What the panel ordered
The WCAB rescinded the WCJ's decision and allowed the matter to proceed to Independent Bill Review (IBR) for resolution of the medical-legal billing dispute.
Defendant filed a timely petition for reconsideration of the WCJ's decision regarding medical-legal billing dispute.
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 WCAB found that the dispute was over the reasonable value of Dr. Nathan's services and thus subject to Independent Bill Review, not WCAB jurisdiction, rescinding the WCJ's decision.
From the decision · page 2Based on our review of the record and applicable law, we find merit in defendant's contention that the WCAB lacks jurisdiction over this dispute because its essence is the reasonable value of Dr. Nathan's services, not coding or the rectitude of defendant's EORs as suggested by the WCJ. We also conclude that it is appropriate to allow this matter to proceed to IBR. Accordingly, we will rescind the WCJ's decision and replace it with a decision reflecting the above conclusions.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.