Lien claimant is not allowed additional fees in excess of official medical fee schedule

This is a Writ Denied case

This is a very significant case for workers’ compensation principles.

The applicant suffered a serious injury in an explosion that resulted in third degree burns to 43 percent of his body. The applicant was hospitalized for months at a burn center. He settled the case for a 99 per cent Stipulation.

The burn center was reimbursed $346,201 by defendants. The burn center filed a lien for an additional $269,094.

The lien went to trial before a Workers’ Compensation Judge (WCJ). The WCJ found the compensation to the burn center was not reasonable under the official medical fee schedule and awarded an additional $176,800. The defendant filed a petition for reconsideration with the Workers’ Compensation Appeals Board (WCAB). Defendant alleged the WCJ could not allow a fee in excess of the official medical fee schedule.

The WCAB indicated that Labor Code section 5307.1 governed and that any reimbursements for extraordinary circumstances were deleted in 2004. Any exceptions did not apply to the burn center so they could not receive anything in excess of the official medical fee schedule. They reversed the WCJ.

The burn center sought reconsideration of the WCAB decision and the WCAB granted review. The WCAB ruled that Gould v. WCAB did not apply. They ruled the official medical fee schedule could not be rebutted in this situation. The burn center filed a writ which was denied.

Penalty payment under section 5814 awarded for unreasonable delay or denial of advance of disability pension payment

This is a published case

This is a very significant case for workers’ compensation principles.

The applicant was a deputy sheriff who had a job related injury and applied for industrial disability retirement. The applicant also requested an advance on her disability pension payment while her application was being processed.

She applied for the benefit on March 6 and the county claimed they did not receive notice for benefits under labor code section 4850.4 until June 11. The applicant claimed there was an unreasonable delay and requested penalties under labor code section 5814 from the Workers’ Compensation Board (WCAB).

The case went to trial. The County contended they objected to the request for benefits and that the WCAB had no jurisdiction for making payments on the disability pension amounts.

The Workers’ Compensation Judge (WCJ) found that section 5814 did apply to an unreasonable delay of advancement of disability pension amounts. The county petitioned for removal.

The WCAB reversed the WCJ because it believed the advancement of disability retirement payments were not equivalent to workers compensation benefits. The applicant filed a writ.

The court of appeal reviewed labor code sections 4850 and specifically labor code section 4850.4. They reviewed numerous cases and determined that a section 5814 may be appropriate and remanded the case.

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