VICTOR DIAZ vs. COR O VAN; TRAVELERS DIAMOND BAR

In this case, Victor Diaz is seeking workers' compensation from Cor O Van and Travelers Diamond Bar. The lien claimant, Monrovia Memorial Hospital, represented by Innovative Medical Management, Inc., is seeking reconsideration of the Findings and Order of January 20, 2016, in which the workers' compensation judge found that on January 2, 2009, applicant sustained industrial injury to his right shoulder and neck, and that the defendant had paid more than enough to the lien claimant. The WCJ also found that the petitioner's claims of penalties and interest were moot, and the WCJ issued an order disallowing the balance of petitioner's lien. The WCJ granted the petition for reconsideration and ordered that all further correspondence

COR O VAN; TRAVELERS DIAMOND BAR VICTOR DIAZ WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAVICTOR DIAZ, Applicant,vs.COR O VAN; TRAVELERS DIAMOND BAR, Defendants.Case No. ADJ6704917(Long Beach District Office)OPINION AND ORDER GRANTING PETITION FOR RECONSIDERATION            Lien claimant, Monrovia Memorial Hospital, represented by Innovative Medical Management, Inc. (“petitioner”) seeks reconsideration of the Findings and Order of January 20, 2016, in which the workers’ compensation judge (WCJ) found, in relevant part, that on January 2, 2009, applicant sustained industrial injury to his right shoulder and neck, and that “defendant has paid more than enough to lien claimant Monrovia Memorial Hospital Monrovia in this matter.” The WCJ also found that petitioner’s claims of penalties and interest are moot, and the WCJ issued an order disallowing the balance of petitioner’s lien.            Petitioner contends that its study under Kunz v. Patterson Floor Coverings, Inc. (2002) 67 Cal.Comp.Cases 1588 (Appeals Board en banc) (Kunz) shows usual and customary reimbursements for same or similar procedures, consistent with Kunz and with Tapia v. Skill Masters Staffing (2008) 73 Cal.Comp.Cases 1338 (Appeals Board en banc) (Tapia). Petitioner further contends that the WCJ erred in relying upon the exhibits and bill review testimony presented by defendant, because this evidence pertains to application of the Official Medical Fee Schedule, and as a long-term acute care hospital petitioner is not subject to any fee schedule under 8 California Code and Regulations section 9789.22(j)(5). Petitioner also contends that it is entitled to reimbursement on a “reasonable cost” basis pursuant to 42 Code of Federal Regulations, sections 412.23(e) and 412.521(b)(2)(vi), and that petitioner is entitled to reimbursement consistent with Gould v. Workers’ Comp. Appeals Bd. (1992) 4 Cal.App.4th , 1059 [57 Cal.Comp.Cases 157] because ”the surgical procedures Were determined to be med

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