ADJ11122688 · September 24, 2021

From the decision · page 6Lien claimant contends that as there is no fee schedule in effect for interpreters, the process for Independent Bill Review (IBR) is inapplicable. Defendant relies upon the recent case of Meadowbrook Ins. Co. v. Workers Comp. Appeals Bd (2019) 42 Cal App.5th 432 [Cal.Rptr.3d 325, 84 Cal Comp Cases 1033] in opposition to lien claimant's position.

Lien claimant failed to request certification documentation from Insurance Commissioner or conduct discovery on certification.

Favours Defendant prevailed

This failure meant no evidence supported the claim that bill reviews were defective due to lack of certification, favoring defendant.

From the decision · page 5I note that the certifications required to be in existence are held by the Insurance Commissioner and are to be presented upon request. There is no evidence presented by lien claimant that it requested production of any certifications from the Insurance Commissioner. Nor is there any evidence presented that lien claimant conducted any discovery relative to the question of certification or lack thereof.

Lien claimant did not request Independent Bill Review for 76.15 hours of billed interpreter services.

Favours Defendant prevailed

Court found no jurisdiction to address these billings and barred recovery, favoring defendant.

From the decision · page 6The Court of Appeals determined that Title 8 California Code of Regulations § 9795.3 served as an applicable fee schedule and that there was no requirement that some future fee schedule to be adopted by the Administrative Director for the regulatory appeal scheme to apply. As there was a fee schedule in place, the Court ruled that lien claimant failure to request second bill review and Independent Bill Review barred recovery of its liens.

Favours Defendant prevailed

Performed right wrist surgery in December 2016 after conservative treatment.

From the decision · page 4Subsequent to her ankle surgery, applicant was referred to Dr. Dana Hess for treatment of her right wrist. After a course of conservative treatment, Dr. Hess performed right wrist surgery in December of 2016.

Evaluated applicant on 2/21/2018, opined MMI with permanent disability related to bilateral wrists, right ankle, and low back, and need for future medical treatment and work restrictions.

From the decision · page 4On February 21, 2018, Dr. Peter Mandell evaluated applicant in the capacity of an Agreed Medical Evaluator (AME). In his report of that date, he opined that applicant had reached Maximum Medical Improvement with permanent disability related to the bilateral wrists, right ankle and low back. Applicant would need future medical treatment and she was precluded from full duty.

Recommended Functional Restoration Program in 2019, which was authorized and attended by applicant.

From the decision · page 4In 2019, Toufan Razi, M.D., applicant's treating physician, recommended participation in a Functional Restoration Program (FRP). Defendant authorized the FRP and applicant attended the program from June 7, 2019 to July 31, 2019.

Meadowbrook Ins. Co. v. Workers Comp. Appeals Bd

Meadowbrook Ins. Co. v. Workers Comp. Appeals Bd (2019) 42 Cal App.5th 432

Court relied on this case to find no jurisdiction over billings not submitted to Independent Bill Review and to bar recovery of liens.

From the decision · page 6The Court of Appeals determined that Title 8 California Code of Regulations § 9795.3 served as an applicable fee schedule and that there was no requirement that some future fee schedule to be adopted by the Administrative Director for the regulatory appeal scheme to apply. As there was a fee schedule in place, the Court ruled that lien claimant failure to request second bill review and Independent Bill Review barred recovery of its liens.

Insurance Code

Insurance Code §11761

Lien claimant argued bill reviewers must be certified; court found no evidence claimant requested certification or that lack of certification voids bill reviews.

From the decision · page 5Lien Claimant places strong [emphasis] on Insurance Code § 11761 that sets forth the requirement of bill reviewers to be certified. Lien Claimant contends that since defendant failed to provide clear documentation of certification, the bill reviews completed by defendant's vendor are defective and the bills should be paid in full.

Title 8 California Code of Regulations

Title 8 California Code of Regulations §9795.3

Regulation sets interpreter fees and supports defendant's initial payments; court applied this in market rate determination.

From the decision · page 6Defendant relied upon Title 8 of the California Code of Regulations § 9795.3(b)(2) in support of its initial payments. That regulation states: "...interpreter fees shall be billed and paid at the rate of $11.25 per quarter hour or portion thereof, with a minimum of two hours, or the market rate, whichever is greater. The interpreter shall establish the market rate...by submitting documentation to the claims examiner, including a list of recent similar services performed and the amounts paid for those services."

Lack of evidence that lien claimant requested certification documentation from Insurance Commissioner or conducted discovery on certification.

From the decision · page 5I note that the certifications required to be in existence are held by the Insurance Commissioner and are to be presented upon request. There is no evidence presented by lien claimant that it requested production of any certifications from the Insurance Commissioner. Nor is there any evidence presented that lien claimant conducted any discovery relative to the question of certification or lack thereof.

No evidence that lack of certification voids bill reviews or requires full payment of bills.

From the decision · page 5In addition, there is no evidence or authority presented by lien claimant that the potential lack of any certification automatically voids the bill reviews performed. There is also no authority presented that states that the bill reviewers certification information must be provided in every Explanation of Review (EOR) conducted by that bill reviewer.

Court relied on Meadowbrook case ruling that Independent Bill Review process applies to interpreter services and that failure to request it bars recovery of liens.

From the decision · page 6The Court of Appeals determined that Title 8 California Code of Regulations § 9795.3 served as an applicable fee schedule and that there was no requirement that some future fee schedule to be adopted by the Administrative Director for the regulatory appeal scheme to apply. As there was a fee schedule in place, the Court ruled that lien claimant failure to request second bill review and Independent Bill Review barred recovery of its liens.