What the panel treated as outcome-determinative, and which side it favoured.
Applicant's attorney filed an Application for Adjudication of Claim on November 29, 2016, alleging disagreements as to liability for all benefits.
Favours Applicant prevailed
This demonstrated that disputes existed regarding benefits, supporting the existence of a contested claim at the time medical-legal services were provided.
From the decision · page 2We will briefly review the relevant facts.
Applicant claimed injury to his right knee and right ankle while employed by defendant as
a machine operator on November 18, 2016.
Applicant's attorney filed an Application for Adjudication of Claim (Application) on
November 29, 2016. It alleged that: "Applicant sustained injuries to his right knee and right ankle
while performing his normal job duties." Paragraph 9 of the Application states that "This
application is filed because of a disagreement regarding liability for: Temporary disability
indemnity, Permanent disability indemnity, Reimbursement for medical expense, Rehabilitation,
Medical treatment, Supplemental Job Displacement/Return to Work, Compensation at proper rate,
Other (Specify) ALL BENEFITS."
On November 29, 2016, applicant's attorney issued a letter to applicant's employer
informing it of the representation and the claimed industrial injury of November 18, 2016.
Defendant issued notices terminating temporary and permanent disability benefits on December 13, 2016.
Favours Applicant prevailed
These notices evidenced the employer's rejection or termination of benefits, confirming a contested claim existed.
From the decision · page 6On November 29, 2016, applicant's attorney filed an Application. According to Paragraph
9 of the Application, there were disagreements as to liability for all benefits. On November 29,
2016, applicant's attorney issued a letter of representation to defendant and requested information
and records. On December 2, 2016, defendant issued an acceptance of claim letter to applicant and
admitted injury. (Exhibit A, 12/2/2016.) On December 13, 2016, defendant issued applicant
notices that further temporary disability and permanent disability benefits were being terminated
and applicant was being returned to work at full duty. (Exhibits 3 and 4, 12/13/2016.) The sole
medical evidence is a Kaiser note discharging applicant to return to work. (Exhibit 2, 12/1/2016.)
As explained above, acceptance of liability for the injury does not equate to an immediate
agreement to pay all benefits. Thus, filing of an Application demonstrates that there were disputes
between the parties.
Lien claimant issued the first Subpoena Duces Tecum on January 23, 2017, after the termination notices.
Favours Applicant prevailed
The timing of the subpoena issuance confirmed the contested claim existed when medical-legal services were provided.
From the decision · page 6Here, the first SDT was issued on January 23, 2017, the Application was filed on November
29, 2016, and defendant sent notices on December 13, 2016. Here, applicant's claim was
unequivocally contested under Labor Code section 4620(b) on January 23, 2017 when the first
subpoena was issued, after defendant issued notices terminating payment of benefits on December
13, 2016.