California Work Comp News,
Issues, Articles Daily
July 25, 2014: Significant Panel Decision
Posted; July 24, 2014:


Where the defendant had unilaterally
terminated nurse case manager services to the
injured worker, the Appeals Board affirmed
the WCJ’s award reinstating those services,
holding as follows:
1.The provision of a nurse case manager is a
form of medical treatment ..."

2.An employer may not unilaterally cease to
provide approved nurse case manager services
when there is no evidence ..."
3.Use of an expedited hearing ..."

4.It is not necessary for an injured worker to
obtain a Request For Authorization ..."

July 25, 2014:DWC Commences Rulemaking
Action to Delay ICD-10 Implementation
Until October 1, 2015

July 25, 2014: Article:
California: Has the Tail of the Lion
(Providers) Been Pulled Once Too Often:
SB863, From IMRs to Medical Legal Disputes
?

July 24, 2014: Article:

Cure or Relieve, Someone Forgot to Send the
Memo to the IMR Reviewers: Why the IMR
Process is using the Wrong Guidelines

July 24, 2014: Decision Trial Judges States
IMRs Defective Wrong  Guidelines


July 23, 2014: Article:
California: Pharmacy Prescription Compound
Drugs, Where Are We in Workers Comp?

July 22, 2014: Education:
Sample  PETITION BY NON-PHYSICIAN
LIEN CLAIMANT FOR MEDICAL
INFORMATION.”

July 21, 2014:  Series: Set of 13 of
Articles on Appearing at WCAB
CALIFORNIA WORKERS COMPENSATION COLLECTIONS
PUBLICATIONS AND INFORMATION FOR MEDICAL PROVIDERS AND
LIEN CLAIMANTS
All States Work Comp News,
Issues, Articles Daily
July 23, 2014: Connecticut News:
The claimant also emphasizes that she
was unaware of her obligation to file a
timely written notice of claim. That
fact is indeed unfortunate. Our system
of jurisprudence has long embraced the
legal maxim that everyone is presumed
to know the law and ignorance of the
law is not an excuse.

July 23, 2014: Arkansas Case Law:
Because the employer did not follow
procedure in filing an accident
report providing the claimant with an
AR-N , treatment with Dr.’s
Crowell did not require the respondent’
s permission.

July 17, 2014: Iowa News:
HEARING REPORT AND ORDER
APPROVING SAME HAS BEEN
AMENDED

July 17, 2014: Illinois News:
Commission increases certain
Evaluation and Management amounts

July 17, 2014: Florida News:
CFO Jeff Atwater Announces Dozens of
Identity Theft and Workers’
Compensation Fraud Arrests at Collier
County Business

July 17, 2014: Connecticut News:
2014 Official Connecticut Practitioner
Fee Schedule will reflect all changes to
the 2013 schedule. This new schedule
will include revisions and clarification of
some rules, and the new 2014 CPT®
codes. This new publication will be
effective for medical services rendered
on or after July 15, 2014, regardless of
the date of injury, that are payable to
health care providers authorized or
permitted to render care under the
Connecticut Workers’ Compensation
Act.
July 10, 2014: 3 Additional IBR Decisions Posted
Bringing total to 11 and 22 overall stating 82486 to be
paid under G0431 at $119.94. ****

June 24, 2014: IBR Decision:
PPO Discount does not apply to medical legal services


May 28, 2014: IBR Decision PPO Issue:
Explanation of review (EOR), the Claims Administrator
made a payment of $2,850.00, and applied a PPO
discount of $3,527.81. MAXIMUS requested a copy of
the PPO contract. The PPO contract was not received.
It does not appear the PPO discount was applied to the
correct OMFS Inpatient Hospital Allowance for the
DRG 491. . The additional reimbursement of $9,597.51
is warranted per the Official Medical Fee Schedule
Inpatient Hospital Fee Schedule DRG code 491


May 26, 2014: IBR Decision:
The dispute regards the payment for surgical facility
services on date of service 3/13/2013. The facility
services were billed on a UB-04/CMS1450 using revenue
codes for services and supplies related to CPT 29881,
CPT 29876, CPT 29870 Modifier 51, CPT 29884
Modifier 51, CPT 20680, CPT 27570 Modifier 51and
CPT 20610. The Provider was reimbursed $4,865.09
and is requesting additional reimbursement of $1,049.35.
The Claims Administrator reimbursed $4,865.09 for the
following billed procedure codes: 29881, 29876, 29870,
20680, 27570, S0020, E0114 and 81025. The Claims
Administrator denied the billed procedure code 20680
with the explanation “Post –op pain management is
included in the global surgical package." The Claims
Administrator denied the billed procedure code 29884
Modifier 51 with the explanation “This separate
independent procedure is considered an integral part of
the total services performed and does not warrant a
separate charge.”
The Provider is disputing the denial of CPT codes
20610 and 29884 Modifier 51.


May 26, 2014: IBR Decision:
Outpatient Surgery: This decision was based on OMFS
Outpatient Hospital Fee Schedule, National Correct
Coding Initiative/Outpatient Code Editor and
comparison with explanation of
May 19, 2014: IMR Decision:
Frovatriptan 2.5mg determined medically necessary

May 01, 2014: IMR Decisions Pain Management
Medically Necessary

April 21, 2014: IMR Decision:
Psych Consult Not Medically Necessary

April 14, 2014: Recorded Lecture on process

March 31, 2014: En Banc
Defective UR to WCAB Failure to review all medicals

March 10, 2014: IMR Decision:
Spinal Fusion not Medically  Necessary

February 16, 2014: IMR Decision:
Urgent PET scan of the brain is not medically necessary
and appropriate.

January 27, 2014: IMR Decision:
Determine Psychiatric Evaluation and Treatment
necessary for spinal injury

January 26, 2014: DWC Presentation on
Authorization, UR and IMR

January 20, 2014: IMR Decision:
24 post operative physical therapy  not medically
necessary

January 16, 2014: IMR Decisions:
Found Spinal Fusion not
January 19, 2013: Article:
The Real Fraud Against Medical Providers the WCAB will Not
Address

January 15, 2013: Article:
Parties Choosing Weapons Under SB 863

January 13, 2013: Article:
Medical Providers' Inactions waiting fro a Lawsuit to Stop SB 863 has
Already Resulted in Millions of Dollars of Lost  Collectible Files.

January 11, 2013: Article:
Litigation at The WCAB the True Reform in 2013

January 10, 2013: Article: Those Who Will Survive SB 863
Knowing the Law in 2013 is Not an Option for Medical Providers
Even under  Requirement Issues of the IBR and IMR Process  
(disputes will still be Argued regardless of the "Check List"
perceptions of these procedures)

January 06, 2013: Article False Sence of Security as to the IBR and
IMR Process
Are Legal Arguments Required for the IBR and IMR Process

January 03, 2013: Article:
Why Collections will Increase for Medical Providers under SB 863.

January 02, 2013: Article:
2013 and SB 863 is Still Here; What Medical Providers Need to
Know About SB 863

December 30, 2012: Article:
Are Lien Claimants Required to pay a $100.00Lien Activation Fee if
a Lien Conference was Completed Prior to 2013 and set  for Lien
Trial After 2013?
January 31, 2013: Article:
What to do When an Insurance Company will Not Settle Unless a
Lien Activation Fee or Lien Filing Fee is Paid.

January 28, 2012; Article:
Medical Providers, Lien Claimants, and Lien Collection Companies
who Do not Understand the Message Sent by the California Law
Makers, the DWC and WCAB and Learn SB 863;  Organize and
Change the way they Present Cases at the WCAB Will not be Long
in this industry.
January 11, 2013: Article
The Message from the California Law Makers, The DWC and
WCAB to Lien Claimants
February 21, 2013: Article:
Every reform in workers comp, insurance companies come up with
some nonsensical   reason not to resolve medical bill disputes with
medical providers regardless of the merits of the claim and SB 863,
has proven to be no different.
February 28, 2013: Article:
Article: DWC Sends Warning  to Unethical Insurance
Companies Stating
Payors must negotiate in good faith with
potential lien claimants - filing a lien is not a prerequisite”
March 14, 2013: Article:
Review of the Third Month into SB 863
March 22, 2013: Article:
Understanding an Order Disallowing for Failure to Appear and or
Failure to Pay a Lien Activation Fee

March 21, 2013: Article:
Defense Attorneys' Dirty Little Tricks now Flooding Lien
Claimants with Petitions for Sanctions.
April 01, 2013: Article:
How Many Times Must SB 863 Be Re-Regulated, Amended, and or
Changed before it is Scrapped as a Failed Reform?

March 30, 2013: Article:
How Many Times Must SB 863 Be Re-Regulated, Amended, and or
Changed before it is Scrapped as a Failed Reform?
April 04, 2013: Article:
The New Norm for Lien Claimants at the WCAB is Pleadings
(There are 23 Different Pleadings Concerning Lien Claimants)
April 17, 2013:  Article:
Article:  Opponents Claiming the “Sky is Falling” or Will Fall if
Petition for Costs Proposed Regulations for Copy Services and
Interpreters is Adopted.

