What the panel treated as outcome-determinative, and which side it favoured.
Applicant sustained injury to right shoulder on September 16, 2003, admitted by defendant.
Favours Applicant prevailed
Established industrial injury as basis for compensable psychiatric injury.
Psychiatric QME Dr. Jaime Anselen diagnosed psychiatric injury with industrial causation and need for further treatment.
Favours Applicant prevailed
Supported compensability of psychiatric injury and medical necessity of treatment.
From the decision · page 3On June 24, 2009, Jaime Anselen, M.D., performed a psychiatric Qualified Medical
Evaluation and issued a corresponding report. The QME identified psychiatric injury with
industrial causation and predominance and the need for further medical treatment. (Ex. 1, Report
of Jaime Anselen, M.D., dated June 24, 2009, at p. 12.)
Reports of Dr. Vahedian consistently found applicant required psychological care and treatment for psychiatric injury.
Favours Applicant prevailed
Supported reasonableness and necessity of treatment and lien claimant's entitlement.
From the decision · page 6We also observe that insofar as defendant challenges the medical necessity of the treatment
rendered, the reporting of orthopedic QME Dr. Nagelberg addresses the issue directly, noting in
his October 22, 2008, report that applicant was experiencing significant psychological distress,
and that "additional psychological care at this point" was strongly recommended. (Ex. 12, Report
of Steven Nagelberg, M.D., dated December 4, 2008, at p. 25.) These recommendations were
echoed in the June 24, 2009, report of QME Dr. Anselen, who diagnosed a depressive disorder not
otherwise specified with underlying suicidal thinking and identified significant whole person
impairment. (Ex. 1, Report of Jaime Anselen, M.D., dated June 24, 2009, at p. 13.) The QME
endorsed applicant's treatment course up through the date of the evaluation and further
recommended additional treatment in the form of ongoing therapy and pharmaceutical
management. (Id. at p. 14.) The ongoing symptoms and need for treatment are further reflected in
the contemporaneous reporting of Dr. Vahedian, who observed ongoing "preoccupation with
symptoms and physical limitations," poor judgment and coping ability, and issues with cognition
and memory. (Ex. 3, Reports of Ahmad Vahedian, Ph.D., various dates.) We thus agree with the
WCJ's conclusion that the evidentiary record supports the medical necessity and reasonableness
Proofs of service and billing statements were credible and supported lien claimant's assertion of service of bills.
Favours Applicant prevailed
Supported validity of lien and entitlement to statutory increase and interest.
From the decision · page 11Weighing the proofs of service, objection letters and explanation of review, it is more
probable than not that the billings were received when lien claimant asserts service. It is noted that
the proofs of service are all in 2012 and 2013 except for one on 10/172007, which (when compared
to the billing) could only have been the initial medical legal report (the change for which was
disallowed.)