February 05, 2010: February Collection
Newsletter

January 25, 2010: California Insurance
Commissioner Steve Poizner today
announced that Bellflower-based Staffing
Services Inc. has been ordered by the Los
Angeles County Superior Court to pay $20
million in restitution after a plea bargain
was reached Jan. 15 in a workers'
compensation insurance fraud case.

January 11, 2010: Insurance
Commissioner Poizner Announces
Morgan Hill Couple Arrested
for Not Carrying Workers' Comp Insurance
at Local Cafe

January 11,2010: After the administrative
director adopted the Jan. 1, 2010
DMEPOS fee schedule update, Medicare
adopted a new fee schedule file which
revises two codes, E1405 and E1406. The
update includes all changes adopted in
the Dec. 2, 2009 order and the two code
revisions.  The order is effective for
services on or after Jan. 1, 2010. The
order can be found at http://www.dir.ca.
gov/dwc/OMFS9904.htm#3 .

January 05, 2010:  Division of Workers’
Compensation administrative director
issues clarification of utilization review
audit measures due to Cervantes decision

December 30, 2009:  Adjustments to the
pathology and clinical laboratory section
of the Official Medical Fee Schedule to
conform to the changes in the Medicare
payment system are posted on the DWC
Web site

December 15, 2009:  $193,000 In Federal
Stimulus Funds Awarded For Training
Health Professionals in Community Clinics

December 14, 2009:  Mileage rate for
medical and medical-legal travel
expenses will decrease Jan. 1, 2010

December 13, 2009:  Collection
Newsletter for December 2009 published

December 09, 2009:  INSURANCE
COMMISSIONER POIZNER ANNOUNCES
ARREST OF PRUNEDALE WOMAN ON
WORKERS’ COMPENSATION FRAUD,
ELDER ABUSE CHARGES

December 09, 2009: INSURANCE
COMMISSIONER POIZNER ANNOUNCES
ANALYSIS REVEALS RELATIVELY-
STABLE WORKERS’ COMP RATES FOR
2010

December 07, 2009:  Adjustments to the
DMEPOS section of the Official Medical
Fee Schedule to conform to changes in
the Medicare payment system are posted
on the DWC Web site

December 02, 2009:  Commissioner
Poizner Calls for Complete Divestment,
Subpoenas 10 Insurance Companies that
Failed to Respond to Data Call

Insurance Commissioner Steve Poizner
today announced that insurance
companies licensed to do business in
California have admitted to holding $12
billion in investments in companies that
do business with the Iranian energy,
nuclear, banking and defense industries.

November 30, 2009:  Division of Workers’
Compensations administrative director
announces 2010 profile audit review and
full compliance audit performance
standards

November 19, 2009: En Banc Decision

(1) when a treating physician
recommends spinal surgery, a defendant
must undertake utilization review (UR); (2)
if UR approves the requested spinal
surgery, or if the defendant fails to timely
complete UR, the defendant must
authorize the surgery; (3) if UR denies the
spinal surgery request, the defendant may
object under section 4062(b), but any
objection must comply with AD Rule
9788.1 and use the form required by AD
Rule 9788.11; (4) the defendant must
complete its UR process within 10 days of
its receipt of the treating physician’s
report, which must comply with AD Rule
9792.6(o), and, if UR denies the requested
surgery, any section 4062(b) objection
must be made within that same 10-day
period; and (5) if the defendant fails to
meet the 10-day timelines or comply with
AD Rules 9788.1 and 9788.11, the
defendant loses its right to a second
opinion report and it must authorize the
spinal surgery.

November 14, 2009: Govt: Medicare paid
$47 billion in suspect claims

November 09, 2009: Insurers Continue to
Ignore Readily-Available Cost Controls,
Commissioner Poizner Says Insurance
Commissioner Steve Poizner today
declined a second consecutive request
by the Workers Compensation Insurance
Bureau (WCIRB) to increase the Workers'
Compensation Claims Cost Benchmark.

