OASIS AVIATION, INC.; CALIFORNIA INSURANCE GUARANTEE ASSOCIATION by its servicing facility SEDGWICK CLAIMS MANAGEMENT SERVICES for LEGION INSURANCE COMPANY, in liquidation,, JOSE ACEVEDO-LOPEZ, WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAJOSE ACEVEDO-LOPEZ, Applicant,vs.OASIS AVIATION, INC.; CALIFORNIA INSURANCE GUARANTEE ASSOCIATION by its servicing facility SEDGWICK CLAIMS MANAGEMENT SERVICES for LEGION INSURANCE COMPANY, in liquidation,, Defendant(s),S & B SURGERY CENTER, INC. and its assignee S & B SPV, LLC, Lien claimants.Case No. ADJ2927392 (MON 0246403)OPINION AND ORDER GRANTING RECONSIDERATION AND DECISION AFTER RECONSIDERATION Lien claimant S & B Surgery Center and its assignee S & B SPV, LLC, (jointly called “S&B”) seeks reconsideration of the August 10, 2009 Findings and Order of the workers’ compensation administrative law judge (“WCJ”) who disallowed SB’s lien claim for failure to carr’y its burden of proof based upon findings that there was no “reliable evidence” as to the reasonableness or necessity of service rendered or to the reasonableness of the amount claimed. Before the lien trial defendant paid S&B $3,926.06 of its $65,000.00 billing for services provided in connection with a lumbar laminectomy or fusion performed at S&B’s facility on October 1, 2003, leaving a claimed balance of $61,073.94. Also prior to the lien trial, applicant’s claim of industrial injury to various body parts, including his spine, while working for defendant as construction worker on December 14, 1998, was addressed by a stipulated award of 44% permanent disability and future medical treatment on April 23, 2001, and was settled by a compromise and release agreement as approved by the WCJ on November 22, 2006, with a lump , sum payment of $120,000.00. S&B contends that the finding concerning the lack of evidence of the reasonableness and necessity of the services provided was not a basis for denying the lien claim because that was not an
Jose Acevedo-lopez, vs. Oasis Aviation, Inc.; California Insurance Guarantee Association By Its Servicing Facility Sedgwick Claims Management Services For Legion Insurance Company, In Liquidation,,
- Filed On:
- Court: California, San Francisco
- Case No. ADJ2927392
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