Workers’ Compensation · Primary-source case analysis
Colamonico: The Medical-Legal Provider Bears the Initial Burden of Proof
Decision: Colamonico v. Secure Transp., No. ADJ9542328 (WCAB Nov. 14, 2019) (en banc).
Colamonico allocates the proof burdens in a medical-legal lien dispute and separates payment-review requirements from the provider’s threshold entitlement to reimbursement.
Copy-service lien after a claimed injury
Ashley Colamonico claimed industrial injury to her spine and internal organs while working as a driver. A copy-service provider issued subpoenas and invoices for records requested in the claim. Years later, the defendant issued explanations of review, and the dispute proceeded to a lien trial over necessity, value, penalty, and interest.
The provider’s two-part initial showing
The Board held that the provider must first prove that a contested claim existed when the expense was incurred and that the expense was incurred to prove or disprove that contested claim under section 4620. It must also prove the services were reasonably, actually, and necessarily incurred under section 4621(a).
An EOR omission does not waive threshold objections
The defendant did not waive sections 4620 and 4621 objections merely by failing to state them in an explanation of review under section 4622. The Board rejected application of the waiver holding in Otis v. City of Los Angeles (1980) 45 Cal.Comp.Cases 1132 to the later statutory framework. It also disagreed with panel decisions applying that older rule. This did not authorize silence without consequences: Delayed objections can still expose a defendant to penalties, interest or sanctions where the applicable requirements are met. Colamonico, slip opinion, pages 6–8.
Disposition
Because the trial ruling did not apply the burden framework announced in the en banc decision, the WCAB rescinded the findings and orders and returned the matter for further proceedings. The ruling preserved an unchallenged penalty-and-interest determination for specified invoices.
Key takeaways
- A provider must prove a contested claim existed when services were incurred.
- The services must help prove or disprove that claim.
- Reasonable, actual, and necessary incurrence is a separate element.
- Not every omitted EOR objection is waived.
Review California Medical-Legal Lien Records
Mishra X Trial Lawyers reviews medical-legal lien disputes, contested claim records, and explanations of review for California workers’ compensation matters. Bring billing invoices, itemized subpoenas, proof of service, explanations of review, and trial exhibit records. Call (949) 343-9735 or email office@mishrax.com.