ADJ13084654 — California WCAB decision

What the panel ordered

Petition for reconsideration granted, WCJ decision rescinded, matter returned to WCJ for further proceedings and decision

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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.

LiensRemanded

The WCJ's analysis did not fully follow the framework required by Colamonico, so the WCAB granted reconsideration and returned the matter to the WCJ for further proceedings and a new decision consistent with Colamonico.

From the decision · page 1We have considered the allegations of the Petition for Reconsideration and the contents of the report of the workers' compensation administrative law judge (WCJ) with respect thereto. Based on our review of the record, and for the reasons stated below, we will grant reconsideration, rescind the WCJ's decision, and return this matter to the WCJ for further proceedings and decision.

The facts that decided it

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

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Colamonico v. Secure Transportation (2019) 84 Cal.Comp.Cases 1059 (Appeals Board en banc)

Lien claimant holds the initial burden of proof pursuant to Labor Code sections 4620 and 4621: that a contested claim existed at the time the expenses were incurred, that the expenses were incurred for the purpose of proving or disproving a contested claim, and that its services were reasonably, actually, and necessarily incurred.

The WCJ's analysis did not fully follow this framework, leading to reconsideration and remand.

From the decision · page 1The proper analysis for these issues was laid out the Appeals Board's en banc decision in Colamonico v. Secure Transportation (2019) 84 Cal.Comp.Cases 1059 (Appeals Board en banc). There, we held that a lien claimant holds the initial burden of proof pursuant to Labor Code1 sections 4620 and 4621: that a contested claim existed at the time the expenses were incurred, that the expenses were incurred for the purpose of proving or disproving a contested claim, and that its

Labor Code sections 4620, 4621, 4622, 4603.3

Defendant has 60 days to review and analyze a medical-legal bill or invoice and may pay in full or less with an explanation of review (EOR) to avoid penalties under Labor Code section 4622.

The WCJ's analysis did not fully follow this framework, leading to reconsideration and remand.

From the decision · page 2If a lien claimant meets its burden of proof pursuant to sections 4620 and 4621, the analysis shifts to the reasonable value of the invoices pursuant to section 4622. A 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.

ADJ13084654 · March 11, 2022

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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The rules the panel named

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