Home/Case Law/GILMA DAVILA vs. JOBS METRO NET, ZURICH AMERICAN INSURANCE COMPANY
Regular DecisionWorkers' Compensation

GILMA DAVILA vs. JOBS METRO NET, ZURICH AMERICAN INSURANCE COMPANY

Filed: Oct 13, 2017
Santa Ana
ADJ8611605 ADJ8611603

CompFox AI Summary

The Workers' Compensation Appeals Board denied reconsideration of a decision disallowing a lien claim from Tri-City Health Group. The WCJ found the lien claimant failed to prove the medical treatment was necessary and reasonable. The Board agreed that the lien claimant did not sustain its burden of proof regarding medical necessity, the reasonableness of the services, or entitlement to payment under Labor Code section 5402(c). Furthermore, the Board found no evidence that the alleged injury arose out of and occurred during the course of employment, precluding employer liability for the self-procured treatment.

Full Decision Text1 Pages

The Workers' Compensation Appeals Board denied reconsideration of a decision disallowing a lien claim from Tri-City Health Group. The WCJ found the lien claimant failed to prove the medical treatment was necessary and reasonable. The Board agreed that the lien claimant did not sustain its burden of proof regarding medical necessity, the reasonableness of the services, or entitlement to payment under Labor Code section 5402(c). Furthermore, the Board found no evidence that the alleged injury arose out of and occurred during the course of employment, precluding employer liability for the self-procured treatment.

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