What the panel ordered
Defendant's petition for reconsideration denied; lien claimant's petition for reconsideration granted only to amend Findings of Fact to reflect failure to meet burden of proving injury AOE/COE; otherwise Findings and Award affirmed.
Petitions for reconsideration of the February 19, 2025 Findings and Award were filed by lien claimant Medland Medical Group and defendant, challenging findings on injury AOE/COE and reimbursement of medical-legal costs; the WCJ prepared a Report and Recommendation to deny both petitions; the WCAB issued a decision on May 19, 2025 affirming the Findings and Award except amending to find lien claimant did not meet burden of proving injury AOE/COE.
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 WCJ and WCAB found lien claimant failed to meet burden of proof for injury AOE/COE due to inconsistent medical history and prior injuries not disclosed to PTP.
From the decision · page 6To receive treatment charges this WCJ determined that Medland is faced with an initial burden of proving that the injured worker sustained injury arising out of and in the course of employment. As noted above, injury arising out of and in the course of employment has been denied. Medland did not provide a witness or applicant to testify at trial, and to establish industrial injury. Whereas Medland's examining physician Omid Haghighinia D.C. does report an injury in report of April 26, 2023, this WCJ takes note of further history of applicant denying prior or subsequent injuries or accidents off the job. Records/exhibits offered by defendant suggest otherwise. Records of Intercare Holdings (Defendant's Exhibit F) reflect injury to the back requiring treatment at US Healthworks dating back to 7/30/2012. Records of ACE Property and Casualty (Defendant's Exhibit G) reflect injury to back, arms and knees requiring treatment at Arrowhead Orthopedics back in May of 2017, and with diagnosis to include disc protrusion, fibromyalgia, and radiculopathy.
The WCJ found the April 26, 2023 PTP report was a valid medical-legal report incurred due to a contested claim as defendant denied liability; award of costs upheld.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Lien claimant failed to meet burden of proof for injury arising out of and in the course of employment due to inconsistent medical history and prior injuries not disclosed to PTP.
Favours Defendant prevailed
This failure resulted in denial of reimbursement for medical treatment costs.
From the decision · page 6To receive treatment charges this WCJ determined that Medland is faced with an initial burden of proving that the injured worker sustained injury arising out of and in the course of employment. As noted above, injury arising out of and in the course of employment has been denied. Medland did not provide a witness or applicant to testify at trial, and to establish industrial injury. Whereas Medland's examining physician Omid Haghighinia D.C. does report an injury in report of April 26, 2023, this WCJ takes note of further history of applicant denying prior or subsequent injuries or accidents off the job. Records/exhibits offered by defendant suggest otherwise. Records of Intercare Holdings (Defendant's Exhibit F) reflect injury to the back requiring treatment at US Healthworks dating back to 7/30/2012. Records of ACE Property and Casualty (Defendant's Exhibit G) reflect injury to back, arms and knees requiring treatment at Arrowhead Orthopedics back in May of 2017, and with diagnosis to include disc protrusion, fibromyalgia, and radiculopathy.
Defendant denied liability for applicant's claim at the time of the April 26, 2023 PTP report.
Favours Applicant prevailed
This established a contested claim justifying reimbursement of medical-legal costs incurred for the report.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Issued April 26, 2023 comprehensive medical-legal report; reported injury but history was inconsistent and incomplete; report found valid for medical-legal cost reimbursement but insufficient to prove injury AOE/COE.
Inconsistent history and prior injuries not disclosed to physician led to failure to meet burden of proof for injury AOE/COE.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code sections 3202.5, 5705; Kunz v. Patterson Floor Coverings, Inc. (2002) 67 Cal.Comp.Cases 1588; Tapia v. Skill Masters Staffing (2008) 73 Cal.Comp.Cases 1338
Lien claimant must prove injury arising out of and in the course of employment by preponderance of evidence to recover medical treatment costs when liability is denied.
Applied to lien claimant's burden to prove injury AOE/COE for medical treatment reimbursement.
From the decision · page 6To receive treatment charges this WCJ determined that Medland is faced with an initial burden of proving that the injured worker sustained injury arising out of and in the course of employment. As noted above, injury arising out of and in the course of employment has been denied. Medland did not provide a witness or applicant to testify at trial, and to establish industrial injury. Whereas Medland's examining physician Omid Haghighinia D.C. does report an injury in report of April 26, 2023, this WCJ takes note of further history of applicant denying prior or subsequent injuries or accidents off the job. Records/exhibits offered by defendant suggest otherwise. Records of Intercare Holdings (Defendant's Exhibit F) reflect injury to the back requiring treatment at US Healthworks dating back to 7/30/2012. Records of ACE Property and Casualty (Defendant's Exhibit G) reflect injury to back, arms and knees requiring treatment at Arrowhead Orthopedics back in May of 2017, and with diagnosis to include disc protrusion, fibromyalgia, and radiculopathy.
Labor Code sections 4060, 4064, 4620, 4621, 4622
Medical-legal costs are reimbursable when incurred for proving or disproving a contested claim where employer denies liability.
Applied to award reimbursement for medical-legal costs based on April 26, 2023 PTP report and defendant's denial of liability.
What proof carried it
The evidence the panel weighed, by kind.
Inconsistent medical history and prior injuries not disclosed to PTP
From the decision · page 6To receive treatment charges this WCJ determined that Medland is faced with an initial burden of proving that the injured worker sustained injury arising out of and in the course of employment. As noted above, injury arising out of and in the course of employment has been denied. Medland did not provide a witness or applicant to testify at trial, and to establish industrial injury. Whereas Medland's examining physician Omid Haghighinia D.C. does report an injury in report of April 26, 2023, this WCJ takes note of further history of applicant denying prior or subsequent injuries or accidents off the job. Records/exhibits offered by defendant suggest otherwise. Records of Intercare Holdings (Defendant's Exhibit F) reflect injury to the back requiring treatment at US Healthworks dating back to 7/30/2012. Records of ACE Property and Casualty (Defendant's Exhibit G) reflect injury to back, arms and knees requiring treatment at Arrowhead Orthopedics back in May of 2017, and with diagnosis to include disc protrusion, fibromyalgia, and radiculopathy.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
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