April 11, 2013: Article:
Why SCIF is Prohibited by Law from Apply PPO Discounts of Blue
Cross
Richard J Boggan JD
Publisher of Work Comp Collections Newsletter

April  11, 2013: Article:
TRAUMA CENTERS ARE EXEMPT FROM THE OFFICIAL
MEDICAL FEE SCHEDULE FOR THE TREATMENT OF
INJURED WORKERS AND ARE TO PAID AT THEIR USUAL
AND CUSTOMARY FEES.
April 21, 2013: Article:
Weighing in on “The Great Debate of Petition for Costs”
(Interpreters, Copy Services and Non-Medical Services)

April 19, 2013: Article:
5th Month into SB 863, What Changes are still to Come and What
Will Not Change

April 17, 2013:  Article:*
Article:  Opponents Claiming the “Sky is Falling” or Will Fall if
Petition for Costs Proposed Regulations for Copy Services and
Interpreters is Adopted.
April 28, 2013: Article:
On July 1, 2013 Additional Changes in SB 863 and Supporting
Regulations Will Automatically Take Effect That Providers Need
to be Aware of and Summary of WCAB Proposed Rules

April 26, 2013: Article:
Is The WCAB realizing that the Trial Judges decisions in the
understanding of law, and in the application of the laws, as reflected
by their decisions, inconsistent with each other Trial Judge causing
the WCAB to issue En Banc Decisions and are more En Banc
Decisions needed.

April 26, 2013. Article News from WCAB:
Article: Notice of recent En banc decision and a Significant panel
decision posted by WCAB on April 26, 2013: Lien Activation fee
1. Lien activation fees do not have to paid at Lien Trial if a Lien
Conference was held prior to 2013 and the Lien Trial After 2013
2.        Lien activation fee must be paid prior to Lien Conference  
or the filing of the DOR or Prior to end of 2013

April 25, 2013: Article:
The Question is Whether a Provider is bound by the Reasons put
forth in the Request for Second Review or Can the provider Bring
up Additional Issues for Payments not Included in the Request for
Second Review.
May 06, 2013: Article:
ARE THERE MORE WAIVES OF DISMISSALS IN THE  
PROVISIONS OF SB 863 THAT MAKE COLLECTIBLE FILES
NON-COLLECTIBLE?

April 30, 2013: Article:
Ways a Collection File can be deemed Noncollectable under SB 863
if Procedures are not followed: (Working Noncollectable Files)

April 29, 2013: Article:
Article: MPNs / Authorization Granted However Revoked if
Provider not Part of MPN Valid or Invalid?

April 28, 2013: Article:
On July 1, 2013 Additional Changes in SB 863 and Supporting
Regulations Will Automatically Take Effect
May 12, 2013: Article:
Are Lien Collections Companies Doomed under SB 863 when
Pre-2013 Collections Files are Gone.

May 10, 2013: Article:
A Plan of Action: How to Develop Phone Collections under 2013
Collection Laws (SB 863)

May 09, 2013: Article:
SB 863 / MPNS: Why Pre-SB 863 Collections Methods Have
Disappeared and Where do Providers go from Here

May 08, 2013: Article:
Duplicate Bills, Bill Revisions, Second Review and the IBR Process
May 12, 2013: Article:
Are Lien Collections Companies Doomed under SB 863 when
Pre-2013 Collections Files are Gone.
May 20, 2013: Article: Misstatement about liens

May 17, 2013: Article:
The New Adverse Party to the Litigation Process for Lien
collections “Rules” , “Laws” and “Burden of Proof” (Everybody
Still Gets Paid Except Providers and Some Collection Companies).

May 16, 2013: Article / Education:
How to Understand the Authorization, Utilization Review and
IMR Process (Independent Medical Reviewer) Under SB 863

May 16, 2013: Article: No Conspiracy Against Lien
Claimants
Lien Claimants failing to understand their Burden of Proof at the  
WCAB,  and Dismissals and Sanctions Keep Raining Down
udicated or admitted by the employer.
May 26, 2013: Article:
Avoiding Sanctions at the WCAB by Lien Claimants

May 24, 2013: Article:
Article – Causation, Medical Necessity; and Reasonable
Reimbursement at the WCAB and Under SB 863

May 21, 2013 ; Article / Education:
Understanding Pleadings at the WCAB for Lien Claimants  
June 05, 2013: Article:
The Judicial Interpretation of Labor Code § 4903.5 (a) Means
Additional Collections for Providers

June 04, 2013: Alert -Article:
The Letter “s” in Labor Code § 4903.5. (a) Saves Providers
Millions in time to File Liens.

June 04, 2013: Article:
Appeals Board Correctly finds that time to file a lien starts from
last date of service of continuous treatment

June 03, 2013: Article:
Training Collectors:  Contested Liability, Denied Injury, Admitted
Injury, IMR, IBR , Burden of Proof and WCAB

May 31, 2013: Article:
What the IMR (Independent Medical Reviewer ) Posted Decisions
are Showing Providers

May 29, 2013: Article:
Do any Default Laws Exist for Insurance Companies under SB 863
and Supporting Regulations when they do not comply?

May 27, 2013: Article
Article: Petitions for Reconsiderations by Lien Claimants
June 16, 2013: Article:
Review Of First 6 Months Of SB 863, Petition of Costs, Lien
Activation Fees / Notice of Intent to Disallow, Burden of Proof,
Sanctions, IMR and IBR

June 13, 2013: Article:
WHAT THE RECENT POST BY THE DWC MEANS
“UPDATES STATUS OF SB 863 EMERGENCY REGULATIONS”

June 07, 2013: Article:
What Makes Collections in 2013 Appear Complicated?
June 19, 2013: Article:
Importance of Collectors in 2013 and What Laws Must they
Know in Handling Disputed Collection Files
June 27, 2013: Article:
SCIF is Still Defrauding Providers out of Millions of Dollars Every
Year, Even Though Labor Codes Exist to Prevent the Fraud.

June 24, 2013: Article /Education:
There are Two Types of Management Approaches in dealing with
2013 Collections (SB863), Reactive and Proactive.

June 21, 2013: Article:
The Formalization of Arguments at the WCAB in 2013 / SB 863
and Bad Law
July 02, 2013: Article:
Knowing What a Contested Liability Issue is and the Several Ways
it Can Be Resolved to Start
the Second Review or IBR Time Requirements, Including Being
Resolved by Operation of Law

July 01, 2013: Article:
Repeating the Behavior that has Resulted in Millions of Dollars of
Lost Collection Files, Sanctions and Dismissals against Providers
and Lien Claimants.

June 28, 2013: Article:
Revisiting the Request for Second Review and IBR Request –What
Happens When Issue of Second Review Arise?
1.        Do I have write off files as un-collectible if I failed to
seek a second review within 90 days?
2.        What happens when the Adjuster states that the
time to file a second review expired when the request for
second review was timely?
July 15, 2013: Article:
SB 863 Has Just Achieved Fairness for all Parties in the Collection
Dispute Process The Importance of the Proposed / Modified
WCAB Policy and Procedures posted For Public Comment until
July 25, 2013.

July 12, 2013: Article:
How the Independent Bill Review (IBR) and Independent Medical
Review ( IMR )Process Changed and or Has Been Clarified Under
The Modified Proposed Rules by the WCAB Posted for Public
Comment.

July 11, 2013: Article:
Recent Developments That Should If Applied Right Increase
Phone Collections for Providers and
Collection Companies in Disputed Medical Bills

July 07, 2013: Article:
Article: WCAB Fears Ruling Against Largest Workers
Compensation Insurance Carrier and Largest Health Care Carrier,
Ignoring Laws Specifically Enacted 13 Years Ago to Prevent the
Profiteering From These Companies. SCIF / Blue Cross
July 16, 2013: Article:
Only The Most Knowledgeable  Will Survive SB 863 as we get
Closer and Closer to 2014

July 15, 2013: Article:*
SB 863 Has Just Achieved Fairness for all Parties in the Collection
Dispute Process The Importance of the Proposed / Modified
WCAB Policy and Procedures posted For Public Comment until
July 25, 2013.
July 18, 2013: Article:
Will the WCAB Proposed Rules Open the Door to Litigation and
Pressure Settlements?

July 17, 2013: Article:
Factual Misrepresentations of the Law under SB 863 That are
being Passed Around Even by Lien Attorney that Can Cost
Providers Millions
July 21, 2013: Article:
The Real Targets of SB 863: Lien Collection Companies.
Why We Have Yet to See the Insurmountable Number  of
Dismissals and Sanctions Against Lien
Claimant That are Sure to Come  in 2014.
August 01, 2013: Article:*
The Simplicity of Negotiating Liens and Achieving Fairness at
the WCAB , Providers Missing The Greatest Tool The DWC
and WCAB has Given Them To Resolve Collection Disputes.

July 31, 2013: Article:
On Federal Lawsuit to Stop Enforcement of Lien Activation Fee

July 30, 2013: Article:
The Apocalypse of Lien Dismissals and Accountability Coming
January 01, 2014.

