ADJ8710590 · May 26, 2026

Cost petitioner met burden to show contested claim existed when services were provided and services were reasonable and necessary; defendant failed to issue timely and compliant objections or Explanations of Review; cost petitioner entitled to reimbursement, penalties, and interest; amount deferred to trial level.

From the decision · page 12FINDINGS OF FACT 1. Cost petitioner met its burden of proof under Labor Code section 4620 to show a contested claim existed at the time it provided its medical-legal services beginning on February 5, 2013, and that the services were reasonable and necessary at the time the costs were incurred pursuant to Labor Code sections 4620 and 4621. 2. Cost petitioner is entitled to be reimbursed for the reasonable value of its services and penalties and interest pursuant to Labor Code section 4622. The issue of the amount of payment is deferred. 3. Defendant did not meet its burden to show that it issued timely and compliant objections or Explanations of Review in response to cost petitioner's invoices. 4. The provisions of Labor Code section 4055.2, including the failure to serve a copy of the subpoena, did not render the subpoenas invalid.

Cost petitioner showed a contested claim existed at the time medical-legal services were provided beginning February 5, 2013

Favours Applicant prevailed

Establishes entitlement to reimbursement under Labor Code sections 4620 and 4621

From the decision · page 12FINDINGS OF FACT 1. Cost petitioner met its burden of proof under Labor Code section 4620 to show a contested claim existed at the time it provided its medical-legal services beginning on February 5, 2013, and that the services were reasonable and necessary at the time the costs were incurred pursuant to Labor Code sections 4620 and 4621. 2. Cost petitioner is entitled to be reimbursed for the reasonable value of its services and penalties and interest pursuant to Labor Code section 4622. The issue of the amount of payment is deferred. 3. Defendant did not meet its burden to show that it issued timely and compliant objections or Explanations of Review in response to cost petitioner's invoices. 4. The provisions of Labor Code section 4055.2, including the failure to serve a copy of the subpoena, did not render the subpoenas invalid.

Defendant did not issue timely and compliant objections or Explanations of Review to cost petitioner's invoices

Favours Applicant prevailed

Resulted in waiver of objections and entitlement to penalties and interest for cost petitioner

From the decision · page 12FINDINGS OF FACT 1. Cost petitioner met its burden of proof under Labor Code section 4620 to show a contested claim existed at the time it provided its medical-legal services beginning on February 5, 2013, and that the services were reasonable and necessary at the time the costs were incurred pursuant to Labor Code sections 4620 and 4621. 2. Cost petitioner is entitled to be reimbursed for the reasonable value of its services and penalties and interest pursuant to Labor Code section 4622. The issue of the amount of payment is deferred. 3. Defendant did not meet its burden to show that it issued timely and compliant objections or Explanations of Review in response to cost petitioner's invoices. 4. The provisions of Labor Code section 4055.2, including the failure to serve a copy of the subpoena, did not render the subpoenas invalid.

Lumbar spine is an injured part due to continuous trauma claim between February 1, 2012 through August 3, 2012.

From the decision · page 3On April 24, 2014, agreed medical evaluator (AME) Paul E. Wakim, D.O., issued a report. As relevant here, he stated that:

Applicant has pain disorder caused by the injury, no other Axis I psychiatric diagnosis.

From the decision · page 4a report following a psychiatric evaluation of applicant. (Exhibit 40, 2/5/2015, p. 1.) Dr. Lustig concluded,

Labor Code sections 4620, 4621, 4622

Labor Code sections 4620, 4621, 4622 provide framework for reimbursement of medical-legal expenses and penalties for non-compliance

Cost petitioner met burden to show contested claim existed and services were reasonable and necessary; defendant failed to timely object with compliant Explanation of Review; cost petitioner entitled to reimbursement, penalties, and interest.

From the decision · page 7A 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-

California Code of Regulations 10786(e)

California Code of Regulations 10786(e) applies to medical-legal expense disputes and requires timely Explanation of Review

Defendant failed to comply with timely Explanation of Review requirements, resulting in waiver of objections and entitlement to penalties and interest for cost petitioner.

From the decision · page 9A defendant has 60 days to review and analyze a medical-legal bill or invoice. (Lab. Code, § 4622(a)(1).) A defendant has two options within this 60-day window: It may pay the bill or invoice in full or pay less than the full amount. Should a defendant decide to pay less than the full amount within the 60-day window, it may still avoid the imposition of a penalty and interest by including an explanation of review (EOR) with its payment. Section 4622 requires that a defendant object to the invoice or billing with an EOR as described in section 4603.3. (Lab. Code, § 4622(a)(1), (e)(1); 4603.3.) Objecting to an invoice with an EOR within the 60-day window is defendant's burden. If a defendant does not pay a proper medical-legal invoice in full or fails to provide an EOR within the 60-day window, then a defendant has waived all objections, other than compliance with sections 4620 and 4621, to the medical-legal provider's billing. (Cal. Code Regs., tit. 8, § 10786(e); see Colamonico, supra.) A defendant is then liable for the reasonable value of the medical-legal services as well as a 10 percent penalty and 7 percent per annum interest.

Labor Code sections 5708, 5709

Labor Code sections 5708 and 5709 allow informality in proceedings and admission of evidence not admissible under common law rules

Supports liberal discovery and evidentiary discretion in workers' compensation proceedings favoring cost petitioner.

From the decision · page 7Our holding herein is consistent with the public policy favoring liberal pre-trial discovery that may reasonably lead to relevant and admissible evidence applicable in workers' compensation cases. (Allison v. Workers' Comp. Appeals Bd. (1999) 72 Cal.App.4th 654, 663 [64 Cal.Comp.Cases 624].) We emphasize that in workers' compensation proceedings, the Labor Code makes explicit that the WCJ and the Appeals Board have greater discretion with respect to evidentiary matters than courts in civil proceedings, and not narrower discretion as defendant appears to believe. Section 5708 mandates that we are not "bound by the common law or statutory rules of evidence and procedure, but may make inquiry in the manner, through oral testimony and records, which is best calculated to ascertain the substantial rights of the parties and carry out justly the spirit and provisions of this division." (Lab. Code, § 5708, emphasis added.) Section 5709 specifically allows informality in our proceedings and ensures that "admission into the record, and use as proof of any fact in dispute, of any evidence not admissible under the common law or statutory rules of evidence and procedure" will not invalidate an order, decision or award. (Lab. Code, § 5709.)

Defendant's Explanation of Review was non-compliant and delayed

From the decision · page 12FINDINGS OF FACT 1. Cost petitioner met its burden of proof under Labor Code section 4620 to show a contested claim existed at the time it provided its medical-legal services beginning on February 5, 2013, and that the services were reasonable and necessary at the time the costs were incurred pursuant to Labor Code sections 4620 and 4621. 2. Cost petitioner is entitled to be reimbursed for the reasonable value of its services and penalties and interest pursuant to Labor Code section 4622. The issue of the amount of payment is deferred. 3. Defendant did not meet its burden to show that it issued timely and compliant objections or Explanations of Review in response to cost petitioner's invoices. 4. The provisions of Labor Code section 4055.2, including the failure to serve a copy of the subpoena, did not render the subpoenas invalid.