ADJ7404188 · March 2, 2026

The WCAB found that a contested claim existed at the time the medical-legal copy services were provided, contrary to the WCJ's finding that the claim was not contested because the low back injury was accepted and the psych claim was subject to the six-month rule. The WCAB emphasized that the denial of the psych claim and the nature of the Compromise & Release settlement showed the claim was contested, thus entitling cost petitioner to reimbursement.

From the decision · page 7contested claim that would entitle it to medical-legal reimbursement under sections 4620 and 4621, and the Colamonico en banc decision. In his Opinion, the WCJ states that the claim was not contested because defendant accepted applicant's claim of injury to the low back and the claim of psych was subject to the six-month rule. We disagree.

Defendant denied liability for applicant's psych injury claim, never paying benefits for that body part.

Favours Applicant prevailed

This denial established that a contested claim existed at the time the medical-legal copy services were provided, supporting cost petitioner's entitlement to reimbursement.

From the decision · page 7While the record is not extensive, it reflects that there were several occasions from 2010 when the Application was filed to 2016 when the matter was resolved where defendant was not paying benefits as shown by the DORs. Further, the parties proceeded to a QME, again demonstrating that there were unresolved issues. Moreover, defendant's denial of applicant's claim for psych means that the claim was contested as defendant never paid any benefits for that body part. Finally, the resolution of the body parts of trunk, lower extremities, psych, body systems, and back in the C&R compared with the clear language in the OACR that liability was only accepted for the low back, again shows that the claim was contested. The very nature of a C&R settlement means that issues remain in dispute and that the parties are "compromising" their disputes.

The Compromise & Release settlement and Order Approving C&R explicitly stated that liability was accepted only for the low back injury, indicating other body parts were contested.

Favours Applicant prevailed

This showed that the claim was contested, contrary to the WCJ's finding, and supported the cost petitioner's claim for reimbursement.

From the decision · page 7While the record is not extensive, it reflects that there were several occasions from 2010 when the Application was filed to 2016 when the matter was resolved where defendant was not paying benefits as shown by the DORs. Further, the parties proceeded to a QME, again demonstrating that there were unresolved issues. Moreover, defendant's denial of applicant's claim for psych means that the claim was contested as defendant never paid any benefits for that body part. Finally, the resolution of the body parts of trunk, lower extremities, psych, body systems, and back in the C&R compared with the clear language in the OACR that liability was only accepted for the low back, again shows that the claim was contested. The very nature of a C&R settlement means that issues remain in dispute and that the parties are "compromising" their disputes.

Concluded that the patient has evidence for a work-related injury to the lower back.

From the decision · page 3On October 3, 2013, Hrair E. Darakjian, M.D., issued a qualified medical evaluator (QME) report addressed solely to defendant. He concluded that: "I believe the patient does have evidence for a work-related injury to the lower back." (Exhibit 29, 10/3/2013.)

Labor Code sections 4620, 4621, 4622(f); Colamonico v. Secure Transportation (2019) 84 Cal.Comp.Cases 1059 (Appeals Board en banc)

A cost petitioner must establish that a contested claim existed at the time the expenses were incurred, that the expenses were for proving or disproving the contested claim, and that the expenses were reasonable and necessary at the time incurred.

The WCAB applied this standard to find that the cost petitioner met its burden to show a contested claim existed at the time the medical-legal copy services were provided.

From the decision · page 6A cost petitioner holds the burden of proof to establish all elements necessary to establish its entitlement to payment for a medical-legal expense. (See § 3205.5, 5705.5; Torres v. AJC Sandblasting (2012) 77 Cal.Comp.Cases 1113, 1115 (Appeals Board en banc).) As we explained in our en banc decision in Colamonico v. Secure Transportation (2019) 84 Cal.Comp.Cases 1059 (Appeals Board en banc), section 4622 provides the framework for reimbursement of medical- legal expenses. Subsection (f) of the statute, however, specifically states that "[t]his section is not applicable unless there has been compliance with Sections 4620 and 4621." (Lab. Code, § 4622(f).)

Defendant's denial of applicant's claim for psych injury shows the claim was contested as defendant never paid benefits for that body part.

From the decision · page 7While the record is not extensive, it reflects that there were several occasions from 2010 when the Application was filed to 2016 when the matter was resolved where defendant was not paying benefits as shown by the DORs. Further, the parties proceeded to a QME, again demonstrating that there were unresolved issues. Moreover, defendant's denial of applicant's claim for psych means that the claim was contested as defendant never paid any benefits for that body part. Finally, the resolution of the body parts of trunk, lower extremities, psych, body systems, and back in the C&R compared with the clear language in the OACR that liability was only accepted for the low back, again shows that the claim was contested. The very nature of a C&R settlement means that issues remain in dispute and that the parties are "compromising" their disputes.

The Compromise & Release settlement and Order Approving C&R show that liability was only accepted for the low back, indicating a contested claim for other body parts.

From the decision · page 7While the record is not extensive, it reflects that there were several occasions from 2010 when the Application was filed to 2016 when the matter was resolved where defendant was not paying benefits as shown by the DORs. Further, the parties proceeded to a QME, again demonstrating that there were unresolved issues. Moreover, defendant's denial of applicant's claim for psych means that the claim was contested as defendant never paid any benefits for that body part. Finally, the resolution of the body parts of trunk, lower extremities, psych, body systems, and back in the C&R compared with the clear language in the OACR that liability was only accepted for the low back, again shows that the claim was contested. The very nature of a C&R settlement means that issues remain in dispute and that the parties are "compromising" their disputes.