ADJ11404325 — California WCAB decision

What the panel ordered

Decision after reconsideration affirms original decision except amended to credit sums paid and adjust penalties and interest

Petition for Reconsideration granted to amend Findings and Order; otherwise original decision affirmed

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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.

LiensApplicant prevailed

Defendant failed to prove existence of PPO contract; lien claimant entitled to stipulated amount less credit for sums paid; penalties and interest adjusted accordingly.

From the decision · page 2Additionally, as the party with the affirmative of the issue, it is defendant that carries the burden of proof to establish the existence and applicability of the alleged PPO contract to this dispute. (Lab. Code § 5705, "[t]he burden of proof rests upon the party or lien claimant holding the affirmative of the issue.") Here, defendant relied on an alleged PPO contract to reduce the amounts reimbursed to lien claimant. (Ex. A, Review Analysis, dated September 29, 2018; Ex. B, Explanation of Bill Review, dated November 9, 2018.) It was thus defendant's affirmative burden to establish the existence of a valid and enforceable PPO contract governing its reimbursement arrangement with lien claimant.

The facts that decided it

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Labor Code 5705

Burden of proof rests on party holding affirmative of the issue (Labor Code 5705).

Defendant had burden to prove existence and applicability of PPO contract to reduce lien amount.

From the decision · page 2Additionally, as the party with the affirmative of the issue, it is defendant that carries the burden of proof to establish the existence and applicability of the alleged PPO contract to this dispute. (Lab. Code § 5705, "[t]he burden of proof rests upon the party or lien claimant holding the affirmative of the issue.") Here, defendant relied on an alleged PPO contract to reduce the amounts reimbursed to lien claimant. (Ex. A, Review Analysis, dated September 29, 2018; Ex. B, Explanation of Bill Review, dated November 9, 2018.) It was thus defendant's affirmative burden to establish the existence of a valid and enforceable PPO contract governing its reimbursement arrangement with lien claimant.

Labor Code 5304

Existence of PPO contract must be proven to apply Labor Code 5304 benefits.

Defendant failed to produce PPO contract document; thus failed burden of proof.

From the decision · page 6Now the other aspect of petitioner's argument is that it misstates the burden of proof. The existence of a PPO contract is a defense, not an element of lien claimant's case. If defendant seeks to invoke Labor Code § 5304, defendant must prove the existence of the PPO contract in order to obtain the benefits of that contract. Once the existence of the PPO contract is established, the

Labor Code 5903

Reconsideration may be granted under Labor Code 5903 for new evidence or error.

Petition for Reconsideration granted to amend credit and penalties; otherwise original decision affirmed.

From the decision · page 1We have considered the allegations of the Petition for Reconsideration and the contents of the report of the workers' compensation administrative law judge (WCJ) with respect thereto. Based on our review of the record, and for the reasons stated in the WCJ's report, which we adopt and incorporate, we will grant reconsideration, amend the WCJ's decision as recommended in the report, and otherwise affirm the decision of May 18, 2022.

ADJ11404325 · August 3, 2022

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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The rules the panel named

What proof carried it

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