What the panel treated as outcome-determinative, and which side it favoured.
Applicant sustained industrial injury to bilateral knees and right shoulder from February 8, 2005 to May 12, 2005, and to left knee on May 5, 2005, while employed by City Auto Body.
Favours neutral
Establishes the basis for lien claims and the application of the 24-visit cap under Labor Code section 4604.5(c)(3).
From the decision · page 2Applicant has filed two applications for adjudication. In Case No. ADJ9313543, applicant
sustained injury to his bilateral knees and right shoulder while employed as an auto body worker
by defendant City Auto Body from February 8, 2005 to May 12, 2005. In Case No. ADJ3093632,
applicant sustained injury to his left knee while similarly employed by defendant City Auto Body
on May 5, 2005. Both cases were resolved by Compromise and Release approved on February 18,
2014.
WCJ found no substantive evidence of a second knee surgery as alleged by petitioners to justify additional chiropractic visits beyond the 24-visit cap.
Favours Defendant prevailed
Supports upholding the 24-visit cap limitation on chiropractic visits for lien of Reinherz Chiropractic.
From the decision · page 4However, Petitioners offer no persuasive legal argument as to why the WCJ's application
of section 4604.5 was in error. While Petitioners contend that the therapeutic allowances otherwise
afforded under section 4604.5 are insufficient in light of the factual circumstances of this case,
Petitioners offer no legal challenge to the validity or applicability of section 4604.5 in the first
instance. Moreover, the WCJ has observed that the record lacks substantive evidence pertaining to
a second knee surgery as alleged by petitioners. Accordingly, and in the absence of a colorable
legal challenge to the application of section 4604.5 to the facts of this case, we decline to disturb
the WCJ's decision with respect to the lien of Reinherz Chiropractic.
Dr. Mirza did not meet the burden of proving medical necessity for diagnostic testing under MTUS guidelines.
Favours Defendant prevailed
Supports disallowance of Dr. Mirza's lien for diagnostic testing.
From the decision · page 5Here, the WCJ has determined that lien claimant did not carry its burden of establishing
that the diagnostic studies provided by Dr. Mirza were medically necessary under the
presumptively correct MTUS. (Opinion on Decision, at p. 5.) Moreover, lien claimant has not
established through a preponderance of scientific medical evidence that a variance from the MTUS
was reasonably required to cure or relieve from applicant's industrial injuries. (Lab. Code,
§ 4604.5(a).) Because the Petition offers no new legal or factual basis for a finding of medical
necessity pursuant to section 4604.5, we decline to disturb the WCJ's regarding the lien of
Dr. Mirza.
Favours neutral
Leads to deferral of the lien issue and remand for further trial-level proceedings to determine certification status.
From the decision · page 7Accordingly, we will amend the F&A to defer the issue of the lien of Corzo Interpreting
and return this matter to the trial level for further proceedings. Upon return of this matter, we
encourage the parties to seek amicable resolution of the interpreting lien in the first instance.
However, should the parties be unable to resolve the interpreting lien, the WCJ must address the
issue of certification and provisional certification in conformity with the analysis set forth in
Guitron, supra, 76 Cal.Comp.Cases 228.