October 29, 2009: Notice of rulemaking
and public hearing regarding proposed
changes to Workers’ Compensation
Information System rules /  rules part of
Division of Workers’ Compensation 12-
point plan to control medical costs

October 29, 2009: Insurance
Commissioner Poizner Announces Guilty
Pleas in Orange County Workers' Comp
Fraud Cases Totalling $6.7 Million

October 16 2009: The Legislative
Analyst's Office has just issued the
following report:
Workers’ Compensation: Recent
Decisions Likely to Increase Benefits and
Employer Costs

October 12, 2009:  Two Bills signed into
law that directly affect Medical Providers  
SB - 186 and AB - 361  
Authorization and pre designation read
BILL ANALYSIS  at the end of each bill.

October 11, 2009: Panel Decision Lack of
UR establishes medical necessity --
republished

October 01, 2009:  Division of Workers'
Compensation Sacramento district office
moves to new location effective Oct. 12

September 25, 2009: Panel Decision
Sanctions Against Lien Claimant for
Failure to Appear

September 25, 2009:  Dismissal Order of
Premier Medical Liens

September 15, 2009:  Division of Workers’
Compensation posts order determining
that changes to billing requirements for
pharmacies billing the Medi-Cal program
are inapplicable to workers'
compensation claims

September 03, 2009:  En Banc

Wanda Ogilvie v. City and County of San
Francisco, Permissibly Self-Insured

The Appeals Board stated further that the
individualized DFEC adjustment factor
must be consistent with section 4660(b)
(2), the RAND data to which section 4660
(b)(2) refers, and the numeric formula
adopted by the Administrative Director
(AD) in the 2005 Schedule, and  it also
must constitute substantial evidence that
the Workers’ Compensation Appeals
Board (WCAB) determines is sufficient to
overcome the DFEC adjustment factor
component of the scheduled permanent
disability rating.  Otherwise, the prior
decision was affirmed.

September 03, 2009:  En Banc
Joyce Guzman v.Milpitas Unified School
District, Permissibly Self-Insured;
Keenan & Associates

and

Mario Almaraz v. Environmental
Recovery Services (aka Enviroserve);
State Compensation Insurance Fund

The Appeals Board stated further that in
light of these holdings, it now specifically
rejects the “inequitable, disproportionate,
and not a fair and accurate measure of the
employee’s permanent disability”
standard set forth in its February 3, 2009
opinion.

August 27, 2009:  INSURANCE
COMMISSIONER STEVE POIZNER TO FILE
LAWSUIT TO STOP UNCONSTITUTIONAL $1
BILLION SALE OF SCIF ASSETS   

August 21, 2009:   Notice of rulemaking
and public hearing for amendments to
medical provider network, employee
information and workers’ compensation
claim form and notice of potential
eligibility regulations

August 20, 2009: Health Professions
Education Foundation Awards $1.5 Million
in Grants for Physicians to Improve
Access to Healthcare in Underserved
Areas

August 19, 2009:   Insurance
Commissioner Poizner Announces Arrest
of Diamond Bar Man in $1.4 Million
Workers' Comp Fraud Case

August 19, 2009: Crackdown on workers'
comp billing fraud is dealt a setback
Lien Claimants Are Getting Issued “Notice of
Intention To Dismiss Lien Claim” For Failure to
Appear At Hearings Other Than Lien Hearings.

June 29, 2009 -Republished
by Richard J Boggan JD

I have been receiving at lest three to four requests
a week in the last two months from different
medical providers (Lien Claimants) who have
received a “Notice of Intention To Dismiss Lien
Claim” for failure to appear at various hearings,
other then Lien Conferences and or Lien Trials
who have requested a drafted response.
1
CASE LAW SELF-PROCURED MEDICAL
TREATMENT AND MPNs (Medical Provider
Networks)

June 12, 2009 - Republished

Bruce Knight, United Parcel Service; and
Liberty Mutual Insurance Company
October 10, 2006  71 Cal. Comp. Cases
1423





Department of Industrial Relations - DIR
Frequently asked questions
http://www.dir.ca.gov/faqslist.html

Division of Workers' Compensation -
Electronic Adjudication Management
System (EAMS) - Filing Liens etc.,
http://www.dir.ca.gov/dwc/eams/eams.htm

Division of Workers' Compensation -
Official Medical Fee Schedule (OMFS)
http://www.dir.ca.gov/dwc/OMFS9904.htm
“Notice of Intention To Dismiss Lien Claim”
For Failure to Appear At Hearings Other
Then Lien Hearings.       