July 29, 2013: Article:
Tricks, Short Cuts, Plans of Attack, and Secrets Revealed by
Collection Companies and Insurance Companies in the
Application of  2013 Collections and Defenses Under SB 863
and 2012 /2013 Laws

July 26, 2013: Article:
A Few Lessor Known Laws in 2013 that results In Money
Losses for Providers

July 25, 2013: Article:
When Will Medical Providers and Lien Claimants Determine
they Had Enough and Become Experts in the 2012 and 2013
Collection Laws.

July 24, 2013: Article:
Overworked, Underpaid, Neglect, Surprise, Excusable Neglect,
Calendared Wrong, the WCAB is not Buying Any.
August 06, 2013: Article / Education:
Workers’ Comp Collection Settlement Demand Letters in
2013, are they Worth Anything for Pre-2013 Collection
Dispute Files?

August 05, 2013: Article:
Substantial Changes in the Independent Bill Review Process
(IBR)  and Independent Medical Reviewer (IMR)Based on
“Contested Liability” and “WCAB Rules”,

August 04, 2013: Article:
Article and Sample Letter on How to Resolve Fee Disputes for
Dates of Services Prior to 2013to Avoid Dismissals on January
01, 2014

August 02, 2013: Article:
Republished: Understanding an Order and a NOI Disallowing for
Failure to Appear and or to Pay a Lien Activation Fee
August 16, 2013: Article:
Modified and updated Medical Legal and Treatment
Disputes Under Proposed WCAB Rule

August 15, 2013: Article:
Medical Legal and Treatment Disputes Under Proposed
WCAB Rules

August 13, 2013: Article:
Are Claims That Fall Outside the Time to File Liens Still
Recoverable, (A Mental Exercise in Law)?

August 13, 2013: Article:
SB 863 and 2012 /2013 Laws  Have Finally Reached
Clarity in 2013 with the Combination of Laws and
Regulations, Revealing

August 11, 2013: Article:
Making Sense of Collection Disputes in 2013 for Both
Pre-2013 and Post -2013 Disputes

August 10, 2013: Article:
Just Because a Claim is Out of The Time to File a Lien
Does not Mean that it is un-collectible under the Present
Rules and Regulations from the DWC and WCAB and
Should be written off, it is still collectable

August 09, 2013: Article:
Some Questions from Providers and Lien Claimants in
the 8th Month of SB 863, Regarding Lien Collections,
2013 Disputes on How to Stop The
August 22, 2013: Article:Missing the Mark on SB 863 by Some
Providers and Collection Companies!

August 22, 2013: IMR Flowchart Modified:

August 21, 2013: Article: Why Some Collections are ensuring that
they Will Not get paid under Disputed Files that Fall under SB 863,
by their System of Collections.

August 21, 2013: Recorded Lecture:Overview of 2013
Collections and Pre-2013 Collection Files

August 19, 2013: Article:Are We Missing An Exception to the
Time to File Liens
August 28, 2013: Article:
Mistakes in Understanding 2013 (SB863) Collection Laws)

August 26, 2013: Article:
Article: MPNs, Interpreter Required to Part of MPNs and
Chiropractor Cannot Stay a Treating Physician after 24, What’s
Wrong with these Provisions?

August 25, 2013: Article:
Medical Provider Networks (MPNs) Without Purpose and
Function Other Than to Exclude Providers, Including Interpreters,
Copy Services and DME Suppliers from Providing Service to
an Injured Worker.

August 25, 2013: Article:
How the Independent Bill Review (IBR) and the Independent
Medical Review (IBR) Has Changed Based On Adopted and
Proposed Rules of DWC and WCAB
September 04, 2013: Article:
Is there a weak link in the  2013 collections laws, is there a
provision, a law, an overlooked unregulated loophole that would
defeat or bring liberation to those who do not follow all the laws or
miss time requirements?

September 03, 2013: Article:
Understanding the IBR Process and Contested Liability Issues

September 01, 2013: Flowchart / Diagram:
Medical Legal Flowchart / Diagram Proposed Rules by the WCAB

August 31, 2013 Article:
Article: Understanding 2013 Collection Laws (SB 863) in Relation
to Pre-2013 Collection Disputes and Post-2013 Collection
Disputes

August 30, 2013: Article:
9th Month into SB 863

August 28, 2013: Article:
Mistakes in Understanding 2013 (SB863) Collection Laws)
September  06, 2013: Article:
How Defaults Against Insurance Company Applies to IBR and
IMR Process

September, 05, 2013: Article:
Whether a Collection Dispute File Is WCAB Qualified to
Warrant Paying a Lien Activation Fee.
September 15, 2013; Article:
Going to the WCAB vs Settlements, Medical Providers, Facilities,
Interpreters, Copy Services DME, etc., all have To Make
Choices.

September 12, 2013: Article:
20 Steps In Determining if a Pre-2013 Collection Dispute Files
are  Collectable and or WCAB Qualified.
September 25, 2013: Article Diagram
What Happens when Adjuster Does not Comply with Time
Requirements.

September 23, 2013: Diagram:
How to Settle Collection Disputes

September 19, 2013: Article:
Providers Provide Services to the Injured Worker, There Exists a
Fee Schedule to Get Paid, So Why are Providers Not Getting Paid
and Writing off Mass Receivables and Receiving Dismissals?

September 18, 2013: Article:
The message has been clear now for over a year; a provider
cannot keep knocking at the WCAB door with the same
collection dispute files that went through the WCAB in years
past, lacking in preparedness and evidentiary documentation to
go forward.
October 03, 2013; Article:
The WCAB Adopted Rules with an Effective Date of October 23,
2013, What it Means for All Parties.

September 30, 2013: Article:
Day of Reckoning Fast Approaching:  Persistence No Longer
Key to Resolving Collection Disputes, Knowledge, Detail and
More Knowledge is Required.
October 14, 2013: Article:
Providers and Lien Collection Companies, Still Putting Their
Hand in the Lions (WCAB) Mouth

October 11, 2013: Education:
Time Sheets IBR

October 10, 2013: Article:
Medical Legal Disputes, If and Or But, Maybe, Which Way do
Medical Legal Disputes Go or Can Go?
October 29, 2013: Article:
Some Making SB 863 More Confusing in 2013 Collections Than it
Is!

October 26, 2013: Article:
Article: An Evaluation of § 10774.5  “Notices of Representation,
Change of Representation, and Non-Representation for Lien
Claimants”

October 25, 2013: Article:
Are Persuasive Arguments a Fading Talent in California Work
Comp Collections?

October 24, 2013: Education:
Members 2014 Guidebook

October 23, 2013: Article:
Chaos at The WCAB Today

October 21, 2013: Article / Research Paper
Denied Body Part, Admitted Injury, Complications for That What
Appears Simple
November 08, 2013: Article:
Lien Activation Fees: Preliminary Injunction  Was Issued to be
Finalized on Tuesday November 12, 2013;

November 07, 2013: Article:
Falling Into the Ways of the Old WCAB

November 05, 2013: Article:
No Victory Yet for Providers: Granted Preliminary Injunction
with Conditions  Still to be decided for Lien Activation Fee
Lawsuit.

November 03, 2013: Article:
Should Providers Be Outraged When They See Their Receivables
Disappear?

November 01, 2013: Article:
WCAB Dismissing Liens with Prejudice Even if Lien Fee paid if
No Proof at Hearing of Payment even if EAMS Shows Paid
November 14, 2013: Article:
Zero Dollars to $3,654.00 in 60 Minutes or Less a WCAB
Collection Dispute File.

November 13, 2013: Article:
The Difference between Authorization and Utilization Review
Certification California Work Comp

November 10, 2013: Article:
Lien Claimants Fearing the WCAB: 10 Cents on the Dollar or 20
Cents on the Dollar if you have a good Argument.

November 08, 2013: Article:
Lien Activation Fees: Preliminary Injunction  Was Issued to be
Finalized on Tuesday November 12, 2013;
December 02, 2013: Article:
Medical Legal Process 2013

November 24, 2013: Article:
Work Comp Collectors, How to Make a Better Collector

November 24, 2013: Article:
How to Increase Collections and Give Dispute Files Their
True Value

November 19, 2013: Article:
MPNs Collection Dispute Issues  in 2013

November 18, 2013: Article:
The Defense of “Post Termination” How it applies and how it
does not apply
December 11, 2013: Article:
Authorization, Express, by Operation of Law, by Default and
Utilization Review

December 10, 2013: Article:
Correct Information on Appeal of Liens for Failure to pay Lien
Activation Fee Orders, (Injunction)Correct Information on
Appeal of Liens for Failure to pay Lien Activation Fee Orders,
(Injunction)

December 06, 2013: Article:
The Ruse of Shifting Body Parts and MPNs by Insurance
Companies

December 04, 2013: Article:
Lien Claimants and Medical Providers Need to Get Angry and Get
Paid
December 18, 2013: Article:
Article: SB863 and the Adoption of OMFS to the RBRVS SB
863 mandate a 4-Year transition

December 17, 2013: DWC News
The Office of Administrative Law (OAL) Has Approved DWC’
s Final Version of Electronic Document Filing and Lien Filing
Fee Rules

December 16, 2013: Educational Book
2019 Page Book on  Case and Statutory Laws Citations
January 03, 2013: Article:
Mistakes in Organizing for Collection disputes That Fall under
SB 863    
December 31, 2013: Article:
What We Saw in 2013 and What to Expect in 2014, Work
Comp Provider Collections Disputes

December 30, 2013:  Article:
Another Rain of Sanctions and Dismissals are Coming for Lien
Claimants: The Laws Passed in 2012 and SB 863 was to Shorten
the Live Span of A Collection Dispute File Either Voluntarily of
by Operation of Law.

