MARIA MERCEDES SANCHEZ, Applicant
v.
PARCO, INC., permissibly self-insured, administered by CLAIM QUEST, INC., Defendants
No. ADJ9011724
California Workers Compensation Decisions
Workers’ Compensation Appeals Board State of California
September 1, 2021
Pomona
District Office
OPINION
AND DECISION AFTER RECONSIDERATION
KATHERINE A. ZALEWSKI, CHAIR
We
granted reconsideration in order to further study the factual
and legal issues in this case. This is our Opinion and
Decision After Reconsideration.
Applicant
seeks reconsideration of the Findings and Award and Order
(FA&O) issued by the workers’ compensation
administrative law judge (WCJ) on November 30, 2018. By the
FA&O, the WCJ found that cost petitioner, Marilyn Strada,
Ph.D., is entitled to payment for the late cancellation fee
of $750.00, as well as penalties, interest and
attorney’s fees. Applicant’s attorney was found
to be liable for payment to Dr. Strada.
Applicant
contends that she is not liable for Dr. Strada’s fee
because Dr. Strada did not object to defendant’s denial
of her invoice within 90 days. Applicant also contends that
defendant waived all objections to Dr. Strada’s billing
and is therefore liable for the late fee. Lastly, applicant
contends that the procedure in Labor Code[1] section 4622 only
applies to the provider and defendant, not applicant. (Lab.
Code, § 4622.)
We
received an answer from defendant. The WCJ issued a Report
and Recommendation on Petition for Reconsideration (Report)
recommending that we deny reconsideration.
We have
considered the allegations of applicant’s Petition for
Reconsideration, defendant’s answer and the contents of
the WCJ’s Report with respect thereto. Based on our
review of the record and for the reasons discussed below, we
will rescind the FA&O and issue a new decision finding
that defendant is liable for the outstanding amount of
$700.00 owed to Dr. Strada.
FACTUAL
BACKGROUND
Applicant
claimed injury to her shoulders, wrists, fingers, upper
extremities, elbows, forearms, psyche, headaches and sleep
through May 14, 2013 while employed as a finishing inspector
by Parco, Inc.
Satish
Lal, M.D. evaluated applicant as the orthopedic qualified
medical evaluator (QME). (Joint Exhibit J, QME reports of
Satish K. Lal, M.D.) In a supplemental report dated December
18, 2015, Dr. Lal stated that applicant’s attorney had
asked if he could evaluate applicant’s psyche, sleep
and headache. (Joint Exhibit J, QME report of Satish K. Lal,
M.D., December 18, 2015, p. 1.) Dr. Lal stated that he could
not evaluate these parts and recommended referral to a
psychologist and neurologist to evaluate these complaints.
(Id. at p. 2.)
On
March 30, 2016, applicant submitted a request to the Medical
Unit for additional QME panels in psychology and neurology.
(Defendant’s Exhibit F, Applicant’s
attorney’s panel request, March 30, 2016.) Defendant
sent a letter to the Medical Unit on April 11, 2016 objecting
to applicant’s request for additional panels in these
specialties. (Defendant’s Exhibit I, Defendant’s
Objection Regarding Applicant Attorney’s Second Attempt
in Request for Psychological and Neurological Panel
Physician, April 11, 2016.)
On
April 15, 2016, the Medical Unit issued panel number 1936501
in psychology and panel number 1936504 in neurology.
(Applicant’s Exhibit No. 6, Medical Unit’s Issued
psychology panel, April 15, 2016, p. 2; Applicant’s
Exhibit No. 7, Medical Unit’s Issued neurology panel,
April 15, 2016, p. 2.) Applicant sent a letter to defendant
on...
