County Of Sacramento, Legally Uninsured Sandra L. Boyd WORKERS-COMPENSATION APPEALS BOARDSTATE OF CALIFORNIASANDRA L. BOYD, Applicant,vs.COUNTY OF SACRAMENTO, legally uninsured, Defendant,MBM BOUTIQUE ACUPUNCTURE, Lien claimant.Case No. ADJ3496351 (SAC 0319422)OPINION AND DECISION AFTER RECONSIDERATION We earlier granted defendant’s petition for reconsideration of the June 24. 2010 Findings and Award of the porkers’ compensation administrative law judge (WCJ) who found that lien claimant MBM Boutique Acupuncture was entitled to full reimbursement of its lien and was ’not limited to one unit per session by the Official Fee Schedule.” It was earlier found on May 23, 2007 that applicant incurred industrial injury to her neck. back, left minor upper extremity and right knee while employed by defendant as a deputy sheriff on September 11, 2002, causing 46% permanent disability after apportionment, and a need for medical treatment. Defendant contends that the evidence shows that lien claimant incorrectly billed for two “untimed” units per session when only timed units may be charged in that fashion under the Official Medical Fee Schedule (OMFS), and that it properly reduced lien claimant’s bills and paid for only one unit per session. An answer was not received. The WCJ provided a Report and Recommendation on Petition for Reconsideration. , As our Decision After Reconsideration we reverse the WCJ’s finding that lien claimant was not limited to billing for one unit per session. Defendant presented unrebutted evidence showing that acupuncture treatments arc billed under the OMFS using either timed or untimed codes, and that lien claimant incorrectly billed for two timed code procedures when, in fact, only one untimed code procedure could be claimed. Because defendant presented the most persuasive evidence in the record as a whole that the amount it paid lien claimant was a reasonable fee under the OMFS for th£ services that w
Sandra L. Boyd vs. County Of Sacramento, Legally Uninsured
(SAC 0319422)In this case, the County of Sacramento was found to be legally uninsured for a workplace injury sustained by Sandra L. Boyd, a deputy sheriff. The County authorized medical treatment in the form of acupuncture, which was provided by lien claimant MBM Boutique Acupuncture. The County's bill reviewer noted that the billings were for two code procedures during applicant's visits, as if the code was for a "timed" procedure under the Official Medical Fee Schedule (OMFS), when in fact the code was for an "untimed" procedure that could only be billed once. The WCJ found in favor of lien claimant and issued his June 24, 2010 decision, but the Appeals Board reversed the decision
- Filed On:
- Court: California, Sacramento
- Case No. ADJ3496351
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