December 25, 2013: Article:
The Secret of Success in Work Comp Collections Why we Plan
for Failure Instead of Success.

December 23, 2013: Article:
The Ability to Change: Billing, Collections and Appearances at
The WCAB , 2012 and 2013 Laws /SB863
January 17, 2014: Education:
25 Procedures for Collection Dispute Files from Birth to Death

January 15, 2014: Article:
SB 863 Laws Lying in Wait, One Thing Not Tolerated in 2014
is the Wait and See Approach

January 13, 2014: Education:
Summary of New Fee Schedule

January 10, 2014: Article:
Providers Creating Garbage Piles of Receivables and No one is
Stopping Them

January 09, 2014: Education:
Corrected Diagram under SB 863 Denied Liability

January 08, 2014:Article:
Preparing for Lien Trials at the WCAB What Lien Claimants
are Missing.
January 31, 2014: Article:
Productive Organization and Training for Collectors in Work
Comp 2014

January 30, 2014: Article:
The Simplicity /Complexities of Collection Disputes in 2013
and 2014 All the Way to The WCAB

January 26, 2014: Article:
Three Fee Schedules Created for Providers: Two Quasi Fee
Schedules Created: One Created by Insurance Companies and
The Other Created by Defense Attorneys at the WCAB  in
Work Comp Claims Disputes.

January 24, 2014: Article:
Toxicology / Drug Screening Reimbursement in Workers
Compensation G0431 and G0434 Are IBR Posted Decisions
Wrong?

January 22, 2014: Article:
SB 863 and “Torres” Case: Friend to Providers, Enemy to Run-
of-the-mill Collections
February 13, 2014: Article:
Part 4 Practicing Law at WCAB for Lien Claimants
(Respecting the WCAB and Providers)

February 12, 2014: Article Part 3 of series "Practicing
Law at WCAB"

February 11, 2014: Article Part 2 of Series "Practicing
Law at WCAB"

February 09, 2014: Article:
WCAB: How to Practice Law for Lien Claimants and
Collectors from Collections to WCAB

February 07, 2014: Article/Information:
The New 2014 Physician Fee Schedule: Some Important
Provisions from Regulations         

February 05, 2014; Article:
Running for the Hills 2014 Official Medical Fee Schedule:

February 04, 2014: Article:
SB 863: The Law They Missed,  Selling out  Providers at The
WCAB
February 20, 2014: Article:
Part 7 Practicing Law at WCAB for Lien Claimants (Spotting
Issues)

February 18, 2014: Article:
Part 6 Practicing Law at WCAB for Lien Claimants (Pleadings
/ Sanctions)Part 6 Practicing Law at WCAB for Lien
Claimants (Pleadings / Sanctions)

February 14, 2014: Article:
Part 5 Practicing Law at WCAB for Lien Claimants
(The Law)

February 13, 2014: Article:
Part 4 Practicing Law at WCAB for Lien Claimants
(Respecting the WCAB and Providers)
February 26, 2014: Article:
Part 9 Practicing Law at WCAB for Lien Claimants (Applying
the Law to the Facts)

February 25, 2014: Article:
Part 8 Practicing Law at WCAB for Lien Claimants (Applying
the Law to the Facts)
March 11, 2014: Article:
Part 13 Practicing Law at WCAB for Lien Claimants (Making
Sense of it All)

March 10, 2014: Article:
Part 12 Practicing Law at WCAB for Lien Claimants (The
Training Process for Lien Claimants in
Substantive and Procedural Laws)

March 10, 2014: Article:
Part 11 Practicing Law at WCAB for Lien Claimants (The
WCAB’s Secret Files on Lien
Claimants)

March 04, 2014: Article:
Part 10 Practicing Law at WCAB for Lien Claimants (Rite of
Passage  to the WCAB)
2014; Article:
Knowledge, Coupled With the Ability to Spot Patterns to
Adjust and Succeed under SB 863 Collections Disputes

2014: Article:
2014 Collection Disputes and WCAB (Getting It)
2014: Article:
Usual and Customary Fees for California Hospitals
(Facilities): Above Fee Schedule, Exempt from Fee Schedule,
Day Outlier for Extended in Patient Stays, Distinct Rehab
Units, Rehabilitation Hospitals, PPO Contracts (Stop Loss
Provisions) where they are in 2014.

April 08, 2014: Article:
Article: Second Bill Review Process Gateway to Dispute
Resolution do it Right or do not get paid
2014: Article:
Insanity: Two Years Later and Still Some Not Getting, The
Second Review Process. --Imagine Treating an Injured Worker
for a year and All Treatment Authorized then Receiving No
Payments  and Have No Recourse. --- Or Treat for a denied
Injury and Then the Injury is  Admitted through C&R and  
getting No payments because you did not do a Second Review
Request and No Recourse.

2014: Article:
How to Fail Under SB 863 – We Can No Longer Blame
Providers

2014: Article:
Sales Pitch  to Providers on SB 863

, 2014: Article:
Usual and Customary Fees for California Hospitals (Facilities):
Per Diem Outlier (Exceeds Average Length of Stay) Awarded
an additional Amount of $58,971.22 above Fee schedule
April 14, 2014: Panel Decision:
The fact that the record does not contain an express designation
of Dr. Mays as the primary treating physician should not defeat a
legitimate claim for medical treatment services.

April 11, 2014: Panel Decision in line with En Banc
Simmons: Proper mechanism for objecting to medical
determinations by a primary treating physician where liability to
at least one body part has been accepted.

April 09, 2014: Panel Decision:
Letter correctly addressed and properly mailed is
23 presumed to have been received in the ordinary course of mail
(Evid. Code, § 641).

April 04, 2014: Panel Decision:
We find that sanctions are warranted in this case in that the
language used by applicant's counsel in the Petition for
Reconsideration is insulting, offensive, insolent, intemperate and
disrespectful towards the WCJ.
Panel Decision:
WCAB / Indicated That a Trial Judge May Have Jumped the Gun
in Pre-Judging an MPN Issue and Sanctions Against Lien Claimant

April 21, 2014: Panel Decision:
We are not persuaded by the response and accompanying
declarations that a sanction should not be imposed in this case.
The argument that the false statement in the petition was an
inadvertent mistake caused by neglect and not by intentional
misconduct is not persuasive given the large number of petitions
filed by LMM around the same time with that same false averment.
April 03, 2014: Recent En Banc Decision on QME Process

March 26, 2014; Panel Decision:
"...when the Order Dismissing had been served on lien claimant. It
was therefore not clear whether the
Petition was timely filed." (Report, pp. 1-2.)

March 25, 2014: Panel Decision:
Kunz and Tapia cases really focus on evidence of what the lien
claimant usually accepts

March 20, 2014: Panel Decision:
"Here, we conclude that the defendant's UR process suffers from
material procedural defects that undermine the integrity of the UR
decision because the UR physicians were not provided with
adequate medical records."

March 14, 2014: Panel Decision:
sanctions: litigating a lien to the point of setting it for
trial without submitting any evidence in support thereof
April 03, 2014: Recent En Banc Decision on QME Process

March 26, 2014; Panel Decision:
"...when the Order Dismissing had been served on lien claimant.
It was therefore not clear whether the
Petition was timely filed." (Report, pp. 1-2.)

March 25, 2014: Panel Decision:
Kunz and Tapia cases really focus on evidence of what the lien
claimant usually accepts

March 20, 2014: Panel Decision:
"Here, we conclude that the defendant's UR process suffers from
material procedural defects that undermine the integrity of the
UR decision because the UR physicians were not provided with
adequate medical records."

March 14, 2014: Panel Decision:
sanctions: litigating a lien to the point of setting it for
trial without submitting any evidence in support thereof
February 28, 2014: New En Banc Decision:
the Appeals Board specifically held as follows:

1.IMR solely resolves disputes over the medical necessity of
treatment requests.  Issues of timeliness and compliance with
statutes and regulations governing UR are legal disputes within
the jurisdiction of the WCAB.

2. A UR decision is invalid if it is untimely or suffers from
material procedural defects that undermine the integrity of the
UR decision.  Minor technical or immaterial defects are
insufficient to invalidate a defendant’s UR determination.

3.If a defendant’s UR is found invalid, the issue of medical
necessity is not subject to IMR but is to be determined by the
WCAB based upon substantial medical evidence, with the
employee having the burden of proving the treatment is
reasonably required.

