ADJ10684244 · April 1, 2026

The WCAB found that a contested claim existed at the time the cost petitioner provided medical-legal services beginning January 23, 2017, based on the filing of the Application, defendant's notices terminating benefits, and issuance of subpoenas, thus meeting the burden under Labor Code section 4620.

From the decision · page 8Accordingly, we rescind the F&O, and substitute a new Findings of Fact that finds that cost petitioner met its burden under Labor Code section 4620 to show a contested claim existed at the time it provided its medical-legal services beginning on January 23, 2017 and defer all other issues. We return this matter to the trial level for further proceedings consistent with this decision. For the foregoing reasons,

Applicant's attorney filed an Application for Adjudication of Claim on November 29, 2016, alleging disagreements as to liability for all benefits.

Favours Applicant prevailed

This demonstrated that disputes existed regarding benefits, supporting the existence of a contested claim at the time medical-legal services were provided.

From the decision · page 2We will briefly review the relevant facts. Applicant claimed injury to his right knee and right ankle while employed by defendant as a machine operator on November 18, 2016. Applicant's attorney filed an Application for Adjudication of Claim (Application) on November 29, 2016. It alleged that: "Applicant sustained injuries to his right knee and right ankle while performing his normal job duties." Paragraph 9 of the Application states that "This application is filed because of a disagreement regarding liability for: Temporary disability indemnity, Permanent disability indemnity, Reimbursement for medical expense, Rehabilitation, Medical treatment, Supplemental Job Displacement/Return to Work, Compensation at proper rate, Other (Specify) ALL BENEFITS." On November 29, 2016, applicant's attorney issued a letter to applicant's employer informing it of the representation and the claimed industrial injury of November 18, 2016.

Defendant issued notices terminating temporary and permanent disability benefits on December 13, 2016.

Favours Applicant prevailed

These notices evidenced the employer's rejection or termination of benefits, confirming a contested claim existed.

From the decision · page 6On November 29, 2016, applicant's attorney filed an Application. According to Paragraph 9 of the Application, there were disagreements as to liability for all benefits. On November 29, 2016, applicant's attorney issued a letter of representation to defendant and requested information and records. On December 2, 2016, defendant issued an acceptance of claim letter to applicant and admitted injury. (Exhibit A, 12/2/2016.) On December 13, 2016, defendant issued applicant notices that further temporary disability and permanent disability benefits were being terminated and applicant was being returned to work at full duty. (Exhibits 3 and 4, 12/13/2016.) The sole medical evidence is a Kaiser note discharging applicant to return to work. (Exhibit 2, 12/1/2016.) As explained above, acceptance of liability for the injury does not equate to an immediate agreement to pay all benefits. Thus, filing of an Application demonstrates that there were disputes between the parties.

Lien claimant issued the first Subpoena Duces Tecum on January 23, 2017, after the termination notices.

Favours Applicant prevailed

The timing of the subpoena issuance confirmed the contested claim existed when medical-legal services were provided.

From the decision · page 6Here, the first SDT was issued on January 23, 2017, the Application was filed on November 29, 2016, and defendant sent notices on December 13, 2016. Here, applicant's claim was unequivocally contested under Labor Code section 4620(b) on January 23, 2017 when the first subpoena was issued, after defendant issued notices terminating payment of benefits on December 13, 2016.

Discharged applicant to return to full unrestricted work with no ratable impairment as of December 1, 2016.

From the decision · page 2The letter requested "all medical reports, any statements oral or written taken from or made by the employee pertaining to his injury; any motion pictures, videos or sub-rosa films that have been taken of the employee; and a statement of benefits paid, including the date of payment, the purpose, the period, and the amount paid." (Exhibit 1, 11/29/2016.) On December 1, 2016, Stephen Kiran Kumar, M.D. issued an Industrial Work Status Report. Discharge/Release status: "This patient is discharged/released and may return to full unrestrictive work with no need for future medical care and no ratable impairment per AMA guides, 5th edition as of 12/1/2016." (Exhibit 2, 12/1/2016.) There is no information about applicant's complaints or the injury, and no information about whether applicant was examined by a physician. On December 2, 2016, defendant issued a letter to applicant accepting his claim of injury. (Exhibit A, 12/2/2016.) On December 13, 2016, defendant issued a NOTICE OF DENIAL OF PERMANENT DISABILITY BENEFITS addressed to applicant. The notice states in relevant part: On 12/01/2016 you were discharged from care. Based upon the report of 12/01/2016 from Dr. Raul Gonzalez, you have recovered from your injury with no

Reported applicant recovered from injury with no permanent disability as of December 1, 2016.

