What the panel ordered
Petition for reconsideration granted; WCJ's decision affirmed except amended to correct dates of service for reports. Initial report (4/5/2023) is medical-legal; subsequent reports are medical treatment costs.
Petition for reconsideration by cost petitioner (Physical Rehabilitation Services, Dr. Abri Mirzaians, D.C.) of WCJ's Findings of Fact and Orders regarding classification of reports as medical-legal or medical treatment costs.
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.
Only the initial report was specifically requested as a medical-legal report to address a disputed issue; subsequent reports were routine progress reports not requested to resolve a dispute and thus are medical treatment costs.
From the decision · page 6In this case only the initial exam with a medical report is medical-legal. The remaining reports from Dr. Mirzaians were mere progress reports of the treating physician. They were not requested by anyone, nor do they identify any contested issue. The provision of progress reports is one of the duties of the primary treatment physician. Cal. Code of Regs. sec. 9785. But unless someone specifically requests a medical-legal opinion which shall be used to determine a dispute, those progress reports are medical treatment costs.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Only the initial report was specifically requested as a medical-legal report to address a disputed issue; subsequent reports were not requested to resolve a dispute.
Favours Defendant prevailed
Determined which reports qualified as medical-legal expenses versus medical treatment costs.
From the decision · page 6In this case only the initial exam with a medical report is medical-legal. The remaining reports from Dr. Mirzaians were mere progress reports of the treating physician. They were not requested by anyone, nor do they identify any contested issue. The provision of progress reports is one of the duties of the primary treatment physician. Cal. Code of Regs. sec. 9785. But unless someone specifically requests a medical-legal opinion which shall be used to determine a dispute, those progress reports are medical treatment costs.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Initial report dated 4/5/2023 was prepared at applicant's attorney's request to address causation and eligibility for compensation; subsequent reports were routine progress reports not addressing a disputed issue.
Initial report was specifically requested as a medical-legal report; subsequent reports were not requested to resolve a dispute.
From the decision · page 7petitioner qualified as a medical-legal expense, as the aforementioned language constituted a request by applicant for a medical-legal report to prove or disprove a disputed issue under Labor Code sections 4060 and 4620.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Cal. Code Regs., tit. 8, § 9793(h)
A medical-legal report must be specifically requested to prove or disprove a disputed legal issue; routine progress reports by a treating physician are medical treatment costs unless specifically requested as medical-legal.
Applied to distinguish between initial report (requested as medical-legal) and subsequent progress reports (not requested as medical-legal).
From the decision · page 6In this case only the initial exam with a medical report is medical-legal. The remaining reports from Dr. Mirzaians were mere progress reports of the treating physician. They were not requested by anyone, nor do they identify any contested issue. The provision of progress reports is one of the duties of the primary treatment physician. Cal. Code of Regs. sec. 9785. But unless someone specifically requests a medical-legal opinion which shall be used to determine a dispute, those progress reports are medical treatment costs.
What proof carried it
The evidence the panel weighed, by kind.
Applicant's attorney issued a letter specifically requesting a comprehensive medical-legal report for the initial evaluation, but not for subsequent reports.
From the decision · page 7I request that [cost petitioner] review all previous records and prepare an initial comprehensive medical-legal report which provides all of the medical information required by 8 CCR § 9785, including your opinion on all medical issues necessary to determine the employee's eligibility for compensation. 8 CCR § 9785(d) (g), 10606(b).
Subsequent reports were routine progress reports required every 45 days by regulation, not requested to resolve a disputed issue.
From the decision · page 7Please submit medical-legal progress reports every forty-five (45) days as required by 8 CCR § 9785(f)(8).
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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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