ADJ18498378 · October 27, 2025

The lien claimant met the burden to show the claim was contested and expenses were for proving or disproving the claim; the medical-legal report by Dr. Michaels was substantial evidence of injury AOE/COE; deficiencies in the report may be curable; the matter is remanded for further proceedings on medical-legal expenses and treatment expenses reasonableness and necessity.

From the decision · page 2On January 29, 2024, Dr. Michaels completed the medical-legal evaluation of applicant. During the evaluation, applicant indicated that since November 2023, she had been seeing a counselor for work-related stress. (Joint Exhibit 2, p. 2.) Dr. Michaels took down applicant's medical history and completed various tests and assessments but noted that "no medical records [were] available at the time of [the] evaluation" but "[s]hould records become available, [he] would be happy to review and incorporate into his overall evaluation findings as appropriate." (Id. at p. 4.) Applicant was diagnosed with adjustment disorder and anxiety resulting in a GAF score of 60. (Id. at p. 14.) It was noted that causation for applicant's "psychological distress" was found to be "predominantly industrial (greater than 50%)" but subject to modification "[s]hould additional relevant information become available[.]" (Id. at p. 16.) Dr. Michaels recommended further treatment over a 3-month period. (Ibid.) The report was signed by Dr. Michaels on April 3, 2024, but per the Proof of Service, not served until June 30, 2024. (Id. at p. 19.)

Applicant's attorney requested medical-legal evaluation and report from Dr. Michaels on compensability due to pending denial by defendant.

Favours Applicant prevailed

Showed claim was contested and expenses were for proving or disproving claim, meeting lien claimant's burden of proof.

From the decision · page 2Thereafter, in a letter dated November 17, 2023, applicant's attorney requested an initial medical-legal evaluation and report from Dr. Mark Michaels of Premier Psychological Services to address the issue of compensability in light of a "pending denial" by defendant. (Lien Claimant's Exhibit 3.)

Defendant denied liability for applicant's psychiatric cumulative trauma injury claim due to lack of substantial medical evidence.

Favours Applicant prevailed

Established contested claim status at time medical-legal expenses were incurred, supporting lien claimant's burden.

From the decision · page 2Per correspondence to applicant dated January 4, 2024, defendant denied "liability for [applicant's] claim of injury" due to lack of "substantial medical evidence" of a "psychiatric cumulative trauma injury[.]" (Joint Exhibit 1.)

Dr. Michaels' January 29, 2024 medical-legal report diagnosed adjustment disorder and anxiety with GAF score of 60 and found causation predominantly industrial (greater than 50%).

Favours Applicant prevailed

Provided substantial medical evidence of injury AOE/COE supporting lien claimant's claim for reimbursement.

From the decision · page 2On January 29, 2024, Dr. Michaels completed the medical-legal evaluation of applicant. During the evaluation, applicant indicated that since November 2023, she had been seeing a counselor for work-related stress. (Joint Exhibit 2, p. 2.) Dr. Michaels took down applicant's medical history and completed various tests and assessments but noted that "no medical records [were] available at the time of [the] evaluation" but "[s]hould records become available, [he] would be happy to review and incorporate into his overall evaluation findings as appropriate." (Id. at p. 4.) Applicant was diagnosed with adjustment disorder and anxiety resulting in a GAF score of 60. (Id. at p. 14.) It was noted that causation for applicant's "psychological distress" was found to be "predominantly industrial (greater than 50%)" but subject to modification "[s]hould additional relevant information become available[.]" (Id. at p. 16.) Dr. Michaels recommended further treatment over a 3-month period. (Ibid.) The report was signed by Dr. Michaels on April 3, 2024, but per the Proof of Service, not served until June 30, 2024. (Id. at p. 19.)

WCJ found report incomplete and no applicant testimony at trial, but WCAB found report substantial evidence and lack of testimony not fatal to lien claimant's burden.

Favours Applicant prevailed

Supported remand for further proceedings rather than take nothing order.

From the decision · page 11Here, in a report dated January 29, 2024, Dr. Michaels diagnosed applicant with adjustment disorder and anxiety with a resulting GAF score of 60. (Joint Exhibit 2, p. 14.) He noted that causation for applicant's "present psychological distress" was "predominantly industrial (greater than 50%)." (Id. at p. 16.) The WCJ argues that the "report is incomplete on its face and not substantial" given the fact that there was no record review and no confirmation by the parties that records were unavailable. (Report, p. 3.) The WCJ also noted that "applicant was not present to testify at trial as to injury." (Opinion on Decision (OOD), p. 1.) As such, "[i]n weighing the lien claimant's evidence[,]" the WCJ continues to believe that lien claimant has failed to meet their burden in establishing injury AOE/COE. (OOD, p. 2; Report, pp. 2-3.) We note that lack of applicant testimony is not fatal to a lien claimant's case as there is no statutory requirement that an applicant testify to meet their burden on AOE/COE.

Diagnosed applicant with adjustment disorder and anxiety with GAF score of 60; found causation for psychological distress predominantly industrial (greater than 50%); recommended further treatment; report was substantial evidence of injury AOE/COE.

Report was thorough evaluation and history, despite lack of medical records at time; findings were substantial evidence of injury AOE/COE.