California Medical Providers Mystified By
MPNs (Medical Provider Networks)      

MPNS (MEDICAL PROVIDER NETWORK)
AND SAMPLE RESPONSES    

GETTING PAID FOR NON-INDUSTRIALLY
CAUSED INJURY   

DENIED CLAIMS AND SELF-PROCURED
MEDICAL TREATMENT
(CORRECTED)        

DISCOVERY, THE NEED TO RESPOND   

LACHES, DOCTRINE OF –    

GETTING PAID FOR NON-INDUSTRIALLY
CAUSED INJURY   

RESPONDING TO "NOTICE OF
INTENTION TO DISALLOW LIEN"    

MPNS ( Medical Providers Networks)    

Cal Lab Code § 4903.5 (2008) Should
there be a "Tolling of The Statute of
Limitations"    

GETTING PAID AFTER  24-VISIT CAP ON
PHYSICAL MEDICINE    

DURABLE MEDICAL EQUIPMENT AND
OUTPATIENT SURGERY BILLING   

SUCCESS OF SELF-PROCURED
TREATMENT   

FICTITIOUS-NAME PERMIT    

Psychiatric Treatment - Getting Paid    

DISCOVERY, THE NEED TO RESPOND

California Labor Code Section 4609 PPO
Contracts in Workers Comp
WE RECOMMEND
24-VISIT CAP ON PHYSICAL MEDICINE and AB
1073

July 19, 2009
workcompliens.com
The goal is to ensure that   injured employees who
have to undergo surgery to repair their  injuries are
never left in a situation where appropriate physical
medicine services such as physical therapy are  
unavailable due to the 24-visit cap.  
Decided December  16, 2008
HERTZ CORPORATION, Petitioner, v.
WORKERS’ COMPENSATION APPEALS BOARD
and MANUEL AGUILAR, Respondents.  
H032438  (W.C.A.B. Nos. SJO226456,  
SJO228891, SJO235420) SIXTH APPELLATE
DISTRICT  Filed 12/16/08

Respondent Manuel Aguilar sustained specific
and cumulative injuries to both of his knees,
shoulders and wrists, and to his right ankle while
working as an auto washer for petitioner Hertz
Corporation (Hertz).  Due to Aguilar’s injuries and
his inability to read and write English, the workers’
compensation judge (WCJ) found him to be non-
feasible for vocational rehabilitation and thus
permanently totally disabled.  Respondent
Workers’ Compensation Appeals Board (the
Board) affirmed the WCJ’s decision and award.  
Hertz petitions for review of the Board’s decision,
contending that an employer should not be
liable for permanent total disability benefits when
an injured worker’s inability to participate in
rehabilitation is due, in part, to nonindustrial
causes.
Decided May 11, 2009    COAST PLAZA
DOCTORS HOSPITAL, v .BLUE CROSS OF
CALIFORNIA et al.,   No. B205892, Cal. App.,
2nd Dist, May 11, 2009  
"Third, section 1371.4 alters the scope of
permissible bargains between the insurer and
insured by telling them what bargains are
acceptable and what bargains are
unacceptable.  (Miller, supra, 538 U.S. at p. 338;
Benefit Recovery Inc. v. Donelon (5th Cir. 2008)
521 F.3d 326, 331 [state law that tells parties
what bargains are acceptable in an insurance
contract substantially affects risk pooling
arrangement].)  Section 1371.4 tells the insurer
and insured that they cannot enter into a bargain
whereby the insurer only pays for emergency
services rendered by providers inside the insured’s
network. "
Tolling of The Statutory Filing of Liens
July 19, 2009
workcompliens.com
"To the extent that the WCJ finds that the notice
described in Labor Code § 4904(a) was given to
the defendant, we find that the defendant was
required to comply with WCAB Rules 10886,
10888, and 10890. Pursuant to Labor Code §
4904(a), When a defendant has been given written
notice ''setting forth the nature and extent of any
claim that is allowable as a lien,'' a lien is created
in favor of the claimant. WCAB Rule 10886
explicitly requires a defendant to serve a lien
claimant with a compromise and release when a   
lien has been served on the defendant regardless
of whether the lien claim has been filed with the
WCAB. We also note that Rules 10888 and 10890
are not limited in their application to lien
claimants who have filed their liens with the
WCAB.".................
Decided July 16, 2009
Cantrell v. WCAB (Wal-Mart Stores)      

