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.

Case: Gross Medical Group v. WCAB (Rus)

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

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