CALISTOGA SPA, and STATE COMPENSATION INSURANCE FUND, CYNTHIA GORDON, WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIACYNTHIA GORDON, Applicant,vs.CALISTOGA SPA, and STATE COMPENSATION INSURANCE FUND, Defendant(s).Case No. ADJ745778 (SRO 0132381)OPINION AND ORDER GRANTING PETITION FOR RECONSIDERATION AND DECISION AFTER RECONSIDERATION Defendant State Compensation Insurance Fund (SCIF) seeks reconsideration of the December 30, 2008 Findings and Order, wherein the workers’ compensation administrative law judge (WCJ) found that, pursuant to Labor Code section 5304, the Workers’ Compensation Appeals Board (WCAB) has jurisdiction over the issue of medical treatment rendered by Queen of the Valley Hospital (QVH) and payment by defendant State Compensation Insurance Fund (SCIF), and that the WCAB does not have jurisdiction to interpret the contract between QVH and Blue Cross Life and Health (BCLH) or the contract between BCLH and SCIF. The WCJ ordered SCIF to pay the outstanding balance on QVH’s lien, pursuant to the Official Medical Fee Schedule, with jurisdiction reserved in the event the parties cannot agree on a sum. Applicant’s underlying claim that she sustained industrial injury to her bilateral knees, bilateral shoulders, left elbow, and left thumb, while employed as a massage therapist on August 19, 2001, and July 1, 2002, was resolved by compromise and release, approved by the Order of January 4, 2005. Defendant contends that, pursuant to Labor Code section 5304, the WCAB does not have jurisdiction to resolve this medical fee dispute, because “an express agreement” exists between the parties and that the agreement requires disputes to be resolved by arbitration. Defendant further contends that QVH’s lien is barred by equitable estoppel and by laches. , We have considered the Petition for Reconsideration, and we have reviewed the record in this matter. We have not received an Answer. The WCJ prepared a Report and Recommen
Cynthia Gordon, vs. Calistoga Spa, And State Compensation Insurance Fund,
This case involves a dispute between Cynthia Gordon, an employee, and Calistoga Spa and the State Compensation Insurance Fund (SCIF) over medical treatment rendered by Queen of the Valley Hospital (QVH) and payment by SCIF. The Workers' Compensation Appeals Board (WCAB) found that, pursuant to Labor Code section 5304, the WCAB does not have jurisdiction to resolve the dispute due to an express agreement between the parties that requires disputes to be resolved by arbitration. The WCAB granted SCIF's petition for reconsideration and rescinded the WCJ's decision, finding that the WCAB has no jurisdiction to determine the payment due to QVH.
- Filed On:
- Court: California, Santa Rosa
- Case No. ADJ745778
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