From the decision · page 2On January 29, 2024, Dr. Michaels completed the medical-legal evaluation of applicant. During the evaluation, applicant indicated that since November 2023, she had been seeing a counselor for work-related stress. (Joint Exhibit 2, p. 2.) Dr. Michaels took down applicant's medical history and completed various tests and assessments but noted that "no medical records [were] available at the time of [the] evaluation" but "[s]hould records become available, [he] would be happy to review and incorporate into his overall evaluation findings as appropriate." (Id. at p. 4.) Applicant was diagnosed with adjustment disorder and anxiety resulting in a GAF score of 60. (Id. at p. 14.) It was noted that causation for applicant's "psychological distress" was found to be "predominantly industrial (greater than 50%)" but subject to modification "[s]hould additional relevant information become available[.]" (Id. at p. 16.) Dr. Michaels recommended further treatment over a 3-month period. (Ibid.) The report was signed by Dr. Michaels on April 3, 2024, but per the Proof of Service, not served until June 30, 2024. (Id. at p. 19.)

Colamonico v. Secure Transportation (2019) 84 Cal.Comp.Cases 1059 (Appeals Bd. en banc)

Applied to lien reimbursement for medical-legal expenses.

From the decision · page 6(Cal. Code Regs., tit. 8, § 9793(h).) Section 4064(a) provides that an employer is liable for the cost of any comprehensive medical evaluations authorized under section 4060. When read alongside section 4064(a), the clear intention of section 4060(b) is to demonstrate that a medical-legal evaluation performed by an employee's PTP may be considered a medical-legal evaluation pursuant to section 4060, and, as such, the employer should be held liable for any corresponding reasonable and necessary medical- legal costs and expenses. Pursuant to sections Colamonico v. Secure Transportation (2019) 84 Cal.Comp.Cases 1059 (Appeals Bd. en banc), a lien claimant holds the initial burden of proof pursuant under sections 4620 and 4621 to provide that a contested claim existed at the time the expenses were incurred; the expenses were incurred for the purpose of proving or disproving a contested claim; and the services were reasonably, actually, and necessarily incurred.

Cal. Code Regs., tit. 8, § 9793(h); Lab. Code § 4064(a)

Medical-legal expenses defined under Cal. Code Regs., tit. 8, § 9793(h) and employer liability under Lab. Code § 4064(a).

Defined medical-legal expenses and employer liability for comprehensive medical evaluations.

From the decision · page 5On the issue of reimbursement for medical-legal expenses, we note that section 4060(b) allows for medical-legal evaluations by a treating physician and section 4620(a) defines medical- legal expenses as "costs and expenses...for the purpose of proving or disproving a contested claim." AD Rule 9793(h) further defines medical-legal expenses as follows:

E.L. Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922

Medical opinion must be based on substantial evidence, not speculation or inadequate facts (E.L. Yeager v. Workers' Comp. Appeals Bd., 2006).

Applied to evaluation of Dr. Michaels' medical-legal report as substantial evidence of injury AOE/COE.

From the decision · page 10Further, a decision "must be based on admitted evidence in the record" and supported by substantial evidence. (Lab. Code, § 5903, 5952, subd. (d); Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476, 478 (Appeals Bd. en banc); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312 [35 Cal.Comp.Cases 500]; LeVesque v. Workers' Comp. Appeals Bd. (1970) 1 Cal.3d 627 [35 Cal.Comp.Cases 16].) Pursuant to E.L. Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687], "[a] medical opinion is not substantial evidence if it is based on facts no longer germane, on inadequate medical histories or examinations, on incorrect legal theories, or on surmise, speculation, conjecture, or guess. (citations.) Further, a medical report is not substantial evidence unless it sets forth the reasoning behind the physician's opinion, not merely his or her conclusions. (citation.)" "A medical report which lacks a relevant factual basis cannot rise to a higher level than its own inadequate premises. Such reports do not constitute substantial evidence to support a denial of benefits. (citation.)" (Kyle v. Workers' Comp. Appeals Bd (City and County of San Francisco) (1987) 195 Cal.App.3d 614, 621.)

Defendant's denial of liability for applicant's psychiatric cumulative trauma injury claim due to lack of substantial medical evidence.

From the decision · page 2Per correspondence to applicant dated January 4, 2024, defendant denied "liability for [applicant's] claim of injury" due to lack of "substantial medical evidence" of a "psychiatric cumulative trauma injury[.]" (Joint Exhibit 1.)

Lack of applicant testimony at trial was noted but not fatal to lien claimant's burden to prove injury AOE/COE.

From the decision · page 11Here, in a report dated January 29, 2024, Dr. Michaels diagnosed applicant with adjustment disorder and anxiety with a resulting GAF score of 60. (Joint Exhibit 2, p. 14.) He noted that causation for applicant's "present psychological distress" was "predominantly industrial (greater than 50%)." (Id. at p. 16.) The WCJ argues that the "report is incomplete on its face and not substantial" given the fact that there was no record review and no confirmation by the parties that records were unavailable. (Report, p. 3.) The WCJ also noted that "applicant was not present to testify at trial as to injury." (Opinion on Decision (OOD), p. 1.) As such, "[i]n weighing the lien claimant's evidence[,]" the WCJ continues to believe that lien claimant has failed to meet their burden in establishing injury AOE/COE. (OOD, p. 2; Report, pp. 2-3.) We note that lack of applicant testimony is not fatal to a lien claimant's case as there is no statutory requirement that an applicant testify to meet their burden on AOE/COE.