Authorities as the decision cited them, with how this panel applied each one.
Cal. Code Regs., tit. 8, 10880(a)(1)
Lien claimant has a duty to know or discover facts regarding compensability of its lien prior to trial.
Lien claimant failed to meet burden of proof on causation and reasonableness of treatment.
From the decision · page 5II.
A lien claimant has a duty to know or discover the facts regarding the compensability of
its lien prior to submitting its lien for trial. (Cal. Code. Regs., tit. 8, § 10880(a)(1).)
Here, the WCJ denied lien claimant's recovery on the grounds that lien claimant failed to
prove causation of injury. In its petition, lien claimant correctly points out that causation of injury
was stipulated. However, lien claimant fails to recognize two important elements to its burden of
proof. First, defendant disputed the nature and extent of injury. (Lien Claimant's Exhibit 2.)
Causation was stipulated as to a head laceration only. (Ibid.) Lien claimant argues that all treatment
rendered in its emergency room was industrial. However, arguments are not evidence. (Hamilton
v. Lockheed Corporation (Hamilton) (2001) 66 Cal. Comp. Cases 473, 476 (Appeals Board en
banc).) Where liability is disputed, lien claimant was required to establish that its treatment was
encompassed within the nature and extent of injury. Absent such evidence, lien claimant failed to
meet its burden of proof.
Lab. Code 4600, 4610.5(c)(2), 5705
Treatment must be reasonable and necessary to cure or relieve effects of industrial injury.
Lien claimant provided no evidence of reasonableness and necessity of treatment rendered.
From the decision · page 6Second, even where a claim is accepted, lien claimant must prove that the treatment
rendered was reasonable and necessary to cure or relieve from the effects of the industrial injury.
(Lab. Code4, § 4600, 4610.5(c)(2); 5705.) Lien claimant provided no evidence as to the
reasonableness of the treatment rendered. Lien claimant could have submitted the treatment it
provided as a request for authorization of retrospective medical treatment. (§ 4610, 4610.5; Cal.
Code Regs., tit. 8, § 9792.9.1.) Then defendant could have either approved the treatment, or
submitted it for retrospective utilization review. This did not happen. Furthermore, lien claimant
submitted no other medical reports establishing the reasonableness and necessity of the treatment
rendered. Instead, it appears that lien claimant simply sent its billing to defendant on the
assumption that reasonableness was not in dispute. (Lien Claimant's Exhibit 1.) Defendant
responded to the billing by denying liability to all body parts outside of a head laceration. At that
point, lien claimant was on notice that a dispute existed and should have obtained evidence to
establish its burden of proof.
Hamilton v. Lockheed Corporation (2001) 66 Cal. Comp. Cases 473
Arguments are not evidence; burden of proof requires evidence.
Lien claimant's argument that all treatment was industrial was rejected for lack of evidence.
From the decision · page 5II.
A lien claimant has a duty to know or discover the facts regarding the compensability of
its lien prior to submitting its lien for trial. (Cal. Code. Regs., tit. 8, § 10880(a)(1).)
Here, the WCJ denied lien claimant's recovery on the grounds that lien claimant failed to
prove causation of injury. In its petition, lien claimant correctly points out that causation of injury
was stipulated. However, lien claimant fails to recognize two important elements to its burden of
proof. First, defendant disputed the nature and extent of injury. (Lien Claimant's Exhibit 2.)
Causation was stipulated as to a head laceration only. (Ibid.) Lien claimant argues that all treatment
rendered in its emergency room was industrial. However, arguments are not evidence. (Hamilton
v. Lockheed Corporation (Hamilton) (2001) 66 Cal. Comp. Cases 473, 476 (Appeals Board en
banc).) Where liability is disputed, lien claimant was required to establish that its treatment was
encompassed within the nature and extent of injury. Absent such evidence, lien claimant failed to
meet its burden of proof.