In this unpublished decision, the WCAB had denied payment of a lien filed by the company that had prepared a life care plan originally obtained for purposes of settling a workers' compensation case involving a catastrophically injured employee.
The case, however, ultimately was resolved by stipulations and was not settled.
The lienclaimant had argued that despite this being a stipulated award, there was
"...an unsettled and unevaluated claim
which, due to the catastrophic nature of the injury, would lend itself to a structured
settlement making the Complex Life Care Plan, which petitioner prepared at the request
of applicant's attorney, a report which was reasonably required to prove-up the value of
the future medical charges, including reconstructive surgery and skilled nursing care."
The appellate court first noted that Labor Code Section 4621(a)'s language states that an employee is entitled to "medical-legal expenses" which are "reasonably, actually, and necessarily incurred."
It then quoted the operative language of the statute defining "medical-legal expenses" as:
"... any costs and expenses incurred by or on behalf of any party ... for... medical reports... for the purpose of proving or disproving a contested claim."
The court pointed out that, since the case resulted in a stipulated award for 100% disability and medical care, there was no "contested claim" here.
As for the lienclaimant's contention that the report was "reasonably required to prove-up the value of
the future medical charges," the court found no such legal support that the report was "required or necessary" in the proceedings since there was no evidence that potential future medical expenses was ever a contested issue.
It therefore concluded that the WCAB "reasonably denied the lien within its discretionary powers."
The case is California Nurse Life Care Planning v. WCAB.
To read the full opinion,
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