Dollar Tree; Sedgwick, Peter Bourassa, WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAPETER BOURASSA,Applicant,vs.DOLLAR TREE; SEDGWICK,Defendants.Case No. ADJ8217279(Long Beach District Office)OPINION AND DECISION AFTER RECONSIDERATION On December 27, 2016 the Appeals Board granted reconsideration of the October 19, 2016 Findings and Order. This is our Decision After Reconsideration. In the October 19, 2016 Findings and Order, the workers’ compensation administrative law judge (WCJ) found that applicant, while employed on June 1, 2010 as an assistant manager sustained an injury arising out of and in the course of his employment to his back, trunk, lower extremities, and upper extremities. The WCJ also found that Monrovia Memorial Hospital (Monrovia) is entitled to $58,272.00 as the reasonable cost for services rendered. Lien claimant Monrovia contends that the WCJ erred in finding that it was entitled to $58,272.00 on its lien, arguing that the WCJ failed to consider the entirety of its Kunz study and that it has provided substantial evidence that it is entitled to recover the balance of its lien as well as penalties and interest. We have considered the Petition and we have reviewed the record in this matter. We have received a Report and Recommendation on Petition for Reconsideration (Report), from the WCJ recommending that the petition be denied. We have received an Answer and Request to Dismiss Petition for Reconsideration from Defendant filed January 23,2017 after we granted reconsideration. For the reasons set forth by the WCJ in her report, which we adopt and incorporate by reference, and for the reasons set forth below, we will affirm the WCJ’s decision. Facility fees for services rendered by a long term care hospital as defined by Title 42 of the Code of Regulations are not subject to the OMFS and must be paid on a “reasonable cost basis.” (Cal. Code , Regs., tit.8, § 9789.22(k)(5).)1
Peter Bourassa, vs. Dollar Tree; Sedgwick,
This case involves Peter Bourassa, an assistant manager employed by Dollar Tree, who sustained an injury to his back, trunk, lower and upper extremities on June 1, 2010. Monrovia Memorial Hospital is entitled to $58,272.00 as the reasonable cost for services rendered. The Workers' Compensation Appeals Board affirmed the decision of the Workers' Compensation Administrative Law Judge, finding that the fee must be reasonable and determined by considering the medical provider's usual fee, the usual fee of other medical providers in the geographical area in which the services were rendered, other aspects of the economics of the medical provider's practice that are relevant, and any unusual circumstances in the case.
- Filed On:
- Court: California, Long Beach
- Case No. ADJ8217279
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