What the panel ordered
Petitions for reconsideration granted; original award affirmed except rescinded and amended findings; liens of Dental Trauma Center and others disallowed; issues of reasonableness and necessity of California Imaging Solutions lien deferred
Petitions for reconsideration granted to amend findings and award; issues deferred to trial level for further determination
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The lien of Dental Trauma Center was disallowed because the applicant did not sustain a dental injury in the industrial claims.
From the decision · page 4FINDINGS OF FACT 7. The lien of Dental Trauma Center is Disallowed. 9. The issues of whether the services provided by California Imaging were reasonable and necessary and whether its charges were reasonable are deferred with jurisdiction reserved at the trial level.
The issue of reasonableness and necessity of CIS services was deferred to the trial level for proper framing and determination consistent with Labor Code and Hamilton requirements.
From the decision · page 4FINDINGS OF FACT 7. The lien of Dental Trauma Center is Disallowed. 9. The issues of whether the services provided by California Imaging were reasonable and necessary and whether its charges were reasonable are deferred with jurisdiction reserved at the trial level.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant did not sustain a dental injury in the industrial claims
Favours Defendant prevailed
This fact led to disallowance of the Dental Trauma Center lien
From the decision · page 4FINDINGS OF FACT 7. The lien of Dental Trauma Center is Disallowed. 9. The issues of whether the services provided by California Imaging were reasonable and necessary and whether its charges were reasonable are deferred with jurisdiction reserved at the trial level.
The WCJ found that the services of California Imaging were reasonable medical legal services and ordered reimbursement in an amount to be adjusted by the parties
Favours Applicant prevailed
This finding supported the applicant's position on the reasonableness of CIS lien services, but the issue was deferred for further trial-level determination
From the decision · page 6The undersigned found that services of California Imaging were reasonable medical legal services and ordered reimbursement in an amount to be adjusted by the parties. Petitioner seeks reconsideration of that portion of the decision.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Records secured from Dr. Julie Goalwin among others for lien services.
From the decision · page 6California Imaging secured records from Illinois Midwest, the administrator for the carrier, and Jon Woods, applicant's former attorney, as well as Buena Vista Medical, California Urgent Care, Julie Goalwin, M.D., KG Pharmacy, Los Angeles Orthopedics, Nachman Brautbar, M.D., Pacific Hospital of Long Beach, Pacific Wellness, Sein Chiropractic, Southern California Medical Diagnostic, United Medical Radiology, and Albert Simpkins, M.D.
Records secured from Dr. Nachman Brautbar among others for lien services.
From the decision · page 6California Imaging secured records from Illinois Midwest, the administrator for the carrier, and Jon Woods, applicant's former attorney, as well as Buena Vista Medical, California Urgent Care, Julie Goalwin, M.D., KG Pharmacy, Los Angeles Orthopedics, Nachman Brautbar, M.D., Pacific Hospital of Long Beach, Pacific Wellness, Sein Chiropractic, Southern California Medical Diagnostic, United Medical Radiology, and Albert Simpkins, M.D.
Records secured from Dr. Albert Simpkins among others for lien services.
From the decision · page 6California Imaging secured records from Illinois Midwest, the administrator for the carrier, and Jon Woods, applicant's former attorney, as well as Buena Vista Medical, California Urgent Care, Julie Goalwin, M.D., KG Pharmacy, Los Angeles Orthopedics, Nachman Brautbar, M.D., Pacific Hospital of Long Beach, Pacific Wellness, Sein Chiropractic, Southern California Medical Diagnostic, United Medical Radiology, and Albert Simpkins, M.D.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473
All decisions must be based on admitted evidence in the record; WCJ must make findings on all facts and state reasons for determination (Lab. Code, 5313; Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473)
Applied to require clear issue framing and evidence-based findings for lien reimbursement
From the decision · page 3All decisions of the Appeals Board "must be based on admitted evidence in the record." (Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476 [2001 Cal. Wrk. Comp. LEXIS 4947] (Appeals Board en banc).) A WCJ is required to "make and file findings upon all facts involved in the controversy and an award, order, or decision stating the determination as to the rights of the parties. Together with the findings, decision, order or award there shall be served upon all the parties to the proceedings a summary of the evidence received and relied upon and the reasons or grounds upon which the determination was made." (Lab. Code, § 5313; see also Blackledge v. Bank of America, ACE American Insurance Company (Blackledge) (2010) 75 Cal.Comp.Cases 613, 621-22.) As required by Labor Code section 5313 and explained in Hamilton, "the WCJ is charged with the responsibility of referring to the evidence in the opinion on decision, and of clearly designating the evidence that forms the basis of the decision." (Hamilton, supra, at p. 475.)
Labor Code section 4621
Lien claimant must prove expenses were reasonably, actually, and necessarily incurred (Lab. Code, 4621(a))
Applied to require proof of necessity and reasonableness of lien services
From the decision · page 3For example, the WCJ issued a finding that CIS provided services that "were reasonably necessary medical legal services" (Finding of Fact 7) without describing the services or citing to the record to support his conclusion. Without knowing what issues the WCJ was attempting to determine, the phrase "reasonably necessary medical-legal services" is ambiguous. Defendant is required to reimburse expenses "reasonably, actually, and necessarily incurred." (Lab. Code, § 4621(a).) Given the deviation from the language in the statute and the lack of clarity regarding the issues in dispute, the finding could address necessity (but not reasonableness) or it could be a broader statement that lien claimant met its burden under Labor Code section 4621. Accordingly, we will defer the issue of the lien of CIS to allow the parties to properly frame issues and to allow the WCJ to issue a decision in accordance with the requirements of the Labor Code.
What proof carried it
The evidence the panel weighed, by kind.
The WCJ found that the services of California Imaging were reasonable medical legal services and ordered reimbursement in an amount to be adjusted by the parties.
From the decision · page 6The undersigned found that services of California Imaging were reasonable medical legal services and ordered reimbursement in an amount to be adjusted by the parties. Petitioner seeks reconsideration of that portion of the decision.
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
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