which is not a scheduled charge. The insurance carrier did not authorize the procedure but negotiated and paid the lien of the primary treating chiropractor for the procedure. The WCJ found the reasonable value of the non-scheduled and unauthorized procedure was 20% of the amount paid to the primary treating chiropractor.] Frank Acunia, D.C. v. Workers' Compensation Appeals Board, Trinet Employer Group (Victoria Lukashevsky) 7 WCAB Rptr. 10,110

MEDICAL LIEN– Denial of request for continuance of trial– The WCJ acted properly and within her discretion when she denied the lien claimant's request for continuance of trial because the lien claimant failed to timely serve a trial subpoena on the only witness who could testify as to the reasonableness of the medical treatment provided. Amal F. Cooper v. Workers' Compensation Appeals Board, Garden Grove Unified School District 7 WCAB Rptr. 10,046

MEDICAL LIENS– Burden of proof– The defendant has the burden of proof relating to the reasonableness of the fee charged by a medical provider. Evidence may include the medical provider's usual accepted fee, the usual fee charged and accepted by similar providers in the same geographical area. In the absence of persuasive rebuttal evidence from a defendant, the billing, by itself, will normally constitute adequate proof that the fee being charged is what is usually accepted bor the services rendered. (See Kunz v. Patterson Floor Covering (2002) 5 WCAB Rptr. 10,024 [en banc].) Lumbermen's Mutual Casualty v. Workers' Compensation Appeals Board (Jesus Zuniga) 6 WCAB Rptr. 10,255

LIEN CLAIM– Welfare & Institution Code §14124.791(a) –A medical provider may recover all provider fees only after making a full refund to Medi-Cal. (See Boehm & Associates v. Workers' Comp. Appeals Bd. (Brower) (2003) 108 Cal.App.4th 137, 5 WCAB Rptr. 10,141.) [In this case, Medi-Cal and defendant entered into a settlement on the lien issue. The medical provider sought reimbursement of the balance of the bill not covered by Medi-Cal, but it had not reimbursed Medi-Cal for the amount not covered by the settlement with the defendant.] St. John's Regional Medical Center (Eulogio Rodriguez) v. Rio Farms, Fremont Compensation Ins. Co. and California Insurance Guarantee Association 6 WCAB Rptr. 10,234

MEDICAL LIENS– Labor Code §5307.1– Medical fees in excess of the Official Medical Fee Schedule– A medical provider may be paid in excess of the Official Medical Fee Schedule, if the fee is reasonable, accompanied by itemization and justified by an explanation of extraordinary circumstances related to the unusual nature of the medical services rendered. [In this case, the medical treatment by a Beverly Hills rheumatologist consisting primarily of trigger point injections, hot/cold packs, examinations and medical report writing did not constitute unusual or extraordinary medical services.] Stuart Silverman, M.D. v. Workers' Compensation Appeals Board, Hinckley & Schmitt (David Brown) 6 WCAB Rptr. 10,140

MEDICAL LIENS– Determining Reasonableness of Charges for Medical Treatment– In determining the reasonableness of any medical treatment charge that is not subject to the Official Medical Fee Schedule, the Board must take into consideration a number of factors, including but not limited to the medical provider's usual fee, the usual fee of other medical providers in the geographical area in which the services were rendered, and any unusual circumstances in the case. (See Gould v. Workers' Comp. Appeals Bd. (1992) 4 Cal.App.4th 1059.) The "usual fee" is the fee usually accepted, not the fee usually charged, because that is an aspect of the economics of a medical provider's practice in the current market. San Mateo County Transit District v. Workers' Compensation Appeals Board (Clyde Wallace) 6 WCAB Rptr. 10,059

MEDICAL LIENS– Labor Code §4603.2–Payment for medical treatment reasonably required to cure or relieve the effects of the injury shall be made by the employer within 60 days after receipt of each separate itemized billing. Any properly documented amount not paid within the 60-day period, shall be increased by 10% together with interest at the same rate as judgments in civil actions, retroactive to the date of receipt of the bill. Joseph Harty v. Workers' Compensation Appeals Board, Labor Ready 5 WCAB Rptr. 10,214

