ADJ11626597 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied

Petition for Reconsideration filed by Optimal Health Institute against denial of lien claim for medical services; WCJ report denying reconsideration adopted by panel

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What was disputed, and how it came out

Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.

LiensDefendant prevailedupper back · thoracic

Optimal Health Institute failed to meet its burden of proof to show a legal or factual basis for treatment outside the MPN, and no evidence of denial of treatment for claimed body parts was found.

From the decision · page 4The issue here is the lien claim filed by Optimal Health Institute against Defendant State Compensation Insurance Fund (SCIF) for medical services provided by Dr. Shen, specialty unknown, and Dr. Kan, a chiropractor. The Findings and Order denying recovery on this lien claim was served on October 12, 2023, and Optimal Health Institute has now filed a timely verified Petition for Reconsideration.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

What the panel did with the medical opinions

The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.

otherRelied upon

Dr. Shen's reports did not indicate any denial of treatment to the applicant and showed knowledge of the MPN and lack of authorization to treat outside it.

Reports showed no claim of denial of treatment and awareness of MPN and non-membership status.

From the decision · page 6It should also be noted that Dr. Shen does not say in any of the histories given in his reports that the applicant was denied treatment (Exhibits 3-9, on p. 1-2 in Exhibit 3 and generally p. 1-2 or p. 2 on the subsequent reports). In the "Discussion" section of his reports (generally on p. 3 or 4 of the reports), he includes a sentence, "Patient wishes to exercise her [sic] right to select a treating doctor of his choice," with no further elaboration. The histories in Dr. Kan's reports (Exhibits 10- 13) are briefer than Dr. Shen's but also have no claim that SCIF denied treatment to the applicant. Based on their reports, they had no belief at the time they provided services that SCIF had denied the applicant treatment or that their providing treatment to the applicant was due to a denial of treatment.

otherRelied upon · chiropractor

Dr. Kan was an administrator of Optimal Health Medical Center and secondary treating doctor, aware of the MPN and non-membership status, and did not claim denial of treatment in reports.

Evidence showed Dr. Kan's administrative role and knowledge of MPN and non-membership; no denial claim in reports.

From the decision · page 4There is no evidence that Dr. Shen tried to get advance authorization for his initial evaluation, and SCIF advised him long before the second evaluation that there was an applicable MPN, he was not a member, and they therefore did not have liability for any bills for his services. That and subsequent notices were addressed to him and sent to the address on his reports, and there was no claim made that he did not receive them. The evidence showed that Dr. Kan was active in the administration of the medical group, particularly that he was the Secretary, Chief Financial Officer and a Director of Optimal Health Medical Center (Exhibit Q) as well as the doctor that Dr. Shen

ADJ11626597 · December 29, 2023

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

What proof carried it

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