4.If there is a timely and valid UR, the issue of medical necessity
shall be resolved through the IMR process if requested by the
employee.

February 24, 2014: Panel Decision:
An order dismissing a lien  claim for failure to appear shall be
served only by the Workers' Compensation Appeals Board and
not by  designated service." (Cal. Code Regs., tit. 8, § 10770.1(i).)
February 19, 2014: Panel Decision:
"Compensable consequences" doctrine. Under this doctrine,
where a subsequent injury is the consequence of an original
industrial  injury, the subsequent injury is considered to relate
back to the original injury

February 15, 2014: Panel Decision:
Appeals Board States When SCIF can use Blue Cross PPO discount
February 10, 2014: WCAB Published Significant Panel
Decision: An expedited hearing may be requested and conducted
under Labor Code section 5502(b)(2) and Administrative
Director Rule 9767.6(c) to determine whether the employee
must treat in the employer’s medical provider network during the
90-day delay

February 06, 2014: Panel Decision:
Here, applicant's attorney barely manages to squeeze the petition
for reconsideration into 25 pages, but he does so only by
violating the 12-point font size requirement (§§ 10845(a),
10205.12(a)(5) [formerly, § 10232(a)(5)1) and possibly by
violating the line- spacing requirement as well (§§ 10845(a),
10205.12(a)(11) [formerly, § 10232(a)(1 1)]).
January 28, 2014: Panel Decision:
Lien claimant did not file the Petition for Reconsideration within
25 days of the decision (20 days per Labor Code section 5903,
plus 5 days for mailing per Code of Civil Procedure section 1013).
January 16, 2014: Panel Decision:
The WCJ's determination "must be based on admitted evidence in
the record."

Labor Code section 5313 requires the WCJ to "make and file
findings upon all facts involved in the controversy

January 14, 2014: Panel Decision:
“It appears that lien claimant does not fully  understand its
evidentiary burden. Under Labor Code section 5705, "The burden
of proof rests upon the party or lien claimant holding the
affirmative of the issue."

January 12, 2014: Panel Decision:
"...we strongly admonish applicant's counsel for citing medical
reports that are not in evidence, thereby failing to "fairly state
all of the material evidence relative to the point or points at issue
[,]"
January 15, 2013: Panel Decision
Order of Dismissal Lien Served by Defense and not Board Held
Invalid Order for Dismissal.

January 31, 2013: Panel Decision:
Sanctions for Lien Claimant withdrawing DOR

January 31, 2013: Panel Decision:
"Finally, we note that Labor code section 4907 will be expanded
on January 01, 2013. Beginning on that date, a Lien
Representative may lose the privilege of practicing before the
WCAB..."
January 12, 2013: Panel Decision:
Lien claimants offered no evidence of the OMFS for the
services provided to treat applicant's industrial injury.
February 15, 2013: Daily News Broadcast: New En Banc
Decision and DEVELOPMENT of a collection file.

February  15, 2013: Newly Published En Banc Decision:
Good cause having been established, we order that
_______________be suspended from appearing before the
Workers' Compensation Appeals Board as a hearing
representative on behalf of any party or lien claimant for a
period of 90 days.

February 15, 2013: WCAB Definition of "Good Cause"
February 20, 2013: Panel Decision: Evidence:
However, while a party's failure to lay a foundation, to
authenticate, and to corroborate documentary evidence with oral
testimony may affect the weight and substantiality of the
evidence, these possible deficiencies do not necessarily render that
evidence inadmissible.

February 19, 2013: Panel Decision:
Additionally, even if lien claimant's assertion about lack of notice
were correct, lien claimant's skeletal petition for reconsideration
would still be "unsupported by specific references to the record and
to the principles of law involved" and thus subject to dismissal.
(Cal. Code Regs., tit. 8, § 10846.)

February 19, 2013: Panel Decision:
"... the petition fails to identify what "good cause" petitioners
contend supports rescission of the WCJ's Order. The petitions are
also unverified."
March 01, 2013: Panel Decision:
Moreover, although the presumption of proper mail service may be
rebutted by evidence that the Findings and Order was not in fact
mailed as declared by the proof of service  a bare declaration of
non-receipt is insufficient to overcome proof of service.g

February 26, 2013: Panel Decision:
Sanctions-- Lien claimant for failure to respond to NOI
March 06, 2013: Panel Decision:
Labor Code section 5502(b) establishes issues which require
expedited hearing. As of 2012,these issues did not include MPN
issues or issues regarding attorney's fees. However, because the case
is now off calendar, defendant's Petition for Removal is moot, and
we deny it.

March 06, 2013: Panel Decision:
"With regard to the defendant's contention that the lien claimant's
attorney did not state under penalty of perjury that the attorney
was appearing on no other matters on that date and that the entire
time was spent at the Pomona Board exclusively waiting for the
defendant to appear in this matter,
the defendant cites no legal authority that in order for the court to
award costs that said Petition must include such a declaration."

March 04, 2013: Panel Decision:
“…affirmative burden of proving all of the elements  necessary to
establishment of its lien and all relevant issues, including that the
lien was for properly  provided services and that the claim is
industrially related.”  “…also require that lien claimant prove that
the treatment rendered was reasonable and necessary to cure or
relieve the effects of the injury.”

March 04, 2013: Panel Decision:
“…defendant unreasonably delayed applicant's referral to his
treating spinal surgeon for a surgical consultation and unreasonably
delayed provision of spinal surgery.”
March 18, 2013: Panel Decision:
However, we note that, although lien claimant filed a Request to be
Available by Phone for the November 21, 2012 lien conference,
there is no indication in the record that the WCJ granted that
request. Notifying an opposing party, or even the WCAB, of
unavailability does not in itself excuse  failure to appear.

March 15, 2013: Panel Decision:
The verified petition for reconsideration is impermissibly skeletal,
contrary to California Code of Regulations, title 8, section 10846.
It is unsupported by specific references to the record and to the
principles of law involved.
March 19, 2013: Panel Decision:
"In order to have been "prior timely payments," the payments
would have had to be made prior to 8:30 a.m. on the date of the
lien conference"
March 28, 2013: Panel Decision:
Lien claimant's excuse for failing to obtain permission and for
filing duplicate documents is that it assumed that the documents  
would be discarded, and it contends that it was not aware of a
provision that would impose sanctions for that behavior.

March 28, 2013: Panel Decision:
However, we determine that lien claimant may have
misunderstood the language and effect of the Order quoted above.
As such, lien claimant may have been objecting to the Notice and
seeking reconsideration if the Order of Dismissal was in effect
.

March 28, 2013: Panel Decision:
Pre-trial orders regarding evidence, discovery, trial setting, venue,
or similar issues - such as the orders here - are non-final
interlocutory orders that do not determine any substantive right of
the parties. Accordingly, the Petition, to the extent it seeks
reconsideration, must be dismissed
March 29, 2013: New En Banc Decision:
Mercy is an “air carrier that may provide air transportation”
within the meaning of the preemption provision of the ADA.?

March 28, 2013: Panel Decision:
Lien claimant's excuse for failing to obtain permission and for
filing duplicate documents

March 28, 2013: Panel Decision:
However, we determine that lien claimant may have
misunderstood the language and effect of the Order

March 28, 2013: Panel Decision:
Pre-trial orders regarding evidence, discovery, trial setting, venue,
or similar issues -
April 16,2013: Panel Decision:
Appeals agrees with Lien Claimant there was no intention to cause
unreasonable or unnecessary delay, and not motivated by bad faith
reduce sanctions from$2,500.0 to $500.00 still unnecessary
hearing.

April 14, 2013: Panel Decision:
The Court does not believe relief should be granted per CCP 473.If
the WCAB does determine that relief should be granted, as CCP
473 includes mandatory costs and sanctions, the matter should be
returned to the trial level for the award of same.
April 23, 2013: Panel Decision:
Treatment outside MPN allowed whenLack of Notice that results
in a neglect or refusal to provide reasonable medical treatment
renders the employer or insurer liable for reasonable medical
treatment self-procured by the employee." (71 Cal.Comp.Cases
at1435.)

April 19, 2013 Panel Decision:
Notice of Intent not a final Order and not subject to Petition for
Reconsideration unless order served by Court

April 18, 2013: Panel Decision:
There are no citations to any evidence or actual testimony, as
required by WCABRule 10842.

April 18, 2013: Panel Decision:
The supplemental response shall only address evidence and issues
raised in lien claimant's Answer, and shall not address any other
evidence or raise any other issues, and must befiled within fifteen
(15) days, plus an additional five (5) days for mailing
April 23, 2013: Panel Decision:
Treatment outside MPN allowed when Lack of Notice that results
in a neglect or refusal to provide reasonable
May 08, 2013: Recent Published En Banc Decision:
Where a medical-legal lien claim for copy costs was filed before
January 1, 2013, and after January 1, 2013 it was withdrawn and
re-filed as a petition for costs under Labor Code section 5811, the
Appeals Board held:
May 15, 2013: Panel Decision:
A failure to fairly state all of the material evidence may be a basis
for denying the petition." (Cal. Code Regs., tit. 8, § 10842.

