CALTEX PLASTICS, INC.; AMERICAN ;COMMERCIAL CLAIMS ADMINISTRATORS, LUIS GONZALES, WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIALUIS GONZALES, Applicant, vs.CALTEX PLASTICS, INC.; AMERICAN COMMERCIAL CLAIMS ADMINISTRATORS, Defendants.Case No. ADJ1264394 (MON 0332061)OPINION AND ORDER DENYING RECONSIDERATION, Lien Claimant, Key Health Management (Key Health) seeks reconsideration of the December 30, 2008 Findings and Order wherein the workers’ compensation administrative law judge (WCJ) found that the applicant did not sustain an industrial injury to his upper extremities on August 17, 2005 and ordered that the lien of Key Health be disallowed. Key Health contends that the WCJ erred in disallowing its lien, arguing that it provided medical-legal services, and, therefore, pursuant to California Code of Regulations, title 8., section 9793(c), its expenses should be reimbursed. We have considered the Petition for Reconsideration, and we have reviewed the record in this matter. We have not received an Answer from the defendant. The WCJ filed a Report and Recommendation on Petition for Reconsideration recommending that we deny reconsideration. For the reasons discussed below, we will deny reconsideration. In its lien, Key Health requests payment of $1016.13 for “the reasonable expense incurred on behalf of said worker for medical worker to cure or relieve from the effects of said injury.” In general, a lien for medical treatment is allowable when the treatment rendered is reasonably required to cure or relieve an injured worker from the effects of an industrial injury. (Lab. Code, , §§ 4600(a), 4903(b).) However, a defendant will not be liable for medical treatment where there is no industrial injury. (Kunz v. Patterson Floor Coverings (2002) 67 Cal.Comp.Cases 1588, 1593 (Appeals Board en banc).) Therefore, where a lien claimant, rather than the injured worker, litigates the issue of entitlement to payment
Luis Gonzales, vs. Caltex Plastics, Inc.; American ;commercial Claims Administrators,
In this case, Luis Gonzalez applied for workers' compensation benefits after sustaining an injury to his upper extremities on August 17, 2005. Key Health Management (Key Health) sought reimbursement for medical-legal services it provided, but the workers' compensation administrative law judge (WCJ) found that the applicant did not sustain an industrial injury and ordered that the lien of Key Health be disallowed. Key Health sought reconsideration, but the Workers' Compensation Appeals Board denied the petition, finding that Key Health failed to prove that the applicant sustained an industrial injury and that the services it provided were not capable of proving or disproving a disputed medical fact.
- Filed On:
- Court: California, San Francisco
- Case No. ADJ1264394
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