Liens: A View From the Oxnard Board
Liens: View from the Oxnard Board
On March 6th, WorkCompCentral held a conference titled, “Liens: View from the Oxnard Boards,” in which featured panelists, such as Judges Glass and Carrero, discussed the moving of liens to the Oxnard board. The panelists also discussed various methods and procedures to keep the process efficient and timely in order to accommodate the move.
The judges plus the PJ at OXN simply have the expectation that the parties be ready. Readiness is two-pronged: it starts with evidence and documentation given by clients and on the back end is the reliance on quality, knowledge, and organization of the hearing representative. Due to the stress on preparation and readiness for all parties, the Oxnard boards may urge against any continuances. As all parties had notice and calendared the hearing months before, adjournments are the instated policy for the OXN board, as discovery should have been completed or requested as applicable. If a party files for a DOR, the party is saying, under penalty of perjury, that they are ready to go forward, unless the “Discovery” box is marked in that DOR and the party has made a documented effort to get that discovery prior to the DOR.
Referral for Treatment
The biggest issue and initial stumbling block that lien claimants fail is with the Referral for Treatment. Although for years, it was referred to as a “4600 letter,” it is actually LC4603.2. That is a threshold issue that the Doctor actually was the treating doctor. Parties need to have the documentation that connects the dots on how the applicant got to Dr. X, the referral to the ancillary providers, etc. It boils down to having the necessary evidence to carry the lien claimant’s burden of proof.
Bill Review Evidence
It is prudent to have a bill review prepared, as evidence of reasonable value, and the board will likely take your bill review into evidence. However, the weight it is given varies. If it is done by a certified, independent reviewer, the bill review will likely be given more weight than an internal person that only reviews the bills of the provider. At OXN, the policy that they have undertaken is that there is only one OMFS, so if there are two bill reviews and they are using reports, cascading, or doing all the proper BR protocols, the bill reviews should come out pretty much the same.
Pre-Prepared Exhibit Sheets and AOE/COE Issues
Be sure that the evidence listed in the pre-prepared exhibit sheets is relevant and actual evidence. The OMFS is not evidence, neither is the ACOEM guidelines, or the dictionary definition of “surgery” or case law; these are simply authorities. If there is an AOE/COE issue on a specific claim of injury, then the applicant must testify. A CT claim injury can be proven up with medical evidence as that is a medical issue; however, a specific injury becomes a factual issue that requires the testimony of the applicant or witness. A deposition transcript will not be taken as evidence as it is usually only used to impeach a witness.
Preparation and readiness is integral to ensuring that the new OXN system will proceed efficiently, for all parties involved. If files are not prepared with the complete and proper documentation, then the expectation of good results in Oxnard, and anywhere for the most part, is a fallacy. Parties involved in litigation can litigate and negotiate good results at the Workers’ Compensation Appeals Board based on issues, but the tools that are necessary to do so effectively lie in the information that is given.