Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, 4600
An employer must provide reasonable medical treatment to cure or relieve effects of industrial injury; if employer refuses, liable for reasonable expenses incurred by employee (Lab. Code, 4600).
Applied to determine reasonableness and necessity of lien claimant's medical treatment.
From the decision · page 2II.
An employer must provide an injured worker with medical treatment to cure or relieve the
injured worker from the effects of an industrial injury. (Lab. Code, § 4600.) Timely provision of
reasonable medical treatment is an essential element of workers' compensation. (Cal. Const.,
Article XIV, § 4; McCoy v. Industrial Acc. Com. (1966) 64 Cal.2d 82, 87 [31 Cal.Comp.Cases
93]; Zeeb v. Workmen's Comp. Appeals Bd. (1967) 67 Cal.2d 496, 501 [32 Cal.Comp.Cases 441];
Braewood Convalescent Hosp. v. Workers' Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159,
165 [48 Cal.Comp.Cases 566]; see also, Lab. Code, § 4600.) If the employer neglects or refuses to
provide reasonable medical care, "the employer is liable for reasonable expense incurred by or on
behalf of the employee in providing treatment." (Lab. Code, § 4600(a).) Here, the WCJ determined
Lab. Code, 4610
Disputes over medical treatment reasonableness must be addressed through utilization review process (Lab. Code, 4610).
Noted defendant did not submit utilization review evidence disputing lien treatment.
From the decision · page 3that the treatment provided by lien claimant was not reasonable or necessary based on her review
of the QME report. However, the appropriate way for a defendant to dispute whether treatment is
reasonable and necessary is through UR, and here, defendant submitted no evidence that it had
considered the RFAs from lien claimant and proceeded with the UR process. (See Lab. Code, § 4610.) Moreover, as noted above, the record indicates that applicant sustained injury to their neck
and back, and the WCJ failed to address the issue of AOE/COE or find that applicant sustained
injury AOE/COE in accordance with the parties' stipulation.
Torres v. AJC Sandblasting (2012) 77 Cal.Comp.Cases 1113 (Appeals Board en banc)
Lien claimants bear burden to prove medical treatment liens are reasonable and necessary (Torres v. AJC Sandblasting (2012)).
Applied to burden of proof for lien claimant's medical treatment charges.
From the decision · page 3Lien claimants hold the burden of proof to establish entitlement to reimbursement for
medical treatment liens. (Torres v. AJC Sandblasting (2012) 77 Cal.Comp.Cases 1113 (Appeals
Board en banc).) This burden includes the burden to show that specific treatments and the charges
for those treatments were reasonable and necessary. (Id. at 1121.)