Coast Community College District, permissibly self-insured, administered by Keenan & Associates Carl Roberson WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIACARL ROBERSON, Applicant,vs.COAST COMMUNITY COLLEGE DISTRICT,permissibly self-insured, administered byKEENAN & ASSOCIATES, Defendants.Case No. ADJ326102 (ANA 0396540)OPINION AND ORDER GRANTING RECONSIDERATION AND DECISION AFTER RECONSIDERATION Defendant seeks reconsideration of the November 28, 2012 Findings and Order issued by the workers’ compensation administrative law judge (WCJ). Therein, the WCJ found that defendant failed to raise Labor Code1 section 4903.5 as to the statute of limitations for the filing of lien claims and, therefore, has waived the issue; that there is insufficient evidence of a “chain of contracts” between Blue Cross and Western Medical Center and between Blue Cross and Keenan and Associates to support an “express agreement” within the meaning of section 5304; that the Appeals Board does have jurisdiction over the fee dispute between Western Medical Center and Keenan and Associates, based on sections 4600-4605; and that the reasonable value of the medical treatment provided to applicant by Western Medical Center is $37,299.34, less credit for sums previously paid. The WCJ ordered defendant to pay Western Medical Center that amount. According to defendant’s verified Petition for Reconsideration, applicant’s underlying case was previously settled by way of an August 2, 2006 Stipulated Award providing that applicant sustained industrial injury on August 19, 2004. On March 17, 2011, lien claimant Western Medical Center filed a lien for $43,788.40 for medical treatment rendered to applicant. A lien conference was held on December 5, 2011. At that time, the WCJ ordered defendant to serve lien claimant Western Medical Center with a copy of the contract between defendant Coast Community 1 All further statutory references are to the Labor Code, unless otherwise noted. , Coll
Carl Roberson's Case Against Coast Community College District
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In this case, the Coast Community College District was self-insured and administered by Keenan & Associates. Carl Roberson, the applicant, had an industrial injury on August 19, 2004 and Western Medical Center filed a lien for $43,788.40 for medical treatment rendered to applicant. The Workers' Compensation Appeals Board granted the defendant's Petition for Reconsideration and rescinded the WCJ's decision, returning the matter to the trial level for further proceedings and decision by the WCJ. The Board ordered the WCJ to conduct further proceedings as necessary to issue a new decision on all the issues in dispute, including the appropriateness of costs and sanctions.
- Filed On:
- Court: California, Santa Ana
- Case No. ADJ326102
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