DEE FAIRBANKS ENTERPRISES; SCIF INSURED REDDING, MATHEW JAMISON WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAMATHEW JAMISON, Applicant,vs.DEE FAIRBANKS ENTERPRISES; SCIF INSURED REDDING, Defendants.Case No. ADJ3694832 (RDG 0125163)OPINION AND ORDER GRANTING RECONSIDERATION AND DECISION AFTER RECONSIDERATION Lien claimant, RS Medical, seeks reconsideration of the Second Amended Findings and Order, issued May 22, 2009, in which a workers’ compensation administrative law judge (“WCJ”) found its lien “is not supported,” and ordered that lien claimant take nothing on its lien. The WCJ concluded in his Opinion on Decision that defendant “timely and properly objected” to the medical treatment based upon Utilization Review (“UR”) principles, and further that lien claimant did not meet the requirements in Tapia v. Skill Master Staffing (2008) 73Cal.Comp.Cases 1338 (Appeals Board en banc), and that “the lien was not scrutinized in terms of line assessment devices including but not limited to RVS code analysis.” claimant contends the WCJ erred in denying its lien for durable medical equipment prescribed by applicant’s treating physician, arguing again that the WCJ failed to make a determination whether the muscle stimulator is reasonable or necessary treatment to cure or relieve applicant from the chronic effects of his industrial injury. Lien claimant argues that defendant’s Utilization Review incorrectly relied upon ACOEM Guidelines to deny applicant’s claim, as their denial was based upon acute low back conditions, not applicant’s chronic neck and upper back pain, and failed to address applicant’s problem taking pain medications. Secondly, lien claimant , argues the WCJ erred in raising the Appeals Board’ en bane decision in Tapia as an issue, since this issue was not raised before trial, and is not relevant to the issues raised for determination. For the reasons set forth below, we shall grant lien claimant’s petition
Mathew Jamison vs. Dee Fairbanks Enterprises; Scif Insured Redding,
(RDG 0125163)This case is about lien claimant, RS Medical, seeking reconsideration of the Second Amended Findings and Order, issued May 22, 2009, in which a workers' compensation administrative law judge found its lien "is not supported," and ordered that lien claimant take nothing on its lien. The WCJ concluded that defendant "timely and properly objected" to the medical treatment based upon Utilization Review principles, and that lien claimant did not meet the requirements in Tapia v. Skill Master Staffing. The Appeals Board granted reconsideration and rescinded the WCJ's Second Amended Findings and Order, returning the matter to the trial level for further development of the medical record.
- Filed On:
- Court: California, Redding
- Case No. ADJ3694832
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