ADJ15853585 — California WCAB decision

What the panel ordered

Petition for Reconsideration granted; final decision after reconsideration deferred pending further review of merits and entire record.

Applicant seeks reconsideration of the Findings of Fact issued by the WCJ on October 21, 2024, which denied payment to Casa Colina for treatment services beyond a previously ordered amount. The WCJ's Report and Recommendation on Petition for Reconsideration recommended denial of the Petition. The Appeals Board granted the Petition for Reconsideration and deferred final decision pending further review.

Read the official decision →

This docket was decided more than once. Shown here is the latest released decision; we also hold February 27, 2024.

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.

Reconsideration / removalApplicant prevailed

The Appeals Board found that the WCJ's denial of payment to Casa Colina was contrary to prior Appeals Board findings that the applicant is entitled to reasonable and necessary medical treatment under Labor Code section 4600, and that the failure to pay Casa Colina amounts to a denial of care regardless of lien status.

From the decision · page 1Applicant seeks reconsideration of the Findings of Fact issued by the workers' compensation administrative law judge (WCJ) in this matter and served on October 21, 2024. In that decision, the WCJ found that no good cause has been shown for the Appeals Board to order defendant to pay Casa Colina for treatment services in an amount over and above that which was previously ordered. The WCJ further found that his decision was without prejudice to Casa Colina's right to pursue reimbursement upon the filing of a valid lien.

The facts that decided it

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

Applicant is entitled to reasonable and necessary medical treatment as authorized by defendant under Labor Code section 4600.

Favours Applicant prevailed

This entitlement was affirmed in a prior Appeals Board Opinion and Order, supporting the grant of reconsideration.

From the decision · page 1Petitioner asserts that the WCJ's findings are contrary to the Opinion and Order Granting Petition for Reconsideration and Decision after Reconsideration of the Appeals Board (Opinion and Order) on February 27, 2024 wherein it was found that applicant is entitled to reasonable and necessary medical treatment as authorized by defendant pursuant to Labor Code1 section 4600 and other relevant provision of the law.

Defendant failed to pay Casa Colina for inpatient treatment, risking premature discharge of applicant from care.

Favours Applicant prevailed

Failure to pay was found to amount to a denial of care, which is contrary to the applicant's rights and supports reconsideration.

From the decision · page 5Here, the evidence indicates that the applicant is in danger of a premature discharge from care due to the non-payment by defendant to Casa Colina. (Ex. 40.) Thus, a failure to provide for payment to the facility amounts to a denial of care. As such, the existence or non-existence of a lien is not of import with respect to defendant's duty to provide such care.

Casa Colina has not filed a lien for its services, and the WCJ found no authority to order payment without a lien.

Favours Applicant prevailed

The Appeals Board found lien status irrelevant to defendant's duty to provide care, overruling the WCJ's jurisdictional finding.

From the decision · page 3Turning to the merits, we note the following, which may be relevant to our review: The WCJ addresses the issue of the services provided by Casa Colina to applicant in his Opinion, in pertinent part, as follows: The problem with the claim that was presented at the 10/9/24 trial herein, is that Casa Colina has never filed a lien on its own behalf for medical treatment services pursuant to Labor Code section 4903(b). Accordingly, it is obvious that this judge has no authority to award payment on their behalf.

The rules the panel named

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

Labor Code section 4600

Defendant's duty to provide reasonable and necessary medical treatment under Labor Code section 4600.

The Appeals Board reaffirmed the applicant's entitlement to medical treatment as authorized by defendant under LC 4600.

From the decision · page 1Petitioner asserts that the WCJ's findings are contrary to the Opinion and Order Granting Petition for Reconsideration and Decision after Reconsideration of the Appeals Board (Opinion and Order) on February 27, 2024 wherein it was found that applicant is entitled to reasonable and necessary medical treatment as authorized by defendant pursuant to Labor Code1 section 4600 and other relevant provision of the law.

Labor Code section 4903(b)

Requirement for filing medical provider liens under Labor Code section 4903(b).

The WCJ found no authority to order payment to Casa Colina without a lien filed under LC 4903(b), but the Appeals Board found lien status irrelevant to defendant's duty to provide care.

From the decision · page 3Turning to the merits, we note the following, which may be relevant to our review: The WCJ addresses the issue of the services provided by Casa Colina to applicant in his Opinion, in pertinent part, as follows: The problem with the claim that was presented at the 10/9/24 trial herein, is that Casa Colina has never filed a lien on its own behalf for medical treatment services pursuant to Labor Code section 4903(b). Accordingly, it is obvious that this judge has no authority to award payment on their behalf.

Labor Code section 5909

Appeals Board must act on petition for reconsideration within 60 days of case transmission under Labor Code section 5909.

The Appeals Board found that service of the Report and case transmission on November 26, 2024, commenced the 60-day period to act on the petition.

From the decision · page 2Former section 5909 provided that a petition for reconsideration was deemed denied unless the Appeals Board acted on the petition within 60 days from the date of filing. (Lab. Code, § 5909.) Effective July 2, 2024, Labor Code section 5909 was amended to state in relevant part that:

ADJ15853585 · January 27, 2025

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

The rules the panel named

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