Determination of Medical-Legal Expense Disputes. [Repealed] 8 CCR § 10451.1

What panels did with this rule

Released decisions that named § 10451.1, with the passage each turned on. A panel decision persuades; it does not bind.

• ADJ2207038 · 2024-01-04 · Van Nuys District Office8 CCR § 10451.1

  Determinative passage · p.6Western could have filed a Petition for Determination pursuant to former Title 8, California Code of Regulations § 10451.1. That section became operative on October 23, 2013 and was in effect when Western provided its services in 2014. Western, however, opted to subsequently file a lien on August 26, 2015 and pursue its balance in that fashion. Having reached no agreement, the defendant filed a DOR on October 9, 2015. Further emails were exchanged that did not result in an agreement. The defendant maintained its position that Western's services were time-barred in its January 20, 2016 Petition for Order Taking Off-Calendar the Lien Conference, to which Western failed to object, respond, or answer. At the time of the March 2, 2016 lien conference, Western also failed to appear, and the defendant's motion to take the matter off calendar was granted. Of note is that Western's Points and Authorities submitted post-trial, on page four, lines six to eight "...concedes that this is true and that its lien was filed past the statute of limitations for lien filing which concluded on 08/12/2015...". Furthermore, Western's Petition for Reconsideration does not argue to the contrary.

  Western could have filed a Petition for Determination timely but chose to file a lien instead; filing both is impermissible.

  Official decision · page 6 →
• ADJ11231953 · 2023-06-05 · Fresno District Office8 CCR § 10451.1

  Determinative passage · p.4Petitioners contend that Title 8, CCR § 10786 applies to this case. However, the report was issued in late 2019, therefore, Title 8, CCR§ 10451.1 applies to medical-legal disputes. As it was the controlling statute at the time of Applicant's injury and Dr. Abri's evaluation, this would be a 11011-IBR issue as to whether or not the claimed medical/legal expense was incurred for the purpose of proving or disproving a contested claim. Petitioners' contention that this is an Independent Bill Review (IBR) dispute is in error.

  Applied to clarify the controlling statute for the medical-legal dispute regarding Dr. Abri's billing and report.

  Official decision · page 4 →
• ADJ11998519 · 2022-06-27 · Los Angeles District Office8 CCR § 10451.1

  Determinative passage · p.3I found that when Defendant resolved the Dr. Konstat bill in April 2019, it was acting in good faith. Part of former CCR Section 10451.1(g)(1) is that due to bad faith actions or tactics, or if a defendant fails to comply with timeliness

  Defines bad faith actions and sanctions criteria relevant to attorney fees

  Official decision · page 3 →
• ADJ8396740 · 2021-04-22 · Long Beach District Office8 CCR § 10451.1

  Determinative passage · p.3I. Former WCAB Rule 10451.1(f)(1)(A)(i)(I) provided that a defendant has waived all objections to a medical-legal provider's billing, except for compliance with section 4620 and 4621, if a defendant failed to serve an EOR within 60 days of a provider's properly documented billing. (Cal. Code Regs., tit. 8, former § 10451.1(f)(1)(A)(i)(I).)2 Here, as stipulated to by the parties, defendant failed to serve timely its EOR. Thus, defendant waived all objections to the billing at issue, and one of the issues that needed to be resolved was the reasonable value of cost petitioner's billing. In our January 13, 2020 Decision After Reconsideration, we remanded this issue to the trial level.

  Defendant failed to serve timely EOR, waiving objections to billing except compliance issues.

  Official decision · page 3 →
• ADJ11998519 · 2021-04-21 · Los Angeles District Office8 CCR § 10451.1

  Determinative passage · p.5Former WCAB Rule 10451.1(g)(1) states: If the [WCAB] determines that, as a result of bad faith actions or tactics, a defendant failed to comply with the requirements, timelines, and procedures set forth in Labor Code section 4622, 4603.3, and 4603.6 and the related Rules of the Administrative Director, the defendant shall be liable for the medical-legal provider's reasonable attorney's fees, costs, and sanctions.... [] For purposes of this subdivision, "bad faith" actions or tactics by a defendant may include but are not limited to:

  Defines bad faith actions for medical-legal billing and attorney's fees

  Official decision · page 5 →
• ADJ9542328 · 2019-11-14 · Long Beach District Office8 CCR § 10451.1

  Determinative passage · p.615 tit. 8, § 10451.1(f)(1)(A)), which specifically states that a defendant "shall be deemed to have finally

  The Appeals Board noted that defendants waive objections by failing to respond timely, except for compliance with sections 4620 and 4621.

  Official decision · page 6 →