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The Appeals Board granted the lien claimant's petition for reconsideration, finding the WCJ erred in ordering reimbursement based on federal regulations. The Board determined that long-term care hospitals are entitled to a reasonable cost basis for their services, not a predetermined federal rate. The case was returned to the trial level for the WCJ to determine a reasonable fee for the lien claimant. The Board also clarified that services from such facilities are exempt from the Official Medical Fee Schedule and the Administrative Director's Independent Bill Review process.
ROSARIO GUTIERREZ vs. ADVANCE PAPER BOX, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION is a workers' compensation case decided in . This case addresses legal issues related to compensation claims, benefits, and court rulings.
It is commonly referenced in legal research involving workers' compensation laws in .
Full Decision Text1 Pages
The Appeals Board granted the lien claimant's petition for reconsideration, finding the WCJ erred in ordering reimbursement based on federal regulations. The Board determined that long-term care hospitals are entitled to a reasonable cost basis for their services, not a predetermined federal rate. The case was returned to the trial level for the WCJ to determine a reasonable fee for the lien claimant. The Board also clarified that services from such facilities are exempt from the Official Medical Fee Schedule and the Administrative Director's Independent Bill Review process.
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