ADJ11122688 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied.

Petition for Reconsideration filed by lien claimant seeking review of Findings of Fact regarding jurisdiction and market rate for interpreter services.

Read the official decision →

What was disputed, and how it came out

Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.

Jurisdiction / venueDefendant prevailed

From the decision · page 6Lien claimant contends that as there is no fee schedule in effect for interpreters, the process for Independent Bill Review (IBR) is inapplicable. Defendant relies upon the recent case of Meadowbrook Ins. Co. v. Workers Comp. Appeals Bd (2019) 42 Cal App.5th 432 [Cal.Rptr.3d 325, 84 Cal Comp Cases 1033] in opposition to lien claimant's position.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

Lien claimant failed to request certification documentation from Insurance Commissioner or conduct discovery on certification.

Favours Defendant prevailed

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Meadowbrook Ins. Co. v. Workers Comp. Appeals Bd

Meadowbrook Ins. Co. v. Workers Comp. Appeals Bd (2019) 42 Cal App.5th 432

Court relied on this case to find no jurisdiction over billings not submitted to Independent Bill Review and to bar recovery of liens.

From the decision · page 6The Court of Appeals determined that Title 8 California Code of Regulations § 9795.3 served as an applicable fee schedule and that there was no requirement that some future fee schedule to be adopted by the Administrative Director for the regulatory appeal scheme to apply. As there was a fee schedule in place, the Court ruled that lien claimant failure to request second bill review and Independent Bill Review barred recovery of its liens.

Insurance Code

Insurance Code §11761

Lien claimant argued bill reviewers must be certified; court found no evidence claimant requested certification or that lack of certification voids bill reviews.

From the decision · page 5Lien Claimant places strong [emphasis] on Insurance Code § 11761 that sets forth the requirement of bill reviewers to be certified. Lien Claimant contends that since defendant failed to provide clear documentation of certification, the bill reviews completed by defendant's vendor are defective and the bills should be paid in full.

Title 8 California Code of Regulations

Title 8 California Code of Regulations §9795.3

Regulation sets interpreter fees and supports defendant's initial payments; court applied this in market rate determination.

From the decision · page 6Defendant relied upon Title 8 of the California Code of Regulations § 9795.3(b)(2) in support of its initial payments. That regulation states: "...interpreter fees shall be billed and paid at the rate of $11.25 per quarter hour or portion thereof, with a minimum of two hours, or the market rate, whichever is greater. The interpreter shall establish the market rate...by submitting documentation to the claims examiner, including a list of recent similar services performed and the amounts paid for those services."

ADJ11122688 · September 24, 2021

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

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