What the panel ordered
Petition for reconsideration granted; Findings and Order of September 12, 2023 amended; lien issue deferred with jurisdiction reserved.
Lien claimant Medland Medical Group petitioned for reconsideration of the WCJ's Findings and Order of September 12, 2023, which disallowed its lien; the WCAB granted reconsideration and deferred the lien issue for further analysis.
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 WCJ disallowed the lien claim based on the discharge of care by the primary treating physician and the requirement to go through the QME or AME process for further care; the WCAB granted reconsideration to analyze the applicability of the discharge and designation of a new primary treating physician.
From the decision · page 1Lien claimant Medland Medical Group seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Findings and Order of September 12, 2023, wherein it was found that, while employed as a machine operator during a cumulative period ending May 27, 2022, applicant sustained industrial injury to the elbow and back, but not to the arm, wrist, or other body parts. As relevant to the instant Petition, it was found that lien claimant was not entitled to reimbursement for its lien. The basis behind the disallowance was the purported fact that applicant had been discharged from care by his primary treating physician, and that any further care from a new treating physician was only available after going through the qualified medical evaluator or agreed medical evaluator process. (Cal. Code Regs., tit. 8, § 9785; Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing) (2000) 80 Cal.App.4th 1041 [65 Cal.Comp.Cases 477.)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Letter dated June 27, 2022 designating Dr. Omid Haghighinia as primary treating physician preceded discharge from care by Concentra.
Favours Applicant prevailed
This fact is critical to analyzing the validity of the discharge and lien claim eligibility under Rushing and Administrative Rule 9785.
From the decision · page 1We will grant reconsideration and defer the issue of Medland Medical's lien so the WCJ may reanalyze the issue of the applicability of Rushing, supra. In the further proceedings, the parties and the WCJ should analyze the applicability of the June 27, 2022 letter designating Dr. Omid Haghighinia as primary treating physician. This letter appears to have preceded the
Discharge from care was signed by a physician's assistant, raising questions about its validity for purposes of lien claim disallowance.
Favours Applicant prevailed
The validity of the discharge affects whether further care requires QME or AME process, impacting lien claim entitlement.
From the decision · page 2discharge of care from Concentra. Additionally, if relevant, the parties and WCJ should analyze the issue of whether the discharge from care, which appears to be dictated and signed by a physician's assistant, was a valid discharge for the purposes of Rushing and Administrative Rule 9785. We believe that the WCJ should analyze this issue in the first instance, allowing for the parties to be heard on this issue. (Rucker v. Workers' Comp. Appeals Bd. (2000) 82 Cal.App.4th 151, 157-158 [65 Cal.Comp.Cases 805]; Gangwish v. Workers' Comp. Appeals Bd. (2001) 89 Cal.App.4th 1284, 1295 [66 Cal.Comp.Cases 584].) We take no position on the ultimate resolution of these issues or the ultimate resolution of how the resolution of these issues affects other issues in this case.
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.
Designated as primary treating physician in a letter dated June 27, 2022, preceding discharge from care by Concentra; relevant to lien claim reconsideration.
From the decision · page 1We will grant reconsideration and defer the issue of Medland Medical's lien so the WCJ may reanalyze the issue of the applicability of Rushing, supra. In the further proceedings, the parties and the WCJ should analyze the applicability of the June 27, 2022 letter designating Dr. Omid Haghighinia as primary treating physician. This letter appears to have preceded the
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Cal. Code Regs., tit. 8, 9785
Cal. Code Regs., tit. 8, 9785
Applied to analyze the validity of discharge from care and lien claim eligibility.
From the decision · page 1Lien claimant Medland Medical Group seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Findings and Order of September 12, 2023, wherein it was found that, while employed as a machine operator during a cumulative period ending May 27, 2022, applicant sustained industrial injury to the elbow and back, but not to the arm, wrist, or other body parts. As relevant to the instant Petition, it was found that lien claimant was not entitled to reimbursement for its lien. The basis behind the disallowance was the purported fact that applicant had been discharged from care by his primary treating physician, and that any further care from a new treating physician was only available after going through the qualified medical evaluator or agreed medical evaluator process. (Cal. Code Regs., tit. 8, § 9785; Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing) (2000) 80 Cal.App.4th 1041 [65 Cal.Comp.Cases 477.)
Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing) (2000) 80 Cal.App.4th 1041
Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing) (2000) 80 Cal.App.4th 1041
Cited as basis for lien claim disallowance and reconsideration analysis.
From the decision · page 1Lien claimant Medland Medical Group seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Findings and Order of September 12, 2023, wherein it was found that, while employed as a machine operator during a cumulative period ending May 27, 2022, applicant sustained industrial injury to the elbow and back, but not to the arm, wrist, or other body parts. As relevant to the instant Petition, it was found that lien claimant was not entitled to reimbursement for its lien. The basis behind the disallowance was the purported fact that applicant had been discharged from care by his primary treating physician, and that any further care from a new treating physician was only available after going through the qualified medical evaluator or agreed medical evaluator process. (Cal. Code Regs., tit. 8, § 9785; Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing) (2000) 80 Cal.App.4th 1041 [65 Cal.Comp.Cases 477.)
What proof carried it
The evidence the panel weighed, by kind.
Discharge from care signed by a physician's assistant questioned for validity under Rushing and Administrative Rule 9785.
From the decision · page 2discharge of care from Concentra. Additionally, if relevant, the parties and WCJ should analyze the issue of whether the discharge from care, which appears to be dictated and signed by a physician's assistant, was a valid discharge for the purposes of Rushing and Administrative Rule 9785. We believe that the WCJ should analyze this issue in the first instance, allowing for the parties to be heard on this issue. (Rucker v. Workers' Comp. Appeals Bd. (2000) 82 Cal.App.4th 151, 157-158 [65 Cal.Comp.Cases 805]; Gangwish v. Workers' Comp. Appeals Bd. (2001) 89 Cal.App.4th 1284, 1295 [66 Cal.Comp.Cases 584].) We take no position on the ultimate resolution of these issues or the ultimate resolution of how the resolution of these issues affects other issues in this case.
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About this page
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