ADJ12399048 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied.

Petition for Reconsideration filed by lien claimant Medvantage Orthocare LLC was considered and denied by the Workers' Compensation Appeals Board panel, adopting and incorporating the WCJ's report except for lien assignment discussion.

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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.

LiensDefendant prevailed

The UCC Financing Statement listing petitioner as debtor and assigning assets to Golden Financial Solutions supported the finding that the lien was assigned.

From the decision · page 8The undersigned found that petitioner's lien had been assigned pursuant to L.C. § 4903.8, based on Defense Exhibit G, a UCC Financing Statement. The statement listed petitioner as a "debtor," and that their assets had been assigned to "Golden Financial Solutions."

Medical treatment / UR / IMRDefendant prevailedvarious body parts

Lien claimant failed to provide evidence that defendant neglected or refused medical treatment by failing to provide timely notice under the MPN, and defendant provided appropriate notice and scheduled medical appointments.

The facts that decided it

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

Defendant provided appropriate notice to applicant within ten days of claim service regarding how to access medical treatment through the employer MPN.

Favours Defendant prevailed

This disproved lien claimant's claim of neglect or refusal of medical treatment due to lack of notice.

From the decision · page 2the claim regarding how to access medical treatment through the employer MPN. (Ex. E, Medical Provider Network Notice, dated August 6, 2019.)

Applicant and attorney acknowledged claims were in delay in settlement documents, supporting presumption that notices were received.

Favours Defendant prevailed

This rebutted lien claimant's argument that notices were not received and supported denial of entitlement to self-procure treatment.

From the decision · page 7"The parties are settling while the claims remain in delay in order to buy their peace for a lump sum certain...Applicant stipulates that his employment was terminated on 07/12/2019...". Compromise and Release, October 30, 2019, page 7. Thus, applicant and his attorney confirmed in the settlement documents that the claims were in delay, and was a basis for settlement. For lien claimant to argue that two out of the three notices submitted as evidence were not received by the applicant, including the delay letter, ignores the fact that applicant and his attorney were aware, and acknowledged that the claims were in delay. Thus, it is presumed the applicant received the three notices in question.

UCC Financing Statement listed petitioner as debtor and assigned assets to Golden Financial Solutions.

Favours Defendant prevailed

Supported finding that lien was assigned, defeating petitioner's challenge to lien assignment.

From the decision · page 8The undersigned found that petitioner's lien had been assigned pursuant to L.C. § 4903.8, based on Defense Exhibit G, a UCC Financing Statement. The statement listed petitioner as a "debtor," and that their assets had been assigned to "Golden Financial Solutions."

The rules the panel named

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

Knight v. United Parcel Service (2006) 71 Cal. Comp. Cases 1423

An employer or insurer's failure to provide required notice to an employee of rights under the MPN that results in neglect or refusal of reasonable medical treatment renders the employer or insurer liable for reasonable medical treatment self-procured by the employee.

Applied to determine entitlement to self-procure treatment due to neglect or refusal of medical treatment.

From the decision · page 1Pursuant to Knight v. United Parcel Service (2006) 71 Cal. Comp. Cases 1423 [2006 Cal. Wrk. Comp. LEXIS 323] (Appeals Board en banc), an employer or insurer's failure to provide required notice to an employee of rights under the MPN that results in a neglect or refusal to provide reasonable medical treatment renders the employer or insurer liable for reasonable medical treatment self-procured by the employee. (Id. at 1434.) Here, lien claimant offers no documentary evidence and interposes no witnesses to establish that an alleged failure of timely notice on the part of defendant resulted in either delay or refusal of medical treatment. Additionally, the WCJ has observed that defendant provided appropriate notice to applicant within ten days of service of

Cal. Code Regs., tit. 8, 9812(g)

Proof of service is not required to accompany a notice of delay under AD Rule 9812(g).

Applied to reject lien claimant's argument that lack of proof of service on delay notice amounted to neglect.

From the decision · page 2Lien claimant asserts that defendant neglected medical treatment because the notice of delay and notice of medical appointment were not accompanied by a proof of service. (Petition for Reconsideration (Petition), at 8:1.) We observe, however, that Administrative Director (AD) Rule 9812 does not require that a proof of service accompany a notice of delay. (Cal. Code Regs., tit. 8, § 9812(g).) Moreover, "[a] letter correctly addressed and properly mailed is presumed to have been received in the ordinary course of mail." (Evid. Code, § 641; see also Minniear v. Mt. San Antonio Community College District (1996) 61 Cal. Comp. Cases 1055, 1059 [1996 Cal. Wrk. Comp. LEXIS 3570] (Appeals Board en banc) [typical presumption affecting the burden of producing evidence "is the presumption that a mailed letter was received"].)

ADJ12399048 · October 11, 2022

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

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