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ALL FORUM'S TOPICS OR LIENS TOPICS [ REFRESH ]
Thread Title: 4603.2(B)
Created On Friday January 30, 2009 3:24 PM


rider001
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Friday January 30, 2009 3:24 PM

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I was wondering if anyone has had any luck arguing that and objection is invlaid unless it specifies why it is being objected to and the remedies available such as the right to file a lien? Any thoughts or case law.

4603.2
(B) Advises, in the manner prescribed by the administrative
director, the physician, or another provider of the items being
contested, the reasons for contesting these items, and the remedies
available to the physician or the other provider if he or she
disagrees. In the case of an itemization that includes services
provided by a hospital, outpatient surgery center, or independent
diagnostic facility, advice that a request has been made for an audit
of the itemization shall satisfy the requirements of this paragraph.

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davidd
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Friday January 30, 2009 3:32 PM

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See Kunz vs. Patterson Floor Coverings (2002) 67 Cal.Comp.Cases 1588

Based on our review of the relevant statutes, regulations, and case law, we conclude:
(1) under section 4603.2, a defendant's failure to specifically object to a medical treatment lien claim on the basis of reasonable medical necessity (or on any other basis) does not effect a waiver of that objection; (2) the provisions of section 4603.2 do not apply unless the prerequisites to the section's application have been met, i.e., the medical treatment in question must have been "provided or authorized by the treating physician selected by the employee or designated by the employer [pursuant to section 4600]" and the medical provider's billing to the defendant must have been "properly documented" with an "itemized billing, together with any required reports and any written authorization for services that may have been received;"

There may be more. I just did a very quick look at 4603.2 on the main WCC site where many sections have cases appended.

-------------------------
 David DePaolo
President, Editor in Chief
www.workcompcentral.com

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ymcgavin@socal.rr.com
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Friday January 30, 2009 5:28 PM

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Hi Rider,

I have prevailed when the IC/TPA failed to inform the lien claimant of the remedies available, if the lien claimant disagrees with the denial of reimbursement.

Although 99 44/100% of objection letters have the proper canned language that comports with ADR 9792.5(d)(4), once in a while I still come across an objection where the IC/TPA has failed to include this mandated language.

An interesting conundrum arises when one seeks the 15% statutory increase (commonly but incorrectly called a penalty) under LC 4603.2 due to the failure of the IC/TPA to comply with ADR 9792.5(d)(4). This is because the statutory increase of 15%, allowed by LC 4603.2, as amended by SB 228, stands in stark contrast to the 10% increase (not interest) allowed under ADR 9792.5(b).

The conflict is due to the fact the last time the language in ADR 9792.5 was amended was in 2002, way prior to the amendment of LC 4603.2, effective 1/1/04 --- and LC 4603.2 was amended once again, effective 7/1/06, doing away with the $100.00 lien filing fee required by former LC 4903.05, as well as reimbursement for repayment of the lien filing fee, as LC 4603.2 allowed from 1/1/04 through 7/1/06.

(As I get closer to my goal of being totally out of the CA comp system, I wish that someone would insert a flash-stick in my ear, then do a cut and paste from my brain to the flash-stick, so as to remove all this comp trivia from my brain --- which would free up a lot of space on the hard drive in-between my ears.)

York McGavin
ymcgavin@socal.rr.com

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rider001
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Friday January 30, 2009 11:33 PM

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PC or Mac? Any time your available.

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davidd
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Saturday January 31, 2009 5:30 AM

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Sorry York - nice try, but you will not be able to divest your brain of WC trivia.

See Organic Computing

Once in comp, always in comp. You can not leave. We take all prisoners!

-------------------------
 David DePaolo
President, Editor in Chief
www.workcompcentral.com

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TOBDNCNG@aol.com
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Saturday January 31, 2009 7:23 AM

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That is pretty cool info David. Thanks for the link.

I think York will have to stick around, since he has so much knowledge. I hope he will because I learn so much from him.

Glowing,

Marygrace~

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rider001
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Tuesday February 03, 2009 2:00 PM

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(2) Notwithstanding paragraph (1), if the employer is a
governmental entity, payment for medical treatment provided or
authorized by the treating physician selected by the employee or
designated by the employer shall be made within 60 working days after
receipt of each separate itemization, together with any required
reports and any written authorization for services that may have been
received by the physician.

Would this paragraph apply to governmental state ran insurance companies such as State Fund or just those claims for which the IW worked for a governamental entity?

Receiving a bunch of denials that are post SOL calculated at 30 working days.

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Jpod
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Thursday February 12, 2009 2:42 PM

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York I think you (and your brain) will be beter off building new pathways (neuron pathways) rather that trying to reuse the old comp pathways. You'll end up with a bigger CPU....

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