WCDefenseCA

On a regular basis, liens I encounter are filed by lien representatives.  Rather than prosecuting the lien itself, the lien claimant assigns the task to one office or another, generally for a percentage of the recovery.  In fact, a regular part of practicing California Workers’ Compensation defense is fighting off unwarranted and baseless liens.

Some cases go on for years, however, and a lien-claimant’s representative might change with the seasons – different person, different office or even a different firm/company.  How do you know if the “new” lien representative actually has the power to negotiate and settle a lien, and the old one no longer does?

For swapping attorneys in the case-in-chief, there is a process to substitute attorneys, as per the Code of Civil Procedure § 284. It appears that no such procedure is followed for lien representatives.

With that in mind, I have a suggestion:  When a lien representative sends that initial demand letter, a proper response includes some demand for documentation that the lien representative actually represents the lien claimant.  That includes authority to negotiate and settle the lien.

In a recent case, Green v. State Roofing systems, Inc., the Workers’ Compensation Appeals Board reviewed a Workers’ Compensation Judge’s granting of a Petition to Quash a Subpoena Duces Tecum, which, among other items, demanded documentation of the agreement and arrangement between the lien claimant and the lien representative.

The case was remanded to work out a discovery plan, but the point is a valid one – defendants must be able to know who the lien claimant is and who its representative is before the lien can be paid, adjusted or litigated.

Apparently there is a new notice coming out of the Medical Unit: Medical Unit Memo.  This copy is reportedly being attached to all panels now issued by the Medical Unit.

The grounds for obtaining a replacement panel are few, but one of the most common ones is when the Medical Unit fails to follow its own procedures for issuing a panel.  In my experience, usually the applicant will request a panel with the specialty of chiropractic (without any supporting documentation), when the treating physician is a orthopedist or some other M.D.

This is, of course, is a violation of California Code of Regulations § 31.1(b).  Requests to issue a replacement panel sometimes meet with resistance and judicial intervention becomes necessary.

According to this memo, however, it appears that the Medical Unit is not reviewing the panel requests for accuracy and is shifting the burden of following the regulations to the parties.

For defense attorneys, this changes little – as always, we must remain vigilant to make sure a lung or psyche applicant does not get “evaluated” by a chiropractor.  So, as always, I am keeping my DoR forms loaded and my finger on the trigger!

Presently, I am trying to get a copy of the memo which has some letterhead or signature, and possibly a date, so that it carries with it some official weight.

As soon as your humble editor has one, so will you.  If anyone has an official copy, eternal gratitude will be yours if you could e-mail it to:  gregory.grinberg@htklaw.com.

In April of 2011, the Workers’ Compensation Appeals Board issued a firm rebuke to applicants’ attorneys and lien claimants all over the state:  “where unauthorized treatment is obtained outside a validly established and properly noticed MPN, reports from the non-MPN doctors are inadmissible, and therefore may not be relied upon, and … defendant is not liable for the cost of the non-MPN reports.”  (Valdez v. Warehouse Demo Services).

The advantages of setting up a Medical Provider Network are many, some of which are discussed here.  In particular, under Labor Code § 4616 insurers and self-insured employers can set up networks of medical providers, and all treatment must be received from one of the providers in the network.

In Valdez, applicant was provided treatment within the insurer’s MPN for an admitted injury.  After a month of such treatment, applicant began receiving treatment from a doctor outside of the insurer’s MPN at the behest of her attorney.  Apparently this was because the MPN doctor’s treatments were not helping her, yet she never contacted the insurer to find a different doctor within the MPN.

The WCJ awarded additional temporary disability, relying on the report of the non-MPN doctor.  The WCJ further allowed a lien from the Employment Development Department for the TD period.

In response to defendant’s petition for reconsideration, the WCAB held that the law was the law, and absent a situation in which defendant refuses to provide medical treatment “that is reasonably required to cure or relieve the injured worker from the effects of his or her injury”, the MPN stands.

But then the WCAB blinked, and now we have the NEW Valdez opinion.  On July 14, the WCAB issued a new en banc opinion, calling for more time to study the issues of the Valdez case.  Hopefully the new opinion will not “fix” what isn’t broken.

As soon as your humble blogger knows more, so shall you.  In the meantime, I would hope for the best.