MEDICAL LIEN FOR PSYCHIATRIC TREATMENT– The determination that there is no psychiatric injury, however, does not necessarily bar any and all psychiatric treatment. If applicant's accepted industrial injury to her feet caused the need for psychiatric treatment to treat the underlying foot condition, the psychiatric treatment would be a reimbursable medical treatment expense. [In this case, the medical record did not support such a finding because the medical reports of the treating physician did not specify the body parts causing the applicant's need for psychiatric treatment and there were several body parts alleged that were found to be nonindustrial in origin.] Nestle U.S.A., Inc. v. Workers' Compensation Appeals Board (Blake Donovan) 5 WCAB Rptr. 10,183

MEDICAL LIEN– Medical-Legal Expenses– Labor Code §4622– Medical-legal costs are the liability of the defendant to prove or disprove a contested claim. [In this case, the medical lien claimant's report failure to include a discussion of the legal standard under Labor Code §3208.3 concerning the causation threshold for an alleged psychiatric injury did not obviate payment of the lien, particularly where the claim was resolved by a Compromise and Release with a Thomas finding.] ChevronTexaco Products Co. v. Workers' Compensation Appeals Board (Thomas Curtis) 5 WCAB Rptr. 10,180

MEDICAL LIENS– Medi-Cal is not precluded by Welfare and Institutions Code §14124.78 from recovering more than one-half of an injured worker's net recovery in contested workers' compensations cases that are resolved by Compromise and Release. Boehm & Associates, Lien claimant on behalf of the State of California Department of Health Services, UCSF Medical Center and Mad River Hospital (Wayne Brower) v. Workers' Compensation Appeals Board, International Union of Hotel Employees and Restaurant Employees #220. 5 WCAB Rptr. 10,141

MEDICAL LIENS– Medical service providers who accept Medi-Cal payments in contested workers' compensation cases are required by law to fully reimburse Medi-Cal for those payments as a prerequisite to recovery in contested workers' compensation cases. Boehm & Associates, Lien claimant on behalf of the State of California Department of Health Services, UCSF Medical Center and Mad River Hospital (Wayne Brower) v. Workers' Compensation Appeals Board, International Union of Hotel Employees and Restaurant Employees #220. 5 WCAB Rptr. 10,141

MEDICAL LIENS– Labor Code §4905– Where it appears in any proceeding pending before the Appeals Board that a lien should be allowed if it had been duly requested by the party entitled thereto, the Appeals Board may, without request for such lien having been made, order the payment of the claim be made, in the same matter and with the same effect as though the lien had been regularly requested. [In this case, the defendant had knowledge of extensive medical treatment prior to settlement by Compromise and Release by reason of reference to the treatment in the AME report.] Kmart v. Workers' Compensation Appeals Board (Jorge Acevedo) 5 WCAB Rptr. 10,100

MEDICAL TREATMENT LIEN– Labor Code §4600– The employer is liable only for medical treatment that is reasonably required to cure or relieve from the effects of the industrial injury. A lien claimant has the burden to establish a prima facie case that the treatment is necessary and then the burden shifts to the defendant to disprove the allowance of the lien. (See Kaiser Foundation Hospitals v. Workmen's Comp. Appeals Bd. (Keifer) (1974) 13 Cal.3d. 20.) [In this case, the prescription for an interferential stimulator failed to establish a prima facie case that it was necessary because the prescription did not justify the lien since there was no discussion of what kind of unit was contemplated, how often it was to be used, what treatment result was anticipated and why it was likely to be beneficial.] Visionquest Industries, Inc. v. Workers' Compensation Appeals Board, First Baptist Church (Lydia Mejia) 5 WCAB Rptr. 10,069

MEDICAL LIENS– Reduction of medical charges billed by a physician for treating an industrially injured worker by application of the Official Medical Fee Schedule must be supported by substantial evidence. Michael M. Sahakian v. Workers' Compensation Appeals Board, Artisan Screen Process, Inc. (Maria Cruz) 5 WCAB Rptr. 10,003

