What the panel ordered
Petition for Reconsideration granted; Findings and Order amended to find a contested claim existed on February 10, 2023; otherwise Findings and Order affirmed.
Defendant sought reconsideration of the WCJ's Findings and Order issued on February 18, 2025, regarding contested claim status and reasonableness of services; WCJ recommended denial of reconsideration; the Appeals Board granted reconsideration and amended the Findings and Order.
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.
The Appeals Board found that a contested claim existed on February 10, 2023, contrary to the WCJ's narrow finding, because defendant continued to dispute liability for some claimed body parts and benefits, thus meeting the statutory definition of a contested claim under Labor Code section 4620.
From the decision · page 5We disagree with the WCJ's finding as to whether a contested claim existed because the WCJ appears to construe the meaning of "contested issues" very narrowly. Defendant authorized treatment and eventually accepted liability for two body parts, but this did not mean that defendant did not dispute any other issues such as injury to other claimed body parts, temporary disability and permanent disability. As is demonstrated by defendant's Answer and the WCJ's OACR, defendant continued to dispute liability for benefits throughout the pendency of applicant's case.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Defendant issued a delay letter on November 14, 2022, and authorized treatment on November 21, 2022, but continued to dispute liability for some claimed body parts and benefits.
Favours Applicant prevailed
This showed that a contested claim existed under Labor Code section 4620 at the time the services were provided on February 10, 2023.
From the decision · page 5(Id. at p. 1062.) Here, on November 14, 2022, defendant issued a delay letter to applicant with QME
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 4620
A contested claim exists when the employer knows or reasonably should know of an employee's claim and denies it outright or fails to act within a reasonable time (Lab. Code, 4620(b)).
The Appeals Board applied this standard to find a contested claim existed on February 10, 2023, based on defendant's ongoing dispute of liability.
From the decision · page 4Section 4620(a) defines a medical-legal expense as a cost or expense that a party incurs "for the purpose of proving or disproving a contested claim." (§ 4620(a).) Copy service fees are considered medical-legal expenses under section 4620(a). (Citations) Lien claimant's initial burden in proving entitlement to reimbursement for a medical-legal expense is to show that a "contested claim" existed at the time the service was performed. Subsection (b) sets forth the parameters for determining
What proof carried it
The evidence the panel weighed, by kind.
Defendant's continued dispute of liability for some claimed body parts and benefits despite partial acceptance of injury
From the decision · page 5We disagree with the WCJ's finding as to whether a contested claim existed because the WCJ appears to construe the meaning of "contested issues" very narrowly. Defendant authorized treatment and eventually accepted liability for two body parts, but this did not mean that defendant did not dispute any other issues such as injury to other claimed body parts, temporary disability and permanent disability. As is demonstrated by defendant's Answer and the WCJ's OACR, defendant continued to dispute liability for benefits throughout the pendency of applicant's case.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
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