ADJ11777176 · February 11, 2026

The Board found the lien claimant's services reasonable and necessary, rejecting defendant's argument that diagnostic testing required separate utilization review authorization, and affirmed the WCJ's award of the lien balance with penalties and interest.

From the decision · page 1The WCJ found, in pertinent part, that the services of lien claimant, Dental Trauma Center, were reasonable and necessary and awarded lien claimant the balance of its lien with penalties and interest.

Lien claimant's services, including diagnostic testing and examination, were reasonable and necessary.

Favours Applicant prevailed

This supported the award of the lien balance with penalties and interest in favor of the applicant.

From the decision · page 1The WCJ found, in pertinent part, that the services of lien claimant, Dental Trauma Center, were reasonable and necessary and awarded lien claimant the balance of its lien with penalties and interest.

Defendant produced no evidence challenging the reasonableness of the medical-legal services provided by lien claimant.

Favours Applicant prevailed

Lack of evidence to dispute reasonableness supported affirming the WCJ's award to the lien claimant.

From the decision · page 3In essence, defendant argues that it authorized an examination with applicant, but that any specific modality of examination should have been approved by UR. Defendant's argument is not supported by the law. Defendant was free to challenge the medical-legal services provided at the consultation as unreasonable, but defendant produced no evidence of this. Furthermore, even if the medical-legal testing in this case was subject to UR, defendant was free to conduct retrospective UR to establish whether the services provided were reasonable, but no evidence of retrospective UR is in the record. Furthermore, defendant was required to inform the primary treater of its objection, but no proper objection from defendant is in the record pursuant to section 4603.2(b)(2).

Defendant failed to provide proper objection to the primary treater as required by Labor Code section 4603.2(b)(2).

Favours Applicant prevailed

This procedural failure supported the Board's decision to affirm the lien award.

From the decision · page 3In essence, defendant argues that it authorized an examination with applicant, but that any specific modality of examination should have been approved by UR. Defendant's argument is not supported by the law. Defendant was free to challenge the medical-legal services provided at the consultation as unreasonable, but defendant produced no evidence of this. Furthermore, even if the medical-legal testing in this case was subject to UR, defendant was free to conduct retrospective UR to establish whether the services provided were reasonable, but no evidence of retrospective UR is in the record. Furthermore, defendant was required to inform the primary treater of its objection, but no proper objection from defendant is in the record pursuant to section 4603.2(b)(2).

Labor Code section 4610(a)

Utilization review (UR) under Labor Code section 4610(a) requires review and approval of treatment recommendations by physicians prior to or concurrent with medical treatment services.

Defendant argued diagnostic testing required UR, but the Board found diagnostic testing is generally a medical-legal expense, not medical treatment, and thus not subject to UR.

From the decision · page 2DISCUSSION Defendant authorized lien claimant to conduct an examination of applicant. However, defendant argues that such an examination does not implicitly include diagnostic tests required to diagnose applicant's condition. Defendant argues that diagnostic testing is subject to utilization review (UR). Per Labor Code2 section 4610(a): For purposes of this section, "utilization review" means utilization review or utilization management functions that prospectively, retrospectively, or concurrently review and approve, modify, or deny, based in whole or in part on medical necessity to cure and relieve, treatment recommendations by physicians, as defined in Section 3209.3, prior to, retrospectively, or concurrent with the provision of medical treatment services pursuant to Section 4600.

Labor Code section 4621

Medical-legal expenses are compensable if reasonably, actually, and necessarily incurred under Labor Code section 4621.

The Board found the lien claimant's diagnostic testing and examination reasonable and necessary, thus compensable.

From the decision · page 3Whether a medical-legal expense is compensable depends on whether the expense is "reasonably, actually, and necessarily incurred". (§ 4621.) While a primary treater may request authorization for diagnostic testing, such a request is not generally subject to utilization review, but instead is simply seeking defendant's agreement that the medical-legal expense is reasonable before it is provided. Here, the primary treater provided medical-legal services in connection with an examination that defendant expressly authorized. All of the medical-legal services provided appear reasonable.

Labor Code section 4603.2(b)(2)

Defendant must inform the primary treater of objections to medical-legal services under Labor Code section 4603.2(b)(2).

Defendant failed to provide proper objection to the primary treater regarding the medical-legal services, supporting the Board's affirmation of the lien award.

From the decision · page 3In essence, defendant argues that it authorized an examination with applicant, but that any specific modality of examination should have been approved by UR. Defendant's argument is not supported by the law. Defendant was free to challenge the medical-legal services provided at the consultation as unreasonable, but defendant produced no evidence of this. Furthermore, even if the medical-legal testing in this case was subject to UR, defendant was free to conduct retrospective UR to establish whether the services provided were reasonable, but no evidence of retrospective UR is in the record. Furthermore, defendant was required to inform the primary treater of its objection, but no proper objection from defendant is in the record pursuant to section 4603.2(b)(2).

Defendant produced no evidence challenging the reasonableness of the medical-legal services provided by lien claimant.

From the decision · page 3In essence, defendant argues that it authorized an examination with applicant, but that any specific modality of examination should have been approved by UR. Defendant's argument is not supported by the law. Defendant was free to challenge the medical-legal services provided at the consultation as unreasonable, but defendant produced no evidence of this. Furthermore, even if the medical-legal testing in this case was subject to UR, defendant was free to conduct retrospective UR to establish whether the services provided were reasonable, but no evidence of retrospective UR is in the record. Furthermore, defendant was required to inform the primary treater of its objection, but no proper objection from defendant is in the record pursuant to section 4603.2(b)(2).