MEDI-CAL LIENS IN CIVIL ACTIONS– Government Code §985– A trial court may properly deny reimbursement of a Medi-Cal lien held by the Department of Health Services if it would result in undue financial hardship. Richard Garcia v. County of Sacramento. 4 WCAB Rptr. 10,325

MEDICAL LIENS– Charges for services rendered by medical assistants– Physicians are not precluded from hiring a medical assistant to perform adjunctive services related to their practice medicine. Such services must comply with the recognized standard of care which requires compliance with the record-keeping requirements of the Business and Professions Code and attendant regulations governing medical assistants. PM&R Associates v. Workers' Compensation Appeals Board, Zenith Insurance Company (Juan Zavala) 4 WCAB Rptr. 10,107

MEDICAL LIENS– At the MSC, the parties executed a compromise and release agreement that included defendant's agreement that the defendants' agreement to adjust or litigate the lien claims. The record in this case clearly established that defendant's were aware of the existence of the reports prepared by the lien holder and by inference the defendants were aware of the contents of the reports and the defendant's objection that the reports did not comply with notice and disclosure provisions was properly rejected. Golden Gate Bridge District v. Workers' Compensation Appeals Board (Marilyn Alvarado) 3 WCAB Rptr. 10,324

LIEN CLAIMS– Reduction of lien by Gregory Formula– Labor Code §4903.1(d)-A lien claim for lost-time benefits or medical services paid of or provided by a health care service plan, a group disability policy, a self-insured employee welfare benefit plan or service contract pursuant to Labor Code §4903.1(d) must be reduced so that the reduced lien amount bears the same ration to the full lien claim that the applicant's actual recovery bears to the applicant's potential recovery. (See Kaiser Foundation Hospitals v. Workers' Comp. Appeals Bd. (Gregory) (1978) 87 Cal.App.3d 336.) Blue Cross of California v. Workers' Compensation Appeals Board (Jeanette Blofsky) 3 WCAB Rptr. 324

LIEN CLAIMS– Burden of proof– When a compromise and release is approved, there is a presumption of industrial causation of injury. The exception to this rule is when there is a Thomas finding [good faith issue as to whether the applicant sustained an industrial injury], and a nominal settlement then the burden shifts to the lien claimant to establish a prima facie showing of industrial causation. [In this case the compromise and release was in the amount of $200,000 and the defendant failed to offer any evidence to support a finding of what the probable full value of the case would have been.] Target Stores v. Workers Compensation Appeals Board (Carlene Ulrich) 3 WCAB Rptr. 10,294

MEDICAL TREATMENT– MEDICAL BILLS– Proper procedure for objections to medical bills-Cal.Code. Regs, Title 8 §9792.5– When a medical provider submits a statement for services using a CPT code which does not have a unit value assigned, such an unlisted service or one that is rarely provided, unusual or variable , may require a report that demonstrates the medical appropriateness of the service. Bloch Medical Clinic v. Workers' Compensation Appeals Board (Bernice Lowery) 3 WCAB Rptr. 10,243

MEDI-CAL LIENS– Welfare and Institutions Code §14124.791– The federal law governing the Medi-Cal program requires that every provider of health services that accepts Medi-Cal payments for the patient must agree not to seek further payment from the patient. Therefore, Welfare and Institutions Code §14124.791, which permits a health care provider to file a lien against a patient's recovery from a third party tortfeasor, is in valid because it is preempted by federal law. Cimmaron Olszewski v. Scripps Health et.al., 3 WCAB Rptr. 10,166

MEDICAL LIEN– Labor Code §3202.5– The entire medical lien for psychological treatment was properly disallowed because none of the medical reports found a need for any psychological treatment and there was absolutely no testimony from the applicant that the psychological treatment rendered by the lien holder was beneficial in any way. Linda Grant v. Workers' Compensation Appeals Board, City of Visalia 3 WCAB Rptr. 10,046

MEDICAL CAUSATION– Burden of proof on medical causation– The injured worker has the burden to prove it is more probable than not that his disability was work-related. [In this case the injured worker showed that it was more probable than not that the industrial chemicals to which he was exposed caused his premature onset of Parkinson's Disease. Texaco Services, Inc. v. Workers' Compensation Appeals Board (James Oblak) 4 WCAB Rptr. 10,069