PDF /   WORD DOC
Unpublished Decision. FIFTH APPELLATE
DISTRICT F057606 Filed 7/16/09

Whether Wal-Mart’s drug testing policy
discriminated against Cantrell as an industrially
injured worker and if so, whether its conduct in
implementing and applying the policy was
necessary and directly linked to the realities of
doing business.                 
Durable Medical Equipment, Prosthetics, Orthotics,
and Supplies When billing for Out-Patient Surgery-

July 28, 2009

Section 9789.38 adopts the federal regulation (42
C.F.R. § 419.2) which addresses the practices of
outpatient facilities. It does not address the
providers of durable medical equipment or restrict
the number of mechanisms for billing for durable
medical equipment that is implantable.

Ocean View School Dist. v. Workers' Comp.
Appeals Bd., 72 Cal. Comp. Cas. (MB) 1683 (Cal.
App. 2d Dist. 2007

A provider of Durable Medical Equipment,
Prosthetics, Orthotics, and Supplies who bills for
the equipment can  file a lien and get paid
regardless of claim that it should be included in
"Outpatient Billing".

"In this case it is the equipment provider's billing
and lien that is in issue. A restriction on the surgery
center cannot automatically be applied to bar
recovery from a medical provider that is not subject
to that regulation."
Failure to Perform  Utilization Review Makes
Medical Necessity Issues Moot

July 29, 2009

State Comp. Ins. Fund v. Workers' Comp. Appeals
Bd., S149257, SUPREME COURT OF
CALIFORNIA, July 3, 2008, Filed

Download in Work Doc        ///     Download in PDF

“The insurer referred the matter for utilization
review but did not communicate its decision within
the 14-day statutory deadline set forth in § 4610,
subd. (g)(1). A workers' compensation judge found
that the insurer's failure to comply with the
statutory deadlines precluded it from relying on the
utilization review process or on its doctor's report to
deny the requested treatment”

“Thus, employers and their insurers could not use §
4062 as an alternative method for disputing
employees' treatment requests. Only an employee
could use the provisions of § 4062 to resolve a
dispute over a treatment request; an employer
could not do so.”
Lien Claimant requested authorization and
utilization review a response was not given within
the time frame allowable which precluded defense
from relaying on any medical reports to deny
treatment.         
About UR and causation decisions:

A denial issued directly from the reviewing
physician or URO to the primary treating physician
on causation grounds alone  could be found in
violation of 8 CCR § 9792.6(s), §  9792.9(j) and
probably §  9792.9(l), as well as the express wording
of Simmons, which states the UR reviewing
physician does not have the authority to determine
causation.
Psychiatric Treatment - Getting Paid

There exists several aspects of psychiatric injury
and or psychiatric treatment.  There is the
claimed psychiatric injury from events that
happened at work (i.e., harassment, stress, etc.,)
and there is psychiatric injury due to the industrial
injury itself (sudden and extraordinary events) and
the most widely used is the psychiatric treatment
for the consequence of being injured (i.e., treating
the consequence of the orthopedic injury or pain
management).

