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Lien claimant San Diego Imaging, Inc., dba California Imaging Solutions filed a lien for services rendered to Applicant Jose Abrego who claimed injuries while he was employed by Tri-State Employment who was insured by Lumbermen’s Underwriting.

It was undisputed that all dates of service of the lien were initially paid, in part, by Lumbermen’s Underwriting. When Lumbermen’s went into liquidation and CIGA took over the case, California Imaging re-submitted its bill of its alleged balance to CIGA.

A lien trial was set on August 14, 2023, and September 20, 2023 regarding the sole issue of the alleged balance of California Imaging’s lien.

California Imaging attempted to prove its claim for the balance of it’s lien with an unauthenticated, partial market survey. The Market Survey Analysis was identified as Lien Claimant Exhibit 10 at trial and objected to by Defendant for lack of foundation and as non-substantial evidence. It was however admitted into evidence over the Defendant’s objection.

California Imaging argued that it should be paid its lien balance, based solely on an in-house created Market Rate Analysis. In this case, Lumbermen’s paid the lien claimant’s bills in excess of the current fee schedule, which fee schedule was operative shortly thereafter on July 1, 2015. Lien claimant acknowledges receiving the EOB/EOR(s) statements for its invoices, within its objections to Lumbermen’s thereto.

California Imaging attached an Affidavit of Yvette Padilla to its Market Rate Analysis. Ms. Padilla is identified in California Imaging’s Petition for Reconsideration as its Collection Supervisor. The Affidavit of Ms. Padilla states that, “On January 30, 2020, I compiled the following report by retrieving data from California Imaging Solutions internal database. For convenience only the first 5 pages of the report are included, and the rest of the report is available upon request.” Thus, the Market Rate Analysis was an unauthenticated, incomplete document.

Also, California Imaging submitted its invoices, which did not include dates of service and detail multiple charges, fees and costs which were unexplained and incomprehensible. “Further, without a witness to authenticate its documentary evidence, Defendant is denied its due process right of cross-examination.”

On November 2, 2023 the WCJ found that lien claimant failed to meet its burden of proving that (1) it is entitled to an additional monetary payment from CIGA; and (2) its lien was reasonable and necessary. and ordered that lien claimant take nothing.

Reconsideration was denied, for the reasons stated in the WCJ Report, in the panel decision of Jose Abrego v Tri-State Employment -ADJ8995855-ADJ10748640-ADJ10749649 (January, 2024).

The court in Ashely Colamonico v. Secure Transportation (2019 Cal.Wrk.Comp.LEXIS 111; 84 Cal.Comp.Cases 1059)(en banc)) states that, “a lien claimant is required to establish that: 1) a contested claim existed at the time the expenses were incurred; 2) the expenses were incurred for the purpose of proving or disproving the contested claim; and 3) the expenses were reasonable and necessary at the time they were incurred.”

Pursuant to Labor Code §4620(a); §4621(a), the lien claimant must prove the medical-legal expense was reasonably, actually, and necessarily incurred [See §§3205.5, 5705; Colamonico, supra; Torres v. AJC Sandblasting (2012) 77 Cal.Comp.Cases 1113, 1115 [2012 Cal.Wrk.Comp. LEXIS 160] (Appeals Board en banc).

Any award, order or decision of the Appeals Board must be supported by substantial evidence in light of the entire record (Labor Code §5952(d); Lamb v. Workers’ Comp. Appeals Bd. (1974) 11 Cal.3d 274,280 [39 Cal.Comp.Cases 310]. It is more than a mere scintilla, and means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion – It must be reasonable in nature, credible, and of solid value (Braewood Convalescent Hospital v. Workers’ Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159,164 [48 Cal.Comp.Cases 566].

California Imaging’s Market Analysis was not substantial evidence, in light of the entire record. This is the only document that lien claimant relied upon to substantiate its alleged balance of $3,840.29. The lien claimant did not prove that its balance was reasonable or necessary.