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.
From the decision · page 5DISCUSSION "The employer shall be liable for the cost of each reasonable and necessary comprehensive medical-legal evaluation obtained by the employee pursuant to Sections 4060, 4061, and 4062." (Lab. Code, § 4064(a).) Defendant sent letters to applicant objecting to an evaluation with a psychological panel QME. However, the record does not reflect that defendant advised Dr. Strada that it objected to her evaluation. In fact, the record shows that defendant sent an advocacy letter to Dr. Strada stating that she had "been appointed and chosen as the Panel Qualified Medical Examiner" prior to the appointment. (Cost Petitioner's Exhibit No. 2, Defendant's Adversarial PQME Letter, August 8, 2016, p. 1.) There are also indications that defendant jointly provided her with records to review as part of her evaluation. (Id.) Defendant's November 1, 2016 letter to Dr. Strada regarding the late appointment fee incorrectly states that the parties were not notified of the missed appointment
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Defendant did not timely object to Dr. Strada's evaluation and billing.
Favours Applicant prevailed
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.
Could not evaluate psyche, sleep and headache; recommended referral to psychologist and neurologist.
From the decision · page 2Satish Lal, M.D. evaluated applicant as the orthopedic qualified medical evaluator (QME). (Joint Exhibit J, QME reports of Satish K. Lal, M.D.) In a supplemental report dated December 18, 2015, Dr. Lal stated that applicant's attorney had asked if he could evaluate applicant's psyche, sleep and headache. (Joint Exhibit J, QME report of Satish K. Lal, M.D., December 18, 2015, p. 1.) Dr. Lal stated that he could not evaluate these parts and recommended referral to a psychologist and neurologist to evaluate these complaints. (Id. at p. 2.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code 4064(a)
The employer shall be liable for the cost of each reasonable and necessary comprehensive medical-legal evaluation obtained by the employee pursuant to Sections 4060, 4061, and 4062.
Defendant is liable for the medical-legal expenses of Dr. Strada's evaluation.
From the decision · page 5DISCUSSION "The employer shall be liable for the cost of each reasonable and necessary comprehensive medical-legal evaluation obtained by the employee pursuant to Sections 4060, 4061, and 4062." (Lab. Code, § 4064(a).) Defendant sent letters to applicant objecting to an evaluation with a psychological panel QME. However, the record does not reflect that defendant advised Dr. Strada that it objected to her evaluation. In fact, the record shows that defendant sent an advocacy letter to Dr. Strada stating that she had "been appointed and chosen as the Panel Qualified Medical Examiner" prior to the appointment. (Cost Petitioner's Exhibit No. 2, Defendant's Adversarial PQME Letter, August 8, 2016, p. 1.) There are also indications that defendant jointly provided her with records to review as part of her evaluation. (Id.) Defendant's November 1, 2016 letter to Dr. Strada regarding the late appointment fee incorrectly states that the parties were not notified of the missed appointment
Labor Code 4622
Labor Code section 4622 governs the billing and payment procedures for medical-legal evaluations.
The procedure in Labor Code section 4622 applies to the parties regarding medical-legal billing disputes.
From the decision · page 1Applicant contends that she is not liable for Dr. Strada's fee because Dr. Strada did not object to defendant's denial of her invoice within 90 days. Applicant also contends that defendant waived all objections to Dr. Strada's billing and is therefore liable for the late fee. Lastly, applicant contends that the procedure in Labor Code1 section 4622 only applies to the provider and defendant, not applicant. (Lab. Code, § 4622.)
What proof carried it
The evidence the panel weighed, by kind.
Defendant's failure to advise Dr. Strada of its objection to her evaluation and its conduct prior to her evaluation reasonably led Dr. Strada to believe her evaluation was valid.
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
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.
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