Court reviews SB 863 and rules on whether WCAB can hear a case that is subject to Independent Bill Review

This is a published appellate court case

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

A billing dispute related to outpatient services for arthroscopic knee procedures, arthroscopic shoulder procedures, and epidural injections provided prior to 2004 resulted in a consolidation of liens.

It went to trial and resulted in a 17 day trial with a decision by the Workers” Compensation Judge (WCJ) in February 2013. Prior to the WCJ decision SB 863 went into effect in January 2013.

The defendant appealed the decision contending the Workers’ Compensation Appeals Board (WCAB) did not have jurisdiction.

The appellate court indicated that SB 863 was ambiguous to whether the Independent Bill Review (IBR) service was intended to apply to pending billing disputes. If the IBR applied to the pending action it would leave the parties without a viable way to resolve the dispute.

Therefore, they ruled SB 863 only applied to billing disputes that arise after the legislation went into effect.

An outpatient surgery center has the affirmative burden of proving that its lien is reasonable. The court then discusses how to determine reasonable. They discuss in this case a “reasonable facility fee.” They indicated that the WCJ did this correctly and may accept the evidence of one expert or choose a figure in the middle based on all the evidence.

Case: CIGA v. WCAB

Harvey Brown
3501 Jamboree Rd. Suite 602
Newport Beach, CA 92660

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