May 15, 2013: Panel Decision
Lien Claimant ordered to pay $10,030.25 in cost and sanctions

May 14, 2013: Panel Decision: NOI:
A letter that is properly addressed and mailed is presumed to be
received, and a bare statement of non-receipt is insufficient to
overcome proof of service. . Additionally, even if lien claimant's
assertion about lack of notice were correct, lien claimant's skeletal
petition for reconsideration would still be "unsupported by specific
references to the record and to the principles of law involved" and
thus subject to dismissal. (Cal. Code Regs., tit. 8, § 10846.)

May 14, 2013: Panel Decision MPN Issue:
The record reflects a neglect or refusal to provide reasonable
medical treatment because defendant did not carry its burden of
proving that such treatment was properly available to applicant
through its MPN. For that reason, defendant is liable for the cost
of the reasonable medical treatment self-procured by applicant.
May 16, 2013: Panel Decision:
As discussed above, section 4600(a) imposes a mandatory duty to
timely provide reasonably required medical treatment. The Labor
Code does not permit a defendant to bury its head in the sand in
order to dodge its obligations.

May 16, 2013: Panel Decision:
A medical provider lien claimant can no longer present a prima
facie case merely by demonstrating that the treatment giving rise
to the lien claim was for an alleged
industrial injury. To the contrary, the present rule of law is that
Lien Claimants have the burden of proof on their lien claims,
including the burden to demonstrate every
element necessary for recovery unless that element was previously
adjudicated or admitted by the employer.
May 21, 2013: Panel Decision:
It is also recommended that petitioner be admonished not to file
Petitions for Reconsideration and mislabel them as
Objection-other and to comply with Reg. 10842.
May 30, 2013: Panel Decision:
The language of the statute is mandatory concerning the payment
of an activation fee by the lien claimant at the lien conference,
and the sanction of dismissal of the lien with prejudice should the
lien claimant fail to pay the fee or show proof of such payment at
the lien conference.

May 28, 2013: Panel Decision:
“____________ have violated a number of important WCAB
Rules in the underlying proceedings and in the Petition for
Reconsideration, making the imposition of Labor Code section
5813 sanctions appropriate in this case.”
June 14, 2013: Panel Decision:
as CCP 473 includes mandatory costs and sanctions, the matter
should be returned to the trial level for the award of same.

June 11, 2013: Panel Decision:
Defendants allege that the Qualified Medical Examiner should not
have his charges adjudicated in the absence of a lien.

June 11, 2013: Panel Decision:
but none of the evidence submitted is evidence that applicant
received notice or that lien
claimants received notice.
June 18, 2013: WCAB Post En Banc Decision:
Bengals are exempted by section 3600.5(b) from the provisions of
California’s workers’ compensation law,

June 18, 2013: Panel Decision:
Lien Claimant contends it was error to dismiss its lien solely for
failure to pay the lien activation fee which it described as a
technicality. This contention is frivolous in light of the express
language of Labor Code section 5903.06 (a) (1), (a) 2 and (a) (4).

June 17, 2013: Panel Decision:
Additionally, it is unclear why lien claimants have raised Code of
Civil Procedure section 473.Claims of mistake, inadvertence,
surprise, or excusable neglect under Code of Civil Procedure
section 473 cannot be used as a basis for avoiding dismissal.

June 17, 2013: Panel Decision:
Labor Code section 4620 defines "medical-legal expenses" as any
costs and expenses incurred by or on behalf of any party for X-
rays, laboratory fees, other diagnostic tests, medical reports,
medical records, medical testimony, and needed, interpreter's fees,
for the purpose of proving or disproving a contested claim. (Lab.
Code § 4620.)
June 25, 2013: Panel Decision:
“…lien claimant is not required to pay a lien activation fee prior to
a 2013 lien trial where: (1) the declaration of readiness (DOR) is
filed prior to January 1, 2013; (2) the lien conference takes place
prior to January 1, 2013; and (3) the lien trial takes place in 2013,
without any intervening 2013 lien conference."

June  25, 2013: Panel Decision:
Petitioner has not provided any specific examples of alleged error
by the WCJ and has failed to
cite to the record in any way whatsoever.
July 01, 2013: Panel Decision:
The [WCAB] shall not designate a party or lien claimant, or their
attorney or agent of record, to serve any final order, decision, or
award relating to a submitted disputed
issue."

July 01, 2013: Panel Decision:
(1) a claim for medical-legal expenses may not be filed as a petition
for costs under section 5811.

July 01, 2013: Panel Decision:
In her Report, the WCJ stated that lien claimant consistently argued
that the settlement agreement did not address the entire lien
July 17, 2013: Panel Decision:
The undersigned is perplexed as to why a member of the bar would
rely on a letter to which there was no response by the Workers
Compensation Appeals Board to assume or presume that no
appearance was required when Notice of Hearing was sent and
received.


July 16, 2013: Panel Decision:
Have to Love Judge Thompsons’ Humor in this decision: “So what
shall we do when faced with a “bogus” Declaration of Readiness”
(DOR)?

July 16, 2013: Penal Decision:
In order to obtain an order pursuant to section 4903.6LC must file a
petition specifying the  medical information to be provided and the
relevance of that information to the proof of the reasonableness
and necessity of the services that are the subject of LC's lien.

July 16, 2013: Panel Decision:
More important, his allegation of "technical difficulties" in paying
the lien activation fee, without reference to any specifics or
evidence to support the allegation, is the same thing as outright
misrepresentation.
July 18, 2013: Panel Decision:
The mailing of an item to a correct address creates a presumption
that that document was received. (Evid. Code see. 641.) However,
the presumption is rebuttable, and in my view was properly rebutted
by the timely objection to the second transmittal of the document,
supported by a sworn declaration of the mail clerk for Frontline's
representative, Controlled Health

July 17, 2013: Panel Decision:
The undersigned is perplexed as to why a member of the bar would
rely on a letter to which there was no response by the Workers
Compensation Appeals Board to assume or presume that no
appearance was required when Notice of Hearing was sent and
received.
July 23, 2013: Panel Decision:
Here, Lopez withdrew its lien prior to the date of the Martinez
decision, and there is no evidence that the lien has otherwise been
dismissed. Although Lopez's petition for costs must be dismissed, it
can  reinstate its lien and pay the lien activation fee prior to the
conference scheduled..."


July 22, 2013: Panel Decision:
Meanwhile, on January 1, 2013, section 4903.6(d) became
operative. That section provides: "With the exception of a lien for
services provided by a physician as defined in Section 3209.3, no
lien claimant shall be entitled to any medical information, as
defined in subdivision

July 22, 2013: Panel Decision:
In Figueroa, the Board stated that '(1) the lien activation fee must  
be paid prior to the commencement of a lien conference, which is
the time that the conference is scheduled to begin, not the time
when the case is actually called
July 30, 2013: Panel Decision:
Every petition for reconsideration "shall fairly state all of the
material evidence."

July 25, 2013: Panel Decision:
Defense Not Sanctioned for not verifying Petition for Recon and
for stating he did not understand the lien issues at Trial.
August 08, 2013: Panel Decision:
While I appreciate the special concerns arising from the huge
volume of lien litigation we are experiencing, I have also considered
that it seems quite unlikely that an applicant would have their case
dismissed or a defendant suffer a default judgment in a high-money
claim under similar circumstances.

August 05, 2013: Panel Decision:
But defendant's failure to conduct utilization review does not relieve
applicant of the evidentiary burden of showing, by a preponderance
of the evidence, that the requested medical treatment is reasonably
required to cure or relieve the effects of his injury.

August 02, 2013: Panel Decision:
The problem here is that there is no evidence that LCs received
notice of the lien conference on April 9, 2013. As the WCJ has
pointed out, LCs do not appear on the Official Address Record.
August 23, 2013: Panel Decision: In addition, we reject the
petitioning lien claimant's contention that because defendant failed
to furnish documents to lien claimant and failed to negotiate its
lien, petitioner is somehow excused from paying the lien activation
fee ("LAF"). The contention fails because the LAF is prerequisite to
invoking the jurisdiction of the WCAB to raise allegations that
defendant failed to negotiate, etc.

August 21 2013: Panel Decision:"lien conference was due to
inadvertence /miscalendaring, relief should be granted pursuant to L.
C. Section §5506 and/or CCP § 473. However, these code sections
only apply to default judgments being entered against a party for its
failure to: appear. In this case, a default judgment (Order of
Dismissal)"

August 20, 2013: Panel Decision: However, our NIT was issued
because lien claimants filed a skeletal Petition for Reconsideration
failing to provide a statement of facts, to raise issues of contention,
to make arguments of law upon which reconsideration was sought,
or to identify the individual filing the Petition for Reconsideration.

