RAYMOND INTERIOR SYSTEMS; and ZURICH NORTH AMERICA, ROGELIO NUNEZ, WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAROGELIO NUNEZ, Applicant,vs.RAYMOND INTERIOR SYSTEMS; and ZURICH NORTH AMERICA, Defendant.Case No. ADJ2122972 (POM 0291979)OPINION AND ORDER GRANTING RECONSIDERATION AND DECISION AFTER RECONSIDERATION Lien claimant, Santa Anita Acupuncture Center (Center), seeks reconsideration of the Findings and Order of June 24, 2009, wherein the workers’ compensation judge (WCJ) found, in essence, that Center’s more than $23,000 lien claim for the medical treatment that it provided to applicant, in the form of acupuncture, purportedly to cure or relieve him from the effects Qfthe admitted industrial injury that he sustained to his back and neck on October 27, 2005, while employed as a construction worker by Raymond Interior Systems, Zurich North America’s insured on the date of injury, was “excessive and unreasonable” and exceeded the Official Medical Fee Schedule (OMFS). The WCJ also found that Khalid Ahmed, M.D., an orthopedic surgeon, was applicant’s primary treating physician, that he referred applicant to Center for treatment, and, accordingly, that “a portion” of the acupuncture Center provided was allowable. The WCJ further found, relying on the trial testimony of defendant’s bill reviewer, that approximately $2,400 was the reasonable value of the allowable acupuncture provided by Center. Thus, she allowed Center 11 nearly $2,400 on its more than $23,000 lien claim. Center contends that its entire lien claim should have been allowed, arguing that the WCJ improperly applied the 24-session limitation of Labor Code section 4604.5(d)1 to acupuncture based on the opinion of defendant’s bill reviewer, that the opinion of Harry Marinow, M.D., an 1All further statutory references are to the Labor Code, unless otherwise noted. , orthopedic surgeon and the agreed medical evaluator (AME) between defendant and applicant, is not substantial evi
Rogelio Nunez, vs. Raymond Interior Systems; And Zurich North America,
This case is about a lien claimant, Santa Anita Acupuncture Center, seeking reconsideration of a workers' compensation judge's decision that their more than $23,000 lien claim for medical treatment was excessive and unreasonable. The judge found that a portion of the acupuncture provided was allowable, and allowed the Center nearly $2,400 on their lien claim. The Appeals Board granted reconsideration, rescinded the June 24, 2009 Findings and Order, and returned the matter to the trial level for further proceedings and a new decision that determines whether the employer timely performed utilization review on the acupuncture.
- Filed On:
- Court: California, Pomona
- Case No. ADJ2122972
To continue reading ... start a FREE Trial for 10 days
Discover the cases you didn’t know you were missing!
Copyright © 2023 - CompFox Inc.