WCAB requires proof of service or other evidence to show defendant served EORs timely and complied with Labor Code §4622(a)(1)


In the Opinion and Decision After Reconsideration in the case of Vasquez v. Aura Systems, ADJ8641717; ADJ9729149, (April 29. 2020), lien claimant Med-Legal sought reconsideration of the Joint Findings and Award (F&A) issued by the workers' compensation administrative law judge (WCJ) on January 22, 2019. Lien claimant contended it was due the full amount of all its bills, less payments already made, plus "interest and increase." At trial, the defendant submitted its explanations of review (“EORs”) without a proof of service. Lien claimant argued defendant's EORs were not compliant with Labor Code sections 4622 and 4603.3 and, thus, defective. Due to the defective EORs, lien claimant argued that it was not required to follow "Non-IBR Determination Process." Lastly, due to the defective EORs, lien claimant argued defendant waived all objections to its billing.
The WCAB noted a defendant has 60 days to review and analyze a medical-legal bill or invoice.  If a defendant does not pay a proper medical-legal invoice in full and fails to provide an EOR within the 60-day window, then a defendant has waived all objections, other than compliance with sections 4620 and 4621, to the medical-legal provider's billing. Since defendant submitted its EORs at trial without a proof of the date of service its exhibit at trial containing the EORs did not establish when defendant served the EORs. Consequently, it was unclear whether defendant responded with its EORs within the 60-day window required by Labor Code Section 4622(a)(1).  The WCAB noted defendant’s compliance with the law may not be clear without a proof of service and without the proofs of service or other evidence, defendant did not meet its burden of proof that it timely objected to lien claimant's invoices pursuant to section 4622(a)(1).

To request a copy of the opinion please email:

« Back to News