The law recognizes that the consequence of not
working due to an industrial injury, and suffering
the financial and related effects of an orthopedic
injury does cause the need for psychiatric
treatment that is the result of the industrial injury
and therefore the treatment reasonable and
necessary. County of Contra Costa v. Workers'
Compensation Appeals Bd., 2005 Cal. Wrk. Comp.
LEXIS 294; 70 Cal. Comp. Cases 1496 (Cal. App.
1st Dist. 2005)
WORK COMP NEWS  
August 24, 2009:     // UR By DWC Education

UR and denied injury

The Lien Claimant, made a request for
authorization and the defendants did not perform
utilization review. The defendants are required to
perform a utilization review when a request for
authorization is made, even if the claim or body
part is denied. Simmons v. California, 70 Cal.
Comp. Cas. (MB) 866 (W.C.A.B. 2005)
WORK COMP CASES
Published August 21, 2009

CERTIFIED FOR PUBLICATION

LANCE BAUR,  Petitioner,   v.WORKERS’
COMPENSATION APPEALS BOARD and CITY
OF STOCKTON, Respondents.   THIRD
APPELLATE DISTRICT C061042(Super. Ct. Nos.
STK0191710, ADJ2866919)

In this case, petitioner Lance Baur, a police
officer employed by respondent City of Stockton
(the city), was injured on the job during an
altercation with suspect Richard Thomas Beck.  
The city provided Baur workers’ compensation
benefits.  Baur then filed a lawsuit against Beck,
but Beck’s insurance company was insolvent.  As
a result, Baur settled his lawsuit with the
California Insurance Guarantee Association
(CIGA).   The city then claimed a credit pursuant
to Labor Code section 3861, up to the amount of
the net settlement, against its liability for future
workers’ compensation benefits.  A workers’
compensation administrative law judge granted
the credit.
Published August 17, 2009

Lawrence Weiner  v.Ralphs Company,
Permissibly Self-Insured; and Sedgwick Claims
Management Services, Inc. (Adjusting Agent)
August 17, 2009 Case No. ADJ347040 (MON
0305426) 74 Cal. Comp. Cases

The Appeals Board denied applicant’s petition
for reconsideration of its en banc opinion of June
11, 2009
Published October 05, 2009

Catholic Healthcare etc. v. CIGA 10/5/09

Accordingly, we interpret the phrase “original
claimant under the insurance policy in his or her
own name” to include Catholic Healthcare West
because it is the continuation of an original
insured.  Specifically, (1) Catholic Healthcare
West is the entity continuing Mercy Hospital
Bakersfield’s corporate activities, (2) it is
continuing Mercy Hospital Bakersfield’s actual
operations, and (3) the 2001 mergers merely
reorganized the structure of a family of
corporations and did not expand or otherwise
change the ownership of the operations.  Based
on these factors, Baxter is distinguishable.  We
regard this decision as creating a narrow
exception to the principles established by
Baxter.  (Baxter, supra, 85 Cal.App.4th at p 306.)
6.        Assignee
CIGA also contends that Catholic Healthcare
West is an assignee of an original insured and
thus excluded from coverage by the language in
section 1063.1, subdivision (c)(9) that states a
covered claim “does not include any claim
asserted by an assignee .…”  In Baxter, the court
concluded that BHC was an assignee because
substantially all of the assets of AHSC were
transferred to a predecessor corporation pursuant
to a document titled “Assignment and
Assumption.”  (Baxter, supra, 85 Cal.App.4th at p.
309.)  In this case, the record does not contain
an assignment document.  Furthermore, we will
not interpret the word “assignee” so broadly as to
include the surviving corporation of the mergers
that occurred in this case.  Doing so would
defeat, rather than promote, the legislative
purpose of the statute.
7.        Conclusion
Based on the foregoing interpretation of section
1063.1, subdivision (c)(9)(B), CIGA is not entitled
to summary judgment on Catholic Healthcare
West’s cause of action against CIGA for
reimbursement.  
October 11, 2009

8 CCR 10240 (2009)
§ 10240.  Appearances Required

(a) All parties and lien claimants shall appear at all
hearings, except as provided below:
COLLECTION
PUBLICATIONS  
Discovery at Deposition

November 07, 2009

California Workers' Compensation Appeals Board in  
Maria Sandoval vs. Dollar Cleaners / State
Compensation Insurance Fund ADJ3447741 (OAK
02828060) denied defendants petition for removal,
for medical provider refusing to answer a discovery
question during a deposition. The Court held the
provider did not have to answer the question, as it
was irrelevant and not likely to lead to discoverable
evidence on  the denial for petition for removal  
dated August 13, 2009.