August 18, 2013: Panel Decision:We note, however, that the
order does not specify that Greenway's lien was dismissed with
prejudice. Because this case concerns a filing fee and not an
activation fee, upon return to the trial level Greenway may re-file
its lien, provided  that it does so within three years from the date
that services were provided and contemporaneously pays the
required lien filing fee. (Lab. Code, § 4903.5(a).)
August 27, 2013: Panel Decision:
Essentially, lien claimant contends that its failure to appear at the
April 15, 2013 lien conference was due to inadvertence because it
had miscalendared this matter.

August 23, 2013: Panel Decision: In addition, we reject the
petitioning lien claimant's contention that because defendant failed
to furnish documents to lien claimant and failed to negotiate its
lien.*
September 04, 2014: Panel Decision: -17
"... therefore, that the order should have been served by the WCAB.
However, procedural rules, such as the service of orders under Rule
10500, serve the convenience of the WCAB and they do not  
deprive it of the power to disregard violations where there is no
substantial prejudice to the parties."

September 03, 2013: Panel Decision:
In addition, we reject the petitioning lien claimant's contention that
because defendant failed to furnish documents to lien claimant and
failed to negotiate its lien, petitioner is somehow excused from
paying the lien activation fee ("LAF").

August 30, 2013: Panel Decision:
provides no evidence that it actually attempted to pay the fee, It
provides no evidence as to the exact problems encountered when it
allegedly tried to pay the lien activation fee. Further, lien claimant
has had ample opportunity to pay the fee since January 1, 2013.

August 29, 2013: Injunction for Dismissals 01/2014 that do not
show a lien fee dismissed by operation of law Scheduled Oct 24 2013;
What it means if rant and what it means if denied.
September 09, 2013: Panel Decision:
"due to human error" and that its lien representative was at the
Marina Del Ray District Office on the day of trial but failed to sign
in "for reason unknown." However, we find that the claim of
"human error ... for reason unknown" does not  rise to the level of
good cause." 21

September 05, 2013: Panel Decision:
Due process simply requires notice and an opportunity to be heard.
If a party does not take advantage of that opportunity, then it
waives its right to be heard.
September 16, 2013: Panel Decision:
From Recent Panel Decision: Because lien claimant did not have a
lien in ADJ7541189, the order dismissing a (nonexistent) lien has
no effect and lien claimant is not aggrieved by the WCJ's Order

September 13, 2013: Panel Decision:
Petition falls within Appeals Board Rule 10561, subdivisions (b)(2),
(b)(5), and (b)(6) because it was filed without justification, appears
to contain multiple material misrepresentations, and takes positions
that are indisputably without merit. -25

September 12, 2013: Panel Decision:
It is clear under [section 4903.8(e),  that if the lien is filed after
January 1, 2013 and violates this section it is invalid.
September 17, 2013: Panel Decision:
Finally, we admonish petitioner that his failure to adhere to the
form requirements of petitions for reconsideration is conduct that is
unacceptable. With respect to the form of the Petition,
October 07, 2013: Panel Decision:
If Dismissed by Operation of Law cannot be with prejudice:

October 05, 2013: Panel Decision:
No Letter of Rep -Petition  for Recon Dismissed as filed by a
NON-Party

September 26, 2013: Case Law, The Case That Changed
Everything for Providers at the WCAB, must be read and Known
October 18, 2013: Panel Decision:
Communications with AMEs are governed by Labor Code section
4062.3 and WCAB Rule 35. "If an agreed medical evaluator is
selected.., the parties shall agree on what information is to be
provided to the agreed medical evaluator." "All communications
with an agreed medical evaluator... shall be in writing and shall be
served on the opposing party 20 days in advance of the evaluation.

October 17, 2013: Panel Decision:
lien claimant never mentions the issue of whether lien claimant
met its burden to show that its medical services were medically
reasonable and necessary

October 15, 2013: Panel Decision:
The WCJ further found that applicant did not receive notice of
defendant's Medical
Provider Network [MPN] prior to her injury and that a letter sent
to applicant on May 4, 2010 did not comply with MPN notice
requirements.

October 09, 2013: Panel Decision:
Petition for Costs Medical Legal
October 28, 2013: Panel Decision:
sanctionable conduct includes "using any language in any pleading or
other document [.. .] where the language or gesture impugns the
integrity of the Workers' Compensation Appeals Board or its
Commissioners,
judges, or staff.

October 22, 2013: Panel Decision:
Petitioner argues that due to an EAMS scheduled maintenance
Petitioner was unable,to pay the activation fee. Although Petitioner
states their inability to pay the activation fee due to regularly
scheduled maintenance, Petitioner offers no offer of proof of this
in the Petition.
November 06, 2013: Panel Decision:
Finally, it is noted that the record contains no requests for
authorization regarding the treatment at issue. In order to meet its
burden of proof, Lien Claimant must show that authorization for
the treatment was properly requested.

October 30, 2013: Panel Decision:
Reconsideration may be had only of a final order, decision, or
award. (Lab. Code, § 5900.)
November 15, 2013: ELAYNE VALDEZSUPREME COURT OF
CALIFORNIA  - MON Admissible of Reports outside MPN

November 12, 2013: Panel Decision:
Between the Petition and the July 30, 2012 lien conference, we
have three purported lien representatives for a single lien claimant.
The record in this matter lacks the appropriate notice appointing
December 19, 2013: Panel Decision:
Failure of PTP to incorporate does not mean the secondary /
consultant does not get paid

December 13, 2013: Panel Decision
Dr. Massey had not yet adopted Dr. Newman's findings does not
mean the latter physician's reports were not reasonable and
necessary at the time the expenses for the reports were incurred
January 06, 2014: Panel Decision:
As all of the requirements have been met, it is appropriate for Dr.
Newman to bill for his evaluation and reports as a medical-legal
expense, rather than services payable pursuant to the OMFS. Here,
Dr. Newman was designated by the primary treating physician -
Educational Materials
April 28, 2014: Lecture Outline:
2014 Collections Disputes Outline

April 27, 2014: Lecture:
2014 Collections Dispute Update

April 07, 2014: Education:
Highlighted Sections of WCAB Policy and Procedures \

April 02, 2014: Education / Information:
2014 Physical Therapy Ground Rules:

April 01, 2014: Article / Education:
Clarifying Second Bill Review (SBR) and Independent Bill Review (IBR)

March 23, 2014: Education 28 Minute Recorded Lecture on 2014
Collections

March 18, 2014; Education:
Diagram  Events that change the status of a collection dispute file.

March 17, 2014: Education:
Flowchart -Collections to WCAB

March 13, 2014: Education 2014 Flowchart Collection Procedures

March 06, 2014: Education:
Diagram e Permitted  to file a lien for WCAB hearing and when not
January 17, 2014: Education:
25 Procedures for Collection Dispute Files from Birth to Death

January 13, 2014: Education:
Summary of New Fee Schedule

January 09, 2014: Education:
Corrected Diagram under SB 863 Denied Liability
January 07, 2014: Education:
Flowchart When Receiving 0 payment under SB 863:

December 27, 2013 Recorded Lecture RB-RVS Fee Schedule for
Physician Services
Part One

December 16, 2013: Educational Book
2019 Page Book on  Case and Statutory Laws Citations

October 11, 2013: Education:
Time Sheets IBR

October 02, 2013: Education:
New Diagram with Recently Adopted Rules IBR and IMR Process

October 01, 2013: Education:
9 pages on Authorization, UR and IMR with New and Proposed Rules /
Regulations

September 30, 2013: Diagram:
Medical Legal Under Newly Adopted Rules / Regulations
Trial Briefs and Petition for Reconsideration WCAB
New Book Published

Why Pain Management /
Psychiatric Treatment as a
Consequence Of the Physical
Injury should be paid In Most
Cases  Even Under SB 863 -- See
Why
$195.00
2014 New Publication
Medical Legal Process – Disputes –
QME –AME- PTP – Interpreters – Copy
Services (with Sample Pleadings and
Petitions (Including 2nd Review and IBR
Samples)
$275.00
2014 Publications In California Work Comp
Treatment and Collections Disputes
Mid May 2014
Collections
Newsletter
California Managed Health Care And
Private Health Insurance News
Medicare and Federal
Work Comp News
July 10, 2014: News: ***
SACRAMENTO, Calif. -Today SB 1446
(DeSaulnier) which will give small
employers the option to keep existing
health policy coverage was signed into
law by Governor Jerry Brown.

June 26, 2014: California
Department of Insurance News:
Business owner arrested on multiple
felony charges for illegal business
operations and workers' compensation
insurance fraud

June 22, 2014: California
Department of Insurance News:
Los Angeles, Calif. - Today Insurance
Commissioner Dave Jones and Assembly
member Matt Dababneh held a joint
press conference at an off-leash dog
park to discuss important pet insurance
legislation. Within California's economy
the pet insurance market is rapidly
growing and expected to reach $750
million by next year

June 12, 2014: Case Law:
The California Court of Appeal upheld
the right of those suffering from severe
mental illnesses to receive medically
necessary treatments, even if insurers do
not provide those treatments for
physical illnesses.

