CA: Insurer Denied Reimbursement for Paying Excessive Treatment Beyond 24 Chiropractic Visit Limit

CA: Insurer Denied Reimbursement for Paying Excessive Treatment Beyond 24 Chiropractic Visit Limit

Silvia Mora v. Steelcase, Inc.

Medical Treatment--Chiropractic--WCAB, rescinding WJC's finding, held that defendant was not entitled to reimbursement by lien claimant/chiropractor for treatment provided to applicant/painter/assembler with injury to her right shoulder and upper extremity during periods 11/89 to 9/9/2001 and 11/89 to 3/9/2004 in excess of 24 chiropractic visits permitted by Labor Code § 4604.5(d)(1), because (1) Labor Code § 4604.5(d)(1) does not authorize restitution for voluntary payment of excessive treatment and, although restitution is allowed in limited circumstances pertaining to medical-legal expenses under Labor Code §§ 4622 and 4625, these sections do not apply to medical treatment, (2) defendant knew of 24-visit limit on chiropractic treatment yet continued to pay for excessive treatment, (3) defendant did not allege unjust enrichment, fraud, duress, or mistakes of law or fact, and (4) WCAB found that principle of transactional stability applied because lien claimant continued to provide treatment based upon defendant's payments. © Copyright 2010 LexisNexis. All rights reserved.

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Source: Calif. Workers’ Compensation Appeals Board