ADJ12210104 — California WCAB decision

What the panel ordered

Defendant's Petition for Reconsideration is denied.

Defendant filed a Petition for Reconsideration of the WCJ's Findings, Award and Order of December 1, 2021, which was denied by the WCAB panel decision on February 14, 2022.

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This docket was decided more than once. Shown here is the latest released decision; we also hold February 9, 2021.

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 / venueApplicant prevailedleft thumb

The WCJ and WCAB found that federal law expressly preempts California Labor Code Section 5307.1 and the OMFS with respect to the VA's billings, and that applicable federal billing schedules apply instead.

From the decision · page 1Defendant seeks reconsideration of the Findings, Award and Order of December 1, 2021, in which the Workers' Compensation Judge (WCJ) found that on February 7, 2018, the injured employee, the applicant, sustained industrial injury to his left thumb while employed as a machinist by Sepragen Corporation, insured by The Hartford (defendant). The WCJ also found that the injury resulted in the need for medical treatment and surgery provided by the lien claimant herein, the United States Department of Veterans Affairs (V.A.). In addition, the WCJ found that the injured employee's case-in-chief was never the subject of a Stipulated Award or Compromise and Release, that the case was administratively closed by defendant, that the current proceeding was initiated by the V.A.

The facts that decided it

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

Federal law expressly preempts California Labor Code Section 5307.1 and the OMFS with respect to the VA's billings.

Favours Applicant prevailed

This preemption means that the VA's billings are governed by federal billing schedules, not the California OMFS, which supports the applicant's position.

From the decision · page 1Defendant seeks reconsideration of the Findings, Award and Order of December 1, 2021, in which the Workers' Compensation Judge (WCJ) found that on February 7, 2018, the injured employee, the applicant, sustained industrial injury to his left thumb while employed as a machinist by Sepragen Corporation, insured by The Hartford (defendant). The WCJ also found that the injury resulted in the need for medical treatment and surgery provided by the lien claimant herein, the United States Department of Veterans Affairs (V.A.). In addition, the WCJ found that the injured employee's case-in-chief was never the subject of a Stipulated Award or Compromise and Release, that the case was administratively closed by defendant, that the current proceeding was initiated by the V.A.

The issue of reasonableness of the VA's medical treatment charges under federal law remains outstanding and was deferred for further proceedings.

Favours neutral

The WCJ deferred the reasonableness issue, indicating that the VA must still prove the reasonableness of its charges under federal standards, which does not affect the preemption ruling.

From the decision · page 2That is, there are various kinds of preemption, but here defendant erroneously relies upon conflict preemption, which is not on point given the facts of this case. (See People v. Hamilton (2018) 30 Cal.App.5th 673 [The four species of preemption include express, conflict, obstacle, and field preemption].) We also reject, as premature, defendant's allegation that the V.A.'s medical treatment charges are unreasonable. As noted by the WCJ on page six of his Opinion on Decision, the V.A. "still has the burden of establishing the reasonableness of its charges in accordance with the billing applicable to V.A. cases, as well as establishing all other applicable elements justifying the payment sought." In other words, the issue of reasonableness of the V.A.'s medical treatment charges under applicable federal law remains outstanding, and thus there is no "final order" on the issue of reasonableness. (Maranian v. Workers' Comp. Appeals Bd. (2000) 81 Cal.App.4th 1068, 1070, 1075 [65 Cal.Comp.Cases 650].) To be clear, however, we affirm the WCJ's finding that the V.A.'s medical treatment charges are not governed by California state law, but rather are subject to the "applicable federal billing schedules."

ADJ12210104 · February 14, 2022

What the panel ordered

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The facts that decided it

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