ADJ2341059 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied.

Petition for Reconsideration filed by Park Compounding challenging Findings of Fact and Order issued December 15, 2022, denied by WCAB panel decision on February 13, 2023.

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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.

LiensDefendant prevailed

The lien claimant failed to prove proper authorization requests and failed to prove the medications were reasonable and necessary based on lack of evidence and medical support in Dr. Latteri's reports.

From the decision · page 5Notably, this section states that in the absence of a proof of service by mail or a dated return receipt, the request shall be deemed to have been received by the claims administrator on the date stamped as received on the document7. In this matter, there was no evidence submitted by the Petitioner to show that the requests for authorization were served on the claims administrator prior to the medications being dispensed. A review of the PR-2 reports and prescriptions do not have a proof of service attached to them8.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Labor Code Section 4600

Physician must send request for authorization for medical treatment to claims administrator with supporting documentation.

From the decision · page 5The Petitioner asserts that it met its burden to prove that it properly requested authorization for the medications dispensed. It is well established that all parties and lien claimants shall meet the evidentiary burden of proof on all issues by a preponderance of the evidence4. Labor Code Section 4600 sets forth an obligation for a physician when said physician seeks to provide medical treatment. Specifically, a physician providing treatment under Section 4600 shall send any request for authorization for medical treatment, with supporting documentation, to the claims administrator for the employer, insurer, or other entity according to the rules adopted by the Administrative Director.5 Title 8, California Code of Regulations Section 9792.9 (a) (2)6 sets forth the timeframes in which a request for authorization is deemed to have been received by the claims administrator.

Title 8, California Code of Regulations Section 9792.9

Timeframes for request for authorization deemed received by claims administrator; absence of proof of service or date stamp affects timing.

From the decision · page 5Notably, this section states that in the absence of a proof of service by mail or a dated return receipt, the request shall be deemed to have been received by the claims administrator on the date stamped as received on the document7. In this matter, there was no evidence submitted by the Petitioner to show that the requests for authorization were served on the claims administrator prior to the medications being dispensed. A review of the PR-2 reports and prescriptions do not have a proof of service attached to them8.

Title 8, California Code of Regulations Section 9792.9.1

DWC Form RFA required for requests for authorization on or after July 1, 2013; failure to provide form affects evidentiary burden.

From the decision · page 5Additionally, there was no testimonial evidence offered by the Petitioner as to when those reports and prescriptions were served on the claims administrator. Applying Title 8, California Code of Regulations Section 9792.9 (a) (2), the undersigned could not utilize the date the PR-2 reports and prescriptions were received by the Defendant because the PR-2 reports and prescriptions offered into evidence by the Petitioner did not have a date stamp on them indicating that they were received by the Defendant9. Moreover, there was no testimony offered as evidence to establish when the PR-2 reports and prescriptions were received by the Defendant. Additionally, for any requests for authorization made on or after July 1, 2013, the Petitioner failed to offer any evidence to show that a DWC Form RFA as required by Title 8, California Code of Regulations Section 9792.9.1 was completed and served on the claims administrator. As such, it was clear that the Petitioner did not meet its evidentiary burden to prove that it properly requested authorization for its compound medications.

What proof carried it

The evidence the panel weighed, by kind.

Documentary evidencefavours Defendant prevailed

lack of proof of service of authorization requests and absence of date stamps on PR-2 reports and prescriptions

From the decision · page 5Notably, this section states that in the absence of a proof of service by mail or a dated return receipt, the request shall be deemed to have been received by the claims administrator on the date stamped as received on the document7. In this matter, there was no evidence submitted by the Petitioner to show that the requests for authorization were served on the claims administrator prior to the medications being dispensed. A review of the PR-2 reports and prescriptions do not have a proof of service attached to them8.

Testimony and credibilityfavours Defendant prevailed

absence of testimonial evidence establishing when authorization requests were received by claims administrator

From the decision · page 5Additionally, there was no testimonial evidence offered by the Petitioner as to when those reports and prescriptions were served on the claims administrator. Applying Title 8, California Code of Regulations Section 9792.9 (a) (2), the undersigned could not utilize the date the PR-2 reports and prescriptions were received by the Defendant because the PR-2 reports and prescriptions offered into evidence by the Petitioner did not have a date stamp on them indicating that they were received by the Defendant9. Moreover, there was no testimony offered as evidence to establish when the PR-2 reports and prescriptions were received by the Defendant. Additionally, for any requests for authorization made on or after July 1, 2013, the Petitioner failed to offer any evidence to show that a DWC Form RFA as required by Title 8, California Code of Regulations Section 9792.9.1 was completed and served on the claims administrator. As such, it was clear that the Petitioner did not meet its evidentiary burden to prove that it properly requested authorization for its compound medications.

Medical recordsfavours Defendant prevailed

Dr. Latteri's reports did not discuss applicant's symptoms or side effects, nor provide scientific or medical evidence supporting compound medications

From the decision · page 6Latteri's PR-2 reports and prescriptions did not discuss the Applicant's symptoms or her history with the side effects of her prescription medication. Further, the reports and prescriptions of Dr. Latteri did not explain the reason that compound medications should have been used11. Moreover, there was no indication that any of the PR-2 reports or prescriptions contained any scientific or medical evidence which supported the use of the compound medications based upon the Applicant's symptoms and her medication usage at that time. As such, it was found that the Petitioner did not meet its burden to prove that the treatment rendered was medically reasonable and necessary.

ADJ2341059 · February 13, 2023

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

What proof carried it

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