ADJ16164777 · July 7, 2026

The WCAB found that the WCA erred in denying reimbursement of the lien based on the timing of the medical report service after the Compromise and Release approval, granting reconsideration for further review.

From the decision · page 1Lien claimant Premier Psychological Services seeks reconsideration of the Findings and Order issued by the workers’ compensation arbitrator (WCA) on June 20, 2025. Therein, the WCA found that lien claimant is not entitled to reimbursement on its lien. Lien claimant contends that the WCA erred in failing to find its lien reimbursable. Lien claimant argues that the purpose of a medical legal report is to prove or disprove a contested claim, that this case became a contented claim when defendant rejected liability, and that service of lien claimant’s report 10 days after approval of the Compromise and Release is not dispositive of entitlement to reimbursement. In its Answer, defendant asserts that the Petition for Reconsideration should be dismissed as untimely or denied on the merits. The WCA issued a Report and Recommendation on the Lien Claimant’s Petition for Reconsideration (Report) recommending that we deny reconsideration.

The medical report substantiating the psychiatric industrial injury was served 10 days after the Compromise and Release Agreement was approved.

Favours Applicant prevailed

This timing was initially the basis for denying lien reimbursement but was found insufficient to deny reimbursement without further review.

From the decision · page 5A Compromise and Release Agreement was submitted by the parties and approved by the Arbitrator on June 20, 2024. At the time of the submission of the settlement, both parties advised the Arbitrator that there were no medical reports to substantiate an industrial psychiatric injury and therefore based on these statements, the settlement was approved.

Designated as primary treating physician by applicant's counsel on November 9, 2023.

From the decision · page 4On November 9, 2023, the applicant's counsel designated Dr. Mark Mathews as the primary treating physician.

Authored a medical report dated January 24, 2024, substantiating a psychiatric industrial injury, served after the Compromise and Release approval.

The timing of the report's service after the settlement approval was central to the dispute over lien reimbursement.

From the decision · page 5Dr. Michaels wrote a medical report dated January 24, 2024.

Lab. Code, §§ 4060, 4064, 4620, 5307.6; Cal. Code Regs., tit. 8, §§ 9785(d), 9793(h)

Section 4060(b) allows a medical-legal evaluation by the treating physician; Section 4620(a) defines medical-legal expense as costs for proving or disproving a contested claim; Section 4064(a) provides employer liability for comprehensive medical evaluations; Cal. Code Regs., tit. 8, § 9785(d) requires primary treating physician opinions on medical issues for compensation eligibility; AD Rule 9793(h) defines medical-legal expense conditions.

These provisions govern the entitlement and timing of medical-legal reports and reimbursement of related expenses.

From the decision · page 5IV. We highlight the following legal principles that may be relevant to our review of this matter: Section 4060(b) allows a medical-legal evaluation by the treating physician. Section 4620(a) defines medical-legal expense as “any costs and expenses … for the purpose of proving or disproving a contested claim.” Section 4064(a) provides that the employer is liable for the cost of a comprehensive medical evaluation that is authorized by section 4060. The regulations provide that the “primary treating physician shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation …” (Cal. Code Regs., tit. 8, § 9785(d).)

The medical report by Dr. Michaels was served 10 days after the Compromise and Release approval, which was initially the basis for denying lien reimbursement.

From the decision · page 5A Compromise and Release Agreement was submitted by the parties and approved by the Arbitrator on June 20, 2024. At the time of the submission of the settlement, both parties advised the Arbitrator that there were no medical reports to substantiate an industrial psychiatric injury and therefore based on these statements, the settlement was approved.