Read More...........
November 22, 2009:  NOT PERFORMING
UTILIZATION REVIEW WHEN TREATMENT IS
REQUESTED MEANS TREATMENT IS AUTHORIZED.

By www.workcompliens .com
November 22, 2009

Through SB 228 many changes in the Workers
Compensation Procedures were enacted, from fee schedule
for outpatient surgery to Utilization Review.


The Courts continually are giving attention to Utilization
Review Process and have been persistent in their quest to
ensure that employers / insures perform utilization review to
achieve the ultimate goal of more efficient and expedite
medical treatment for the injured worker. Accordingly, the
implicit legislative purpose in establishing UR was to create
an expeditious and inexpensive method to assess treating
physician’s medical treatment recommendations.. Read More
Satisfaction Guaranteed, if not
satisfied return within 30 days
for a full  refund.  
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CALIFORNIA WORKERS COMPENSATION COLLECTIONS FOR LIEN CLAIMANT
REPRESENTATION AND MEDICAL PROVIDERS
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For Complete List Of Lien Claimant
Issue Booklets Follow Link
"Collection Issue Booklets Complete
List"
  • POINTS AND AUTHORITIES FOR CIGA ON ASSIGNED / COVERED CLAIMS
AND LEGISLATIVE HISTORY OF AB 1310 (1969) CREATING CIGA
  • UTILIZATION REVIEW AND MEDICAL NECESSITY
  • DURABLE MEDICAL EQUIPMENT AND MEDICAL NECESSITY
Richard J Boggan J.D. / email link
January 22, 2010: : CIGA on Assigned Claims

Black Diamond Asphalt, Inc. v. Superior Court, 114
Cal. App. 4th 109, 7 Cal. Rptr. 3d 466, 2003 Cal.
App. LEXIS 1827, 2003 Cal. Daily Op. Service
10641, 2003 D.A.R. 13420 (Cal. App. 3d Dist. 2003

“Under the unambiguous language of the statutory
scheme, an original claimant can be any person
(other than an insurer) instituting a liability claim
within the coverage of the policy, provided that he
or she does so in his or her own name and not
through assignment or by right of subrogation. (§
1063.1, subds. (c)(1), (c)(9), (g).) Because Black
Diamond wishes to make a liability claim in its own
name and for its own benefit, section 1063.1,
subdivision (c)(9), does not exclude the claim from
coverage and does not preclude Black Diamond
from pursuing a claim against Adames for
indemnity.”
COLLECTION ISSUES TO BE AWARE
OF for Lien Claimants / Medical
Providers  -- over 50 pages --

Overview on how the system works and
how to get paid

  • Helpful hints for collectors
  • How to maximize collections
  • What tools are you have to
    collect more revenue
  • Issues Regarding Collections
  • Case Law
  • Statutory Law
  • and more
MPNs (Medical Provider Networks)
Collections Booklet for
Lien Claimants / Medical Providers    
  • Contains, helpful hints on how to
    collect when treating outside the
    MPN.
  • Several cases that show when
    providers get paid when treating
    outside an MPN
  • Statutory Regulations and how
    they apply
  • Several sample appeal letters
  • Trial Brief on the issue
  • Article on the issue
  • and more
SELF-PROCURED MEDICAL TREATMENT
Collections Booklet  for Lien Claimants /
Medical Providers    -- 26 pages -- plus
attached flow chart

  • Contains helpful hints on self-
    procured medical treatment
  • How lack of Utilization Review
    establishes medical necessity
  • How a "Thomas Finding" effects
    medical payments
  • Usual and Customary Fees for
    denied cases
  • Flowchart
  • Sample trial briefs
  • Case Law
  • Statutory Law
  • and more
RESPONDING TO NOTICE OF
INTENTION TO DISALLOW LIEN CLAIM
Collections Booklet for Lien Claimants /
Medical Providers    --  15 pages --