June 09, 2014: Insurance Fraud:
Robert Gunn, 70, of Pacific Grove,
pleaded guilty to one felony count of
failure to register as an employer and
one misdemeanor count of failing to
secure workers' compensation insurance.
A Department of Insurance
investigation found that Gunn had not
purchased workers' compensation
insurance prior to an employee's injury.
July 14, 2014: VA News:
VA Directs Monthly Meetings
Between Local Health Facilities,
Veterans Service Organizations in All
50 States

July 01, 2014: Medicare News:
Medicare could penalize local hospitals

June 25, 2014: Insurance News:
Dallas National/Freestone Insurance
cases may proceed On June 25, 2014,
Judge Flanagan in the Circuit Court of
Cook County entered an order i

June 22, 2014: Medicare News
Medicare Billing Outliers Often Have
Disciplinary Problems, Too
As news organizations analyze data on
Medicare payments, doctors with
disciplinary records keep popping up.

June 09, 2014: US Dept of Labor
News :Nearly $5M in back wages for
approximately 500 workers at
federally-assisted project in New York
secured by US Labor Department

June 09, 2014: US Labor
Department News:
US Labor Department reaches $5.25
M settlement with GreatBanc Trust

June 09, 2014: United States
Department of Labor Employees’
Compensation Appeals Board
Decision:

To require OWCP to reopen a case
for merit review under section 8128
(a) of FECA[3] OWCP’s regulations
provide that the evidence or argument
submitted by a claimant must:  (1)
show that OWCP erroneously applied
or interpreted a specific point of law;
(2) advance a relevant legal argument
not previously considered by it; or (3)
constitute relevant and pertinent new
evidence not previou
1. Response to NOI Dismissal
2. Response to NOI sanctions
3. Response to sanctions (From Defense)
4. Petition for Sanctions (Against the Defense)
5. Points and authorities for trial
6. Petitions for Reconsideration
7. Response to Petition for Reconsideration
8. Petition for Removal
9. Response to Petition for Removal
19. Petition for Medical Information by a
Non-physician Lien Claimant
20. Notice to produce – non-medical
21. Motion to Quash
22. Response to Motion to Quash
23. Response to Notice to Produce
24. MPN Points and Authorities
25. Trial Briefs on Denied Injuries
26. Additional 10 Trial Briefs on all subjects
10.Petition for Non-IBR Medical Legal dispute /
Providers / Interpreters / Copy Services
11. Petition to Enforce IBR
13. Petition to Enforce IMR
14. Petition for IBR Ineligibility Requirement
15. Petition IMR Eligibility Requirements
16. Petition to Appeal IBR Decisions
17. Petition to Appeal IMR Decisions
18. Petition for Order Allowing Lien after Defense
Failed to Respond to NOI
June 2014
Collections
Newsletter
2012 Published 2nd
Appellate Decision on CIGA
and Assigned Claims Issue
2012 Published 2nd
Appellate Decision on MPN  
Treatment Outside MPN
VALDEZ
En Banc Decision on
Causation / Medical Legal
Simmons
En Banc Decision on MPN
-Notice /Offer of Treatment
Knight
Supreme Court Decision
Medical Necessity
/Utilization Review
SANDHAGEN
En Banc Decision
Lien Claimants' Burden of
Proof
Tapia
En Banc Decision
Transfer Medical Treatment
Into Existing MPN
SHARON BABBITT
En Banc Decision
Spinal Surgery Medical
Necessity / Medical Legal
JESUS CERVANTES
En Banc Decision
Interpreting Services / At
Medical Treatment
JOSE GUITRON
Panel Decision
Lien Claimant Proving
Injury after Case Settled
with no Injury
Panel Decision
Getting Above Fee Schedule
When Fee Schedule
Unreasonable
Panel Decision
Payment for Treatment
When Applicant Employed
for Less Than 6 Months
Panel Decision
Failure to Perform
Utilization Review
Established Medical
Necessity
Panel Decision
Coming and Going Rule for
Industrial Injury
Panel Decision
Payment by Defense did not
create notice of lien
Panel Decision
Implants not paid for
outpatient services
Panel Decision
Issue of Laches
Panel Decision
FTBN Issues
Panel Decision
Utilization Review Applies to
all Providers
Panel Decision
Notice of Transfer into
Existing MPN
Panel Decision
What is not Discoverable at
a Deposition of a Medical
Provider
Panel Decision
Issues of Post Termination
Defense
Writ Denied Case
Labor Code 4903.5 time to
file liens does not apply to
treatment for future
medical treatment
Panel Decision
MPN Issues Judge Rule
Defense can Cure Defective
Notice of MPN (Specific
Facts Case)
Panel Decision
MPN Issue Injured Worker
Allowed to Treat Outside
MPN no Offer of Reasonable
Medical Treatment
Panel Decision
Lien Claimant Failed to
prove Case for
reimbursement
Panel Decision
Retroactive Effect of Labor
Code 4903.5
Panel Decision
Provider Failed to Show
Injury in Medical Report
Panel Decision
$2,500.00 sanctions plus cost
against lien claimant to
bases no proceed to Trial
Panel Decision
Defense Subject to Sanctions
Failed to Serve Medical on
Lien Claimant within 6 days
Panel Decision
Sanctions for using
boiler plate pleadings
Panel Decision:
Labor Code 139.3 and Labor
Code 139.31 (Referrals)
Lien Claimants' Burden to
Establish Fee Schedule
Panel Decision MPN
Applicant not notified  that
he could challenge his
release from care within the
MPN
Panel Decision
Sanctions for Raising 23
issues without proof
Panel Decision:
Case in Chief Stipulations
not binding on Lien
Claimants who were not
part of Stipulations
Panel Decision: Third, both LC
and defendant appear to have
simply printed boilerplate in
their Request for Production and
Petition to Quash.
Panel Decision Lien claimant did not
file the Petition for Reconsideration
within 25 days of the decision(20
days per Labor Code section 5903,
plus 5 days for mailing per Code of
Civil Procedure section  1013)
Privilege for Lien Claimant
to Practice before the WCAB
Sanctions for Withdrawing
DOR
Panel Decision: Court held
Lien could not be dismissed if
no lien filed with WCAB
Case in Chief Stipulations not
binding on Lien Claimants who
were not part of Stipulations
Panel Decision
Lien Claimant sanctioned no
Evidence,  Exhibits on EAMS but
not Offered into Evidence /
Discovery Not final Order
2012 En Banc Decision
"Torres" Lien Claimants
Burden of Proof
Panel: Elements of Lien
Claimants Burden of Proof
Panel Decision / Evidence at
WCAB
Panel Decision /Service by
Mail
Panel Decision
/Non-Appearance Letter
Panel Decision No
Reference to Documents on
Recon
Panel Decision Supplement
Pleadings
Panel Decision attaching
documents to Recon
Panel Decision: Court held
Lien could not be
dismissed if no lien filed
with WCAB
Panel Decision:
Labor Code 139.3 and
Labor Code 139.31
(Referrals)
Panel Decision
Petition  plus 5 days
for mailing per Code
of Civil Procedure
section  1013)
Panel Decision:
Admissibility of Medical
Bills and Medical Reports
Not Signed
Download Case
Panel Decision: Third,
both LC and defendant
appear to have simply
printed boilerplate in their
Request for Production
and Petition to Quash.
Panel Decision
Lien claimant was
insolent, obstructive,
disrespectful and
frivolous warranting
sanctions by the Court
in the amount of
$1,500.00
Panel Decision
Lien Claimant's Burden to
Show Fee schedule
Panel Decision
Notice of Intent
Lien Claimants' Burden to
Establish Fee Schedule
Panel Decision:
Frivolous prosecution
based on failure to
provide evidence related
to the issue at hand
.
Panel Decision
Lien Claimant
sanctioned no
Evidence,  Exhibits on
EAMS but not Offered
into Evidence /
A Check List of 105 Ways / Whys
a Provider Should or Should not
be Paid, Even in Authorized Cases.
The Book for Work Comp Judges:
Providers, Defense Attorneys.
Lien Claimants and Adjusters
July 2014
Collections
Newsletter
2014 Collectors’ Hand Book,
A Desk Top Guide to What is Required to be Productive
Collector  
Easy Reference Guide with Quick Reference,  Including
Pleadings Needed at The Collections Stage

$65.00 for Book Plus 30 minute lecture video,  for additional
each additional book.
Use  paypal below or mail check to Richard Boggan  PO Box 6291
Garden Grove California 92846
Building  Better Collectors with the Right Tools Since 2001
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$250.00 per year
Email Contact Information:
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Consulting Plans, having a consultant available 24 hours a day, low monthly fee. Your
collectors or staff will have their questions answered immediately, one wrong turn or
right turn can make the differences of 10s of thousands of dollars, just one law, or just
the knowledge of the right law.

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regardless of state or type of practice with monthly plans staring at low as $75.00 a
month. Meaning you have a question as to a law or procedure you email the question and
the response will be immediate with the required law that applies to your question
including any applicable case law.
Important Posted IMR
Decisions
Past Articles:
Case Law Regarding Lien Issue
Important Posted IBR
Decisions