What the panel ordered
The WCAB granted the Petition for Reconsideration in part, affirmed the WCJ's decision except amended to find defendant did not issue timely and compliant objections or Explanations of Review (EORs) to cost petitioner's invoices, entitling cost petitioner to payment, penalties, and interest. Exhibits 32-36 were admitted into evidence. The issue of sanctions, fees, and costs was deferred to the WCJ for further proceedings.p. 10
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.
Defendant failed to issue timely and compliant objections or Explanations of Review (EORs) to cost petitioner's invoices as required by Labor Code section 4622(a) and WCAB Rule 10786(e), resulting in waiver of objections and entitlement to payment, penalties, and interest for cost petitioner.
From the decision · page 8(Cal. Code Regs., tit. 8, § 10786(e) and (f).) Here, there is no evidence in the record that defendant objected to cost petitioner’s invoices or issued any EORs. At time of trial, defendant offered no exhibit evidence or witness testimony about its timely compliant objections or EORs in response to cost petitioner’s invoices. Accordingly, under section 4622(a), defendant has waived their objections to cost petitioner’s invoices, and they owe the bills, penalties of 10 percent, and 7 percent per annum interest. Furthermore, the WCJ’s order of payment per fee schedule is incorrect. Specifically, under WCAB Rule 10786(f), the fee schedule applies when defendant has sent EORs. We also note that the order to bill review is also not appropriate given that defendant failed to submit evidence that it issued timely compliant objections or EORs. (Lab.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Defendant did not issue timely Explanations of Review (EORs) to cost petitioner's invoices.
Favours Applicant prevailed
This failure resulted in waiver of objections and entitlement to payment, penalties, and interest for cost petitioner under Labor Code section 4622(a) and WCAB Rule 10786(e).
From the decision · page 103. Defendant did not issue timely Explanations of Review. Under Labor Code section 4622(a) and WCAB Rule 10786(e) (Cal. Code Regs., tit. 8, § 10786(e)), cost petitioner is entitled to payment, penalties, and interest. The issue of defendant’s liability for sanctions, fees, and costs under WCAB Rule 10786(i) is deferred.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Cal. Code Regs., tit. 8, § 10786(e)
WCAB Rule 10786(e)
Defendant deemed to have waived objections if no timely EOR is served within 60 days of billing.
From the decision · page 8(Cal. Code Regs., tit. 8, § 10786(e) and (f).) Here, there is no evidence in the record that defendant objected to cost petitioner’s invoices or issued any EORs. At time of trial, defendant offered no exhibit evidence or witness testimony about its timely compliant objections or EORs in response to cost petitioner’s invoices. Accordingly, under section 4622(a), defendant has waived their objections to cost petitioner’s invoices, and they owe the bills, penalties of 10 percent, and 7 percent per annum interest. Furthermore, the WCJ’s order of payment per fee schedule is incorrect. Specifically, under WCAB Rule 10786(f), the fee schedule applies when defendant has sent EORs. We also note that the order to bill review is also not appropriate given that defendant failed to submit evidence that it issued timely compliant objections or EORs. (Lab.
Labor Code section 4622
Labor Code section 4622
Defendant's failure to issue timely and compliant objections or EORs results in waiver of objections and liability for payment, penalties, and interest.
From the decision · page 8(Cal. Code Regs., tit. 8, § 10786(e) and (f).) Here, there is no evidence in the record that defendant objected to cost petitioner’s invoices or issued any EORs. At time of trial, defendant offered no exhibit evidence or witness testimony about its timely compliant objections or EORs in response to cost petitioner’s invoices. Accordingly, under section 4622(a), defendant has waived their objections to cost petitioner’s invoices, and they owe the bills, penalties of 10 percent, and 7 percent per annum interest. Furthermore, the WCJ’s order of payment per fee schedule is incorrect. Specifically, under WCAB Rule 10786(f), the fee schedule applies when defendant has sent EORs. We also note that the order to bill review is also not appropriate given that defendant failed to submit evidence that it issued timely compliant objections or EORs. (Lab.
Labor Code section 5813
Labor Code section 5813
Sanctions may be imposed for bad faith failure to comply with medical-legal billing requirements, deferred to WCJ for fact finding.
What proof carried it
The evidence the panel weighed, by kind.
Defendant failed to show evidence of timely and compliant objections or Explanations of Review (EORs) to cost petitioner's invoices.
From the decision · page 8(Cal. Code Regs., tit. 8, § 10786(e) and (f).) Here, there is no evidence in the record that defendant objected to cost petitioner’s invoices or issued any EORs. At time of trial, defendant offered no exhibit evidence or witness testimony about its timely compliant objections or EORs in response to cost petitioner’s invoices. Accordingly, under section 4622(a), defendant has waived their objections to cost petitioner’s invoices, and they owe the bills, penalties of 10 percent, and 7 percent per annum interest. Furthermore, the WCJ’s order of payment per fee schedule is incorrect. Specifically, under WCAB Rule 10786(f), the fee schedule applies when defendant has sent EORs. We also note that the order to bill review is also not appropriate given that defendant failed to submit evidence that it issued timely compliant objections or EORs. (Lab.
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About this page
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