  • Contains helpful hints for
    responding to Notice of
    Intention to Disallow
  • Three sample responses with
    detail instructions
  • Case Law
  • Statutory Law
  • Article
  • and more
HOW TO PREPARE A TRIAL BRIEF
Collections Booklet for Lien Claimants /
Medical Providers    -- 19 pages --

  • Contains helpful hints on how to
    prepare a Trial Brief
  • Three sample Trial Briefs on
    Lien Claimant issues
  • Detail instructions as to each
    element of a Trial Brief
  • and more
PREPARING A PETITION FOR
RECONSIDERATION Collections Booklet
for Lien Claimants / Medical Providers
--17 pages --

  • Contains helpful hints on how to
    prepare a Petition For
    Reconsideration
  • Several  samples, of actual  
    petitions
  • Detail instructions as to each
    element
  • Petitions for Removal
  • and more
Cal Lab Code § 4903.5 (2008)
"Tolling of The Statute of Limitations"
for Lien Claimants / Medical Providers

  • Contains helpful hints on
    "Tolling The Statutory Time
    Limit for Filing Liens"
  • Case Law
  • Statutory Law
  • Trial Briefs
  • Sample appeal letters
  • Laches arguments
  • and more
Psychiatric Injury and Pain
Management for Lien Claimants /
Medical Providers
-- 20 pages --

  • Contains, helpful hints on how
    to collect when treating for
    psychiatric injury.
  • How Utilization Review effects
    medical necessity
  • Exception for 6 month
    employment rule
  • Statutory Regulations and how
    they apply
  • Trial Brief on the issue
  • Article on the issue
  • and more
OVERVIEW OF COURT PROCESS for
Lien Claimants / Medical Providers
  • Helpful Hints
  • Where to get information
  • Court Rules and procedures
GETTING PAID AFTER 24-VISIT CAP
ON PHYSICAL MEDICINE
for Lien Claimants / Medical Provider
  • Contains, helpful hints on
    how to collect when treating
    over 24 cap
  • Case Law
  • Statutory Regulations and
    how they apply
  • Trial Brief on the issue
  • Article on the issue
  • and more
UTILIZATION REVIEW AND
AUTHORIZATION WHAT MUST BE
DONE
GETTING PAID USUAL AND
CUSTOMARY FEES
For Complete List Of Lien Claimant
Issue Booklets Follow Link
"Collection Issue Booklets Complete
List"
Orange v. FST Sand & Gravel, Inc., 63 Cal. App.
4th 353, 73 Cal. Rptr. 2d 633, 1998 Cal. App.
LEXIS 353, 98 Cal. Daily Op. Service 2983, 98 D.
A.R. 4037 (Cal. App. 4th Dist. 1998)

“The acid test of statutory interpretation based on
principles of statutory construction is always
whether the interpretation yields an absurd result.”

American Nat. Ins. Co. v. Low, 84 Cal. App. 4th
914, 101 Cal. Rptr. 2d 288, 2000 Cal. App. LEXIS
859, 2000 Cal. Daily Op. Service 9023, 2000 D.A.
R. 11961 (Cal. App. 2d Dist. 2000

“The meaning of a statute may not be determined
from a single word or sentence; the words must be
construed in  context, and provisions relating to
the same subject matter must be harmonized to
the extent possible. . . . An interpretation that
renders related provisions nugatory must be
avoided."


St. Joseph’s Hospital v. Workers’ Compensation
Appeals Bd., 70 Cal. Comp. Cas. (MB) 1612 (Cal.
App. 1st Dist. 2005) the Court held as follows:

“With regard to the lien of St. Joseph’s Hospital,
the WCAB stated that reasonable charges for
treatment that relate to Applicant’s injury would
constitute a ‘’covered claim’’ within the meaning
of Insurance Code § 1063.1.”
For Complete List Of Lien Claimant Issue Booklets Follow Link
"Collection Issue Booklets Complete List"