Recent decisions provide guidance of new procedures under SB 863
One aspect of SB 863 that is confusing both non-physician lien claimants and judges is how these lien claimants may obtain medical reports in a case. Prior to SB 863, non-physician lien claimants would often run into problems securing medical reports from defendants and would end up having to subpoena medical reports or seek an order to compel service of medical information about an injured worker. Amended LC 4903.6(d) now provides that non-physician lien claimants must petition a judge for an order that the defendant release the medical records to them. Since these lien claimants seek medical reports in almost every case, this new law will most likely increase the workload for everyone involved in the case. Two recent panel decisions provide guidance on (a) who is a non-physician lien claimant such that the new process under LC 4903.6(d) applies, and (b) what the non-physician lien claimant must specify in its petition in order to show that the medical reports are relevant to its case.
Case #1: The WCJ denied lien claimant/Regal Medical Group’s petition to compel production of medical records, stating that lien claimant was not a physician. The WCAB, granting removal and reversing the WCJ, found instead that (1) Regal Medical Group stipulated that it is a health plan, despite its name, and, as such, LC 4903.6(d) applied, (2) because it must prove injury AOE/COE and that medical treatment was reasonable and necessary to establish its lien, Regal Medical Group must have access to medical records, and (3) since the medical records were not available in EAMS, Regal Medical Group must obtain them from the defendant. Held: The WCAB ordered that Regal Medical Group be served by defendant with all relevant medical records and medical-legal reports. Allen v. Universal Bank, 2013 Cal. Wrk. Comp. P.D. LEXIS --.
Case #2: The WCJ denied lien claimant/Aetna-Traditional’s request for an order compelling production from the defendant of medical reports in connection with the applicant’s claim for industrial injuries to her neck and shoulders, and for hypertension. The WCAB, granting removal and rescinding the WCJ’s order, found that the applicant’s claims had settled by compromise and release, but that the lien claimant’s claim for reimbursement remains unresolved, that the lien claimant had stipulated it is a health plan and thus LC 4903.6(d) applied, and that the lien claimant had the burden of proving injury AOE/COE and that the medical services for which the lien claimant paid on the applicant’s behalf were reasonable and necessary. The WCAB further found that, in order to sustain this burden of proof, the lien claimant must have access to medical reports and medical-legal reports obtained by the parties in the course of litigating the applicant’s claims. Held: The WCAB ordered the defendant to serve the lien claimant with copies of all relevant medical and medical-legal reports in the applicant’s cases. Kayl v. The Vitamin Store, 2013 Cal. Wrk. Comp. P.D. LEXIS --.
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