ADJ11295772 — California WCAB decision

What the panel ordered

Petition for Reconsideration granted, F&O rescinded, matter returned to trial level for further proceedings and new decision by WCJ

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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.

LiensRemanded

The WCJ's decision denying payment was rescinded due to lack of substantial evidence and due process concerns; the matter was remanded for further proceedings to determine if PPT is entitled to payment under the statute.

From the decision · page 1Prime Physical Therapy (PPT or lien claimant), by and through its lien representative, Innovative Medical Management, seeks reconsideration of the Findings and Orders and Opinion on Decision (F&O) issued in this case by a workers' compensation administrative law judge (WCJ), wherein the WCJ found that PPT was not entitled to collect payment on a lien for physical therapy services rendered to applicant. The WCJ found that: 1) PPT had listed itself as both the billing service and the medical provider on the lien, 2) PPT was not licensed to provide the medical services rendered, and 3) there was insufficient evidence to support PPT's assertion that it was simply the billing service seeking payment on behalf of, and as contractually authorized by, the actual medical provider, Alternative Healthcare Center (AHC). The WCJ thus ordered that PPT take nothing on its lien claim.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

PPT listed itself as both billing service and medical provider on the lien, but parties stipulated AHC provided the services.

Favours Applicant prevailed

This stipulation established the actual medical provider, affecting lien ownership determination.

From the decision · page 4Here, there is no dispute that PPT filed a timely section 4903(b) lien for medical services provided to applicant. (Lien, April 23, 2020.) Although PPT listed itself as both the billing and collections service and the medical provider on the lien, during trial, the attorneys for SCIF and PPT stipulated that the disputed medical services were provided by Alternative Healthcare Center (AHC). (MOH, January 3, 2023, p. 2.) We do not see, nor do the parties argue, any reason to reject this stipulation. (County of Sacramento v. Workers' Comp. Appeals Bd. (2000) 77 Cal.App.4th 1114 [65 Cal.Comp.Cases 1] [good cause is required to set aside factual stipulations].) Thus, we turn to the issue at hand, namely, whether PPT may properly pursue payment on the section 4903(b) lien; in doing so, we must analyze PPT's position, the WCJ's decision, and the evidence, using the framework set forth in section 4903.8(a)(1)-(2).

No evidence of contract between PPT and AHC to establish PPT as lien owner.

Favours Defendant prevailed

Without evidence of contract, entitlement to payment under section 4903.8(a)(1)-(2) cannot be determined.

From the decision · page 5Similar circumstances exist in the case at hand. Here, PPT argues that it was the billing and collections service for AHC, and that AHC contractually authorized PPT to pursue payment on the section 4903(b) lien. However, as in Rebolledo II, there is currently no evidence of any such agreement, or contract, between AHC and PPT. Without such evidence, we cannot determine whether PPT is entitled to payment under section 4903.8(a)(1)-(2) as the "lien owner." Again, as clearly explained in section 4903.8(a)(2) and Rebolledo II, "no payment shall be made to any lien claimant without evidence that he or she is the owner of that lien." (Rebolledo II, supra, 2022 Cal. Wrk. Comp. P.D. LEXIS 73, *9, quoting Lab. Code, § 4903.8(a)(2), emphasis sic.)

WCJ decided the matter without testimony, violating due process rights.

Favours Applicant prevailed

Due process violation required rescinding the decision and remanding for further proceedings.

From the decision · page 5As explained above, the current record does not contain substantial evidence to support the WCJ's decision that PPT is not entitled to payment on the lien. We also note that the WCJ decided the matter without obtaining testimony. (MOH, January 3, 2023.) All parties to a workers' compensation proceeding retain the fundamental right to due process and a fair hearing under both the California and United States Constitutions. (Rucker v. Workers' Comp. Appeals Bd. (Rucker) (2000) 82 Cal.App.4th 151, 157-158 [65 Cal.Comp.Cases 805].) A fair hearing is "... one of `the rudiments of fair play' assured to every litigant..." (Id. at p. 158.) The "essence of due process is simply notice and the opportunity to be heard." (San Bernardino Cmty. Hosp. v. Workers'

What proof carried it

The evidence the panel weighed, by kind.

Documentary evidencefavours Applicant prevailed

stipulation that Alternative Healthcare Center provided the disputed medical services

From the decision · page 4Here, there is no dispute that PPT filed a timely section 4903(b) lien for medical services provided to applicant. (Lien, April 23, 2020.) Although PPT listed itself as both the billing and collections service and the medical provider on the lien, during trial, the attorneys for SCIF and PPT stipulated that the disputed medical services were provided by Alternative Healthcare Center (AHC). (MOH, January 3, 2023, p. 2.) We do not see, nor do the parties argue, any reason to reject this stipulation. (County of Sacramento v. Workers' Comp. Appeals Bd. (2000) 77 Cal.App.4th 1114 [65 Cal.Comp.Cases 1] [good cause is required to set aside factual stipulations].) Thus, we turn to the issue at hand, namely, whether PPT may properly pursue payment on the section 4903(b) lien; in doing so, we must analyze PPT's position, the WCJ's decision, and the evidence, using the framework set forth in section 4903.8(a)(1)-(2).

Documentary evidencefavours Defendant prevailed

lack of evidence of contract between PPT and AHC to establish lien ownership

From the decision · page 5Similar circumstances exist in the case at hand. Here, PPT argues that it was the billing and collections service for AHC, and that AHC contractually authorized PPT to pursue payment on the section 4903(b) lien. However, as in Rebolledo II, there is currently no evidence of any such agreement, or contract, between AHC and PPT. Without such evidence, we cannot determine whether PPT is entitled to payment under section 4903.8(a)(1)-(2) as the "lien owner." Again, as clearly explained in section 4903.8(a)(2) and Rebolledo II, "no payment shall be made to any lien claimant without evidence that he or she is the owner of that lien." (Rebolledo II, supra, 2022 Cal. Wrk. Comp. P.D. LEXIS 73, *9, quoting Lab. Code, § 4903.8(a)(2), emphasis sic.)

Testimony and credibilityfavours Applicant prevailed

WCJ decided matter without testimony, raising due process concerns

From the decision · page 5As explained above, the current record does not contain substantial evidence to support the WCJ's decision that PPT is not entitled to payment on the lien. We also note that the WCJ decided the matter without obtaining testimony. (MOH, January 3, 2023.) All parties to a workers' compensation proceeding retain the fundamental right to due process and a fair hearing under both the California and United States Constitutions. (Rucker v. Workers' Comp. Appeals Bd. (Rucker) (2000) 82 Cal.App.4th 151, 157-158 [65 Cal.Comp.Cases 805].) A fair hearing is "... one of `the rudiments of fair play' assured to every litigant..." (Id. at p. 158.) The "essence of due process is simply notice and the opportunity to be heard." (San Bernardino Cmty. Hosp. v. Workers'

ADJ11295772 · June 30, 2023

What the panel ordered

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