Pre-injury liens? (California) (California)

The filing and enforcement of liens (different states refer to these with different terms) to secure payment for services or goods against a workers' compensation award is complex and filled with special rules - this category is for questions and discussion of this special area of work comp law.

Re: Pre-injury liens? (California) (California)

Postby jpod on Wed Dec 15, 2010 2:25 pm

York I agree with all you said. I had recognized the lien claimant was the health insurer not the PTP/PCP. If I were Ozzie I would go and get not only the chart notes but the insurance paperwork filed by the PCP with the lien claimant insurer and either move to have the DOI changed under LC 5412 or go after the PCP who knowingly treated a WC injury without reporting it as required.

Years ago there was a case, I can't cite it, but the patient had told the PCP that he injured himself off work b/c "he did not want to hassle with WC". But it turned out his injury became much more serious and he changed his mind and decided he wanted to file for WC. The appellate court was not swayed. Much like the recent query posted by Rose the other day the appellate court ruled the employee had made his bed and he had to lie in it; that his admission he had lied to his PCP had damaged his credibility and no court could fairly determine if the claimant was lying when he told his PCP it happened outside of work or lying now when he recanted his previously story and claimed it had occurred at work. The court barred the WC claim.

With many orthopedic CT claims a patient can forget, or not put together how work may have caused or contributed to injury. But it seems less likely with a psyche claim although I am sure there are some situations where it could happen. But if the topic was "my supervisor is driving me crazy" it would seem hard for a PCP to be unaware of the nexus to work and therefore the doctor would have violated the law and an E&O coverage claim may be in order. Ozzie's client would still owe the insurer lien claimant but might be able to go after the PCP for negligence in failing to report when there was a duty to report. Or the records may show that Ozzie's client is not the right client after all b/c under 5412 the DOI is much earlier than previously believed.
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