What the panel ordered
Petition for Reconsideration granted; May 22, 2024 Findings and Order rescinded and substituted; lien claimant found to qualify as a primary treating physician and met burden under Labor Code sections 4620 and 4621; issue of reasonable value of lien deferred; matter returned to WCJ for further proceedings.
Lien claimant Omid Haghighinia, D.C., sought reconsideration of the May 22, 2024 Findings and Order that found he was not a primary treating physician and not entitled to lien recovery; the WCJ recommended denial of reconsideration; the Appeals Board granted reconsideration, rescinded the May 22, 2024 F&O, and returned the matter to the WCJ for further proceedings consistent with the new decision.
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.
The Appeals Board found that the lien claimant met the burden to show designation as PTP, that the medical-legal report was reasonable and necessary, and that the lien claimant met its burden under Labor Code sections 4620 and 4621. The Board rejected the prior finding that the lien claimant was not a PTP and that the report was not recoverable, emphasizing the duty to develop the record further if evidence is insufficient.
From the decision · page 1Lien claimant Omid Haghighinia, D.C., seeks reconsideration of the May 22, 2024 Findings and Order (F&O), wherein the workers' compensation administrative law judge (WCJ) found that Dr. Haghighinia was not a primary treating physician (PTP), and that lien claimant was not entitled to recovery of its lien.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant designated Dr. Haghighinia as PTP in a letter to defendant and appeared for evaluation acknowledged as medical-legal.
Favours Applicant prevailed
This established the validity of the PTP designation and the nature of the medical-legal report, supporting lien recovery.
From the decision · page 2On December 30, 2022, applicant through her attorney designated Dr. Haghighinia as her PTP in a letter to defendant. (Joint Exhibit 2.) In the same letter, applicant's attorney indicated that a medical-legal evaluation would be sought from Dr. Haghighinia.
Lien claimant met burden to show contested claim existed and medical-legal reporting was reasonable and necessary at time incurred.
Favours Applicant prevailed
This satisfied the burden under Labor Code sections 4620 and 4621 for lien recovery.
From the decision · page 5services were reasonably, actually, and necessarily incurred. Additionally, it was held in Colamonico that a defendant does not waive an objection based on section 4620 or 4621 by failing to raise these objections in accordance with section 4622. Here, our review indicates that lien claimant met its burden to show that there was a contested claim, and that the medical-legal reporting was reasonable and necessary at the time that it was incurred.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Recommended x-rays of lumbar spine and chiropractic/physiotherapy; concluded applicant sustained industrial injury based on work duties history.
The Appeals Board found the designation of Dr. Haghighinia as PTP valid and that his medical-legal report was reasonable and necessary for proving a contested claim.
From the decision · page 2On January 31, 2023, Dr. Haghighinia issued a "Primary Treating Physician's Comprehensive Medical-Legal Report." (Exhibit 9.) He recommended that applicant have x-rays of her lumbar spine and a course of chiropractic/physiotherapy and return in six weeks. (Exhibit 9, p. 10.) He took a history of applicant's work duties and concluded that applicant sustained an industrial injury. (Exhibit 9, pp. 3, 11.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code sections 4600, 4601, 4060, 4064, 4620, 4621, 4622
The Board applied these statutes to determine the validity of the PTP designation, the nature of medical-legal expenses, and the burden of proof for lien recovery.
From the decision · page 1Lien claimant contends that pursuant to Labor Code sections1 4600 and 4601, applicant and applicant's attorney properly designated Dr. Haghighnia as the PTP and appropriately requested and obtained a comprehensive medical-legal report under section 4060. As such, lien claimant contends that it is entitled to recovery of its lien pursuant to sections 4620 and 4064.
Cal. Code Regs., tit. 8, 9793(h)
Cal. Code Regs., tit. 8, 9793(h)
The Board applied this regulation to define medical-legal expenses and conditions for their recovery.
Colamonico v. Secure Transportation (2019) 84 Cal.Comp.Cases 1059
Colamonico v. Secure Transportation (2019) 84 Cal.Comp.Cases 1059
The Board applied this case to clarify the burden of proof for lien claimants under Labor Code sections 4620 and 4621.
From the decision · page 4Pursuant to Colamonico v. Secure Transportation (2019) 84 Cal.Comp.Cases 1059 (Appeals Board en banc), a lien claimant holds the initial burden of proof pursuant under sections 4620 and 4621: that a contested claim existed at the time the expenses were incurred, that the expenses were incurred for the purpose of proving or disproving a contested claim, and that its
Warren Brower v. David Jones Construction (2014) 79 Cal.Comp.Cases 550 (Appeals Board en banc)
Warren Brower v. David Jones Construction (2014) 79 Cal.Comp.Cases 550 (Appeals Board en banc)
The Board cited this en banc case to support that a PTP's medical-legal report is a recoverable medical-legal expense.
From the decision · page 4be held liable for any associated reasonable and necessary medical-legal costs and expenses. Moreover, the Appeals Board has previously held that there is no legal authority to support the proposition that an injured worker is not entitled to a medical-legal report from a PTP and no legal authority to support that a PTP's report is not a medical-legal expense for which defendant is liable. (Warren Brower v. David Jones Construction (2014) 79 Cal.Comp.Cases 550 (Appeals Board en banc).)
What proof carried it
The evidence the panel weighed, by kind.
Applicant designated Dr. Haghighinia as PTP in a letter to defendant; applicant appeared for evaluation; evaluation acknowledged as medical-legal.
From the decision · page 2On December 30, 2022, applicant through her attorney designated Dr. Haghighinia as her PTP in a letter to defendant. (Joint Exhibit 2.) In the same letter, applicant's attorney indicated that a medical-legal evaluation would be sought from Dr. Haghighinia.
Lien claimant met burden to show contested claim existed and medical-legal reporting was reasonable and necessary at time incurred.
From the decision · page 5services were reasonably, actually, and necessarily incurred. Additionally, it was held in Colamonico that a defendant does not waive an objection based on section 4620 or 4621 by failing to raise these objections in accordance with section 4622. Here, our review indicates that lien claimant met its burden to show that there was a contested claim, and that the medical-legal reporting was reasonable and necessary at the time that it was incurred.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
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