Koutal v. Bernini, Inc. (2024 Cal. Wrk. Comp. P.D. LEXIS 37)

The WCAB held that medical-legal providers seeking reimbursement have a dual remedy available to them.

The provider may file a lien pursuant to LC §4900 et seq, or may file a petition for reimbursement of medical-legal expenses pursuant to CCR §10786(b).

CCR §10786(b) applies when a defendant disputes payment for any reason other than the amount to be paid pursuant to the fee schedules in effect on the date of service .

The WCAB added that if a provider chooses to file a petition pursuant to CCR §10786(b), it has the initial burden of proof that: (1) a contested claim existed at the time the expenses were incurred, and that the expenses were incurred for the purpose of proving or disproving a contested claim pursuant to LC §4620; and (2) its medical-legal services were reasonably, actually and necessarily incurred pursuant to LC §4621(a).