ADJ9935791 · December 15, 2025

The Board found that a contested claim existed at the time the lien claimant provided services, and that the services were reasonable and necessary, thus entitlement to payment was established. The amount owed was deferred for further proceedings.

From the decision · page 8Accordingly, we rescind the F&O, substitute a new Findings of Fact that finds that a contested claim existed at the time lien claimant provided its services and that it should be paid for its services, but we defer the amount and return this matter to the trial level for further proceedings consistent with this decision.

Defendant accepted liability for specific injury to back only, denied cumulative injury claim

Favours Applicant prevailed

Established contested claim existed for cumulative injury claim, supporting lien claimant's entitlement to reimbursement.

From the decision · page 5We disagree. The WCJ relies on defendant's acceptance of liability for the specific injury in October 2014 and stresses that the continuous injury claim involved the same body parts claimed in the specific injury claim, and therefore lien claimant failed to prove a contested claim. First, the cumulative injury claim is not for the same body parts; it was denied by defendant on July 24, 2015, and defendant continued to deny it even at the time of the Stipulations. On February 23, 2015, defendant objected to the report of applicant's treating physician, pursuant to sections 4061 and 4062, which is clearly not an acceptance of liability for payment of all species of claimed benefits. Moreover, in the specific injury claim, the only body part that defendant accepted was the back, and this was made clear in the Stipulations. The fact that the WCJ has misconstrued the claims has resulted in the finding that there was not a contested claim, when in fact a contested claim existed as early as October 1, 2014, when defendant accepted applicant's claim for the back only and not the other body parts.

Applications filed on April 28, 2015, stated disagreement regarding liability for all benefits

Favours Applicant prevailed

Confirmed contested claims existed at time subpoenas were issued, supporting lien claimant's entitlement to reimbursement.

From the decision · page 6Temporary disability indemnity, Permanent disability indemnity, Reimbursement for medical expense, Rehabilitation, Medical treatment, Compensation at proper rate, Other (Specify) ALL BENEFITS." Thus, contested claims existed at the time that the subpoenas were issued from April 30, 2015 to August 24, 2015.

Notices and Proof of Service for subpoenas issued April 30 to August 24, 2015, showed defendant had notice despite alleged defective service

Favours Applicant prevailed

Negated defendant's claim of prejudice and supported reasonableness and necessity of lien claimant's services.

From the decision · page 3From April 30, 2015, to August 21, 2015, lien claimant issued Notice(s) to Interested Parties (Notices) to the entities regarding the subpoenas. (Exhibit 3, 4/30/2015-8/21/2015.) At the bottom of each Notice there is a fully executed Proof of Service by mail indicating the date of service and the entity served. (Exhibit 3, 4/30/2015-8/21/2015.) From April 30, 2015, to August 24, 21015, lien claimant issued subpoenas to 18 entities. (Exhibit 2, 4/30/2015-8/24/2015.)

Provided a medical report dated February 5, 2015, which defendant objected to regarding further medical treatment, MMI status, nature and extent of disability, temporary and permanent disability.

From the decision · page 2BACKGROUND We will briefly review the relevant facts. Applicant claimed a specific injury to his leg, back, knee, ankle, and foot while employed by defendant as a dishwasher on August 30, 2014. (ADJ9935791) Applicant claimed cumulative injury to his upper extremities, lower extremities, and back while employed by defendant as a dishwasher during the period from March 17, 2014, to March 17, 2015. (ADJ9935792) On October 1, 2014, AmTrust North America issued a letter to applicant, wherein it accepted liability for applicant's specific injury. (ADJ9935791) (Exhibit C, 10/1/2014.) On February 23, 2015, AmTrust North America issued a letter to applicant in ADJ9935791, informing applicant that it was in receipt of the medical report from Kambriz Hannani, M.D., dated February 5, 2015.

Labor Code sections 3205.5, 5705.5, 4620, 4621, 4622(f)

Labor Code section 4620 defines medical-legal expense and contested claim requirements

Lien claimant must show contested claim existed when expenses were incurred and that expenses were reasonable and necessary.

From the decision · page 4A lien claimant holds the burden of proof to establish all elements necessary to establish its entitlement to payment for a medical-legal expense. (See Lab. Code, § 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), Labor Code section 46222 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).) Thus, a lien claimant is required to establish that: 1) a contested claim existed at the time the expenses were incurred; 2) the expenses were incurred for the purpose of proving or disproving the contested claim; and 3) the expenses were reasonable and necessary at the time were incurred. (Lab. Code, § 4620, 4621, 4622(f); Colamonico, supra, 84 Cal.Comp.Cases 1059.)

Defendant's denial of cumulative injury claim and objection to medical report

From the decision · page 5We disagree. The WCJ relies on defendant's acceptance of liability for the specific injury in October 2014 and stresses that the continuous injury claim involved the same body parts claimed in the specific injury claim, and therefore lien claimant failed to prove a contested claim. First, the cumulative injury claim is not for the same body parts; it was denied by defendant on July 24, 2015, and defendant continued to deny it even at the time of the Stipulations. On February 23, 2015, defendant objected to the report of applicant's treating physician, pursuant to sections 4061 and 4062, which is clearly not an acceptance of liability for payment of all species of claimed benefits. Moreover, in the specific injury claim, the only body part that defendant accepted was the back, and this was made clear in the Stipulations. The fact that the WCJ has misconstrued the claims has resulted in the finding that there was not a contested claim, when in fact a contested claim existed as early as October 1, 2014, when defendant accepted applicant's claim for the back only and not the other body parts.

Notice(s) to Interested Parties and Proof of Service by mail for subpoenas issued April 30, 2015 to August 24, 2015

From the decision · page 3From April 30, 2015, to August 21, 2015, lien claimant issued Notice(s) to Interested Parties (Notices) to the entities regarding the subpoenas. (Exhibit 3, 4/30/2015-8/21/2015.) At the bottom of each Notice there is a fully executed Proof of Service by mail indicating the date of service and the entity served. (Exhibit 3, 4/30/2015-8/21/2015.) From April 30, 2015, to August 24, 21015, lien claimant issued subpoenas to 18 entities. (Exhibit 2, 4/30/2015-8/24/2015.)