From the decision · page 2The letter requested "all medical reports, any statements oral or written taken from or made by the employee pertaining to his injury; any motion pictures, videos or sub-rosa films that have been taken of the employee; and a statement of benefits paid, including the date of payment, the purpose, the period, and the amount paid." (Exhibit 1, 11/29/2016.) On December 1, 2016, Stephen Kiran Kumar, M.D. issued an Industrial Work Status Report. Discharge/Release status: "This patient is discharged/released and may return to full unrestrictive work with no need for future medical care and no ratable impairment per AMA guides, 5th edition as of 12/1/2016." (Exhibit 2, 12/1/2016.) There is no information about applicant's complaints or the injury, and no information about whether applicant was examined by a physician. On December 2, 2016, defendant issued a letter to applicant accepting his claim of injury. (Exhibit A, 12/2/2016.) On December 13, 2016, defendant issued a NOTICE OF DENIAL OF PERMANENT DISABILITY BENEFITS addressed to applicant. The notice states in relevant part: On 12/01/2016 you were discharged from care. Based upon the report of 12/01/2016 from Dr. Raul Gonzalez, you have recovered from your injury with no

From the decision · page 3Between January 23, 2017, through May 24, 2017, lien claimant issued Subpoenas Duces Tecum (SDT) to the following: Allura Printing, Inc., (1/23/17) SCPMG/KFH (2/13/17), and UCI Medical Center (5/18/17), and Richard Raczka, M.D. (5/24/17). (Exhibit 6, 1/23/2017-5/24/2017.)

Labor Code sections 4620, 4622; Colamonico v. Secure Transportation (2019) 84 Cal. Comp. Cases 1059

The WCAB applied these standards to determine that a contested claim existed at the time medical-legal services were provided, supporting reimbursement.

From the decision · page 5reimbursement of medical-legal expenses. Subsection (f) of the statute, however, specifically states that "[t]his section is not applicable unless there has been compliance with Sections 4620 and 4621." (Lab. Code, § 4622(f).) Thus, a lien claimant is required to establish that: 1) a contested claim existed at the time the expenses were incurred; 2) the expenses were incurred for the purpose of proving or disproving the contested claim; and 3) the expenses were reasonable and necessary at the time were incurred. (Lab. Code, § 4620, 4621, 4622(f); Colamonico, supra, 84 Cal.Comp.Cases 1059.)

Filing of Application for Adjudication of Claim showing disagreements as to liability for all benefits

From the decision · page 2We will briefly review the relevant facts. Applicant claimed injury to his right knee and right ankle while employed by defendant as a machine operator on November 18, 2016. Applicant's attorney filed an Application for Adjudication of Claim (Application) on November 29, 2016. It alleged that: "Applicant sustained injuries to his right knee and right ankle while performing his normal job duties." Paragraph 9 of the Application states that "This application is filed because of a disagreement regarding liability for: Temporary disability indemnity, Permanent disability indemnity, Reimbursement for medical expense, Rehabilitation, Medical treatment, Supplemental Job Displacement/Return to Work, Compensation at proper rate, Other (Specify) ALL BENEFITS." On November 29, 2016, applicant's attorney issued a letter to applicant's employer informing it of the representation and the claimed industrial injury of November 18, 2016.

Defendant's notices terminating temporary and permanent disability benefits

From the decision · page 6On November 29, 2016, applicant's attorney filed an Application. According to Paragraph 9 of the Application, there were disagreements as to liability for all benefits. On November 29, 2016, applicant's attorney issued a letter of representation to defendant and requested information and records. On December 2, 2016, defendant issued an acceptance of claim letter to applicant and admitted injury. (Exhibit A, 12/2/2016.) On December 13, 2016, defendant issued applicant notices that further temporary disability and permanent disability benefits were being terminated and applicant was being returned to work at full duty. (Exhibits 3 and 4, 12/13/2016.) The sole medical evidence is a Kaiser note discharging applicant to return to work. (Exhibit 2, 12/1/2016.) As explained above, acceptance of liability for the injury does not equate to an immediate agreement to pay all benefits. Thus, filing of an Application demonstrates that there were disputes between the parties.

Issuance of first Subpoena Duces Tecum by lien claimant on January 23, 2017

From the decision · page 6Here, the first SDT was issued on January 23, 2017, the Application was filed on November 29, 2016, and defendant sent notices on December 13, 2016. Here, applicant's claim was unequivocally contested under Labor Code section 4620(b) on January 23, 2017 when the first subpoena was issued, after defendant issued notices terminating payment of benefits on December 13, 2016.