4060 (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: 4060 (California)

Postby steve appell on Tue Jan 04, 2011 3:05 pm

Court:
The quality of our help can only be as good as the info you provide us with. Since you first said "the adjuster put no pay" and then you said "she really didnt stamp the billing no pay, she just did not authorize payment", I have to wonder what else about your scenerio is not really correct/accurate/factual/the truth?

So we can provide you the best possible advice, please restate your question so all info you provide is correct the first time.
Steve

appellandassociates.com
6311 Van Nuys Bl #480
Van Nuys, Ca 91401
wcexaminer@aol.com


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Re: 4060 (California)

Postby gaiassoul1@yahoo.com on Tue Jan 04, 2011 4:33 pm

^^^touche..what is the reaosn the examiner is refusing to pay --- exactly?

what if the parties go to an AME regarding causation and the AME finds injury and in his reports states that treatment rendered was reasonable and necessary ? isnt the carrier supposed to start paying once the issue of causation is resolved?


AMEs nor SPQME cannot find an injury to be compensable, they can say for instance that it appears to be compensable and the mechanics of injury support a type of injury. However, if you have a false and inaccurate history, then the AME's statements are naked, no substantiality ---

Only a WCAB trier of fact can determine if an injury is compensable unless the parties stipulate to all of the findings in the AME reporting.

That bologna statement that some AMEs use that the prior treatment was all reaonable and necessary --- another meaningless conclusiion --- AMEs must present substantial evidence to support the treatment, AMEs say a lot of thing, what stands up in court is what they lay a foundation for and most don't bother or their bills to the carriers would be at least triple.

Evidence, no matter what must be substantial - that means you just don't make a statement, you support it.
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Re: 4060 (California)

Postby courtmechanic on Thu Jan 06, 2011 12:53 pm

well when i contacted the bill review they stated that the adjuster did not authorize payment i have nothing from the carrier.
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Re: 4060 (California)

Postby gaiassoul1@yahoo.com on Thu Jan 06, 2011 1:08 pm

They have codes on the bottom of any bill review as to why payment is not issuing.

Having worked in liens for way too long, can't imagine it, had 100s of examiners willing to vent everyday why they were not paying.
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Re: 4060 (California)

Postby courtmechanic on Thu Jan 06, 2011 1:52 pm

just the usual amount billed in excess of OMSF
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Re: 4060 (California)

Postby gaiassoul1@yahoo.com on Thu Jan 06, 2011 3:43 pm

Demand the medical reporting, that should clear it up
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Re: 4060 (California) (California)

Postby courtmechanic on Mon Jan 10, 2011 11:14 am

can someone please tell what 4060 subdivision (A) means and how it applies
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Re: 4060 (California)

Postby courtmechanic on Mon Jan 10, 2011 1:29 pm

can anyone explain 4060 subdivion (a)
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Re: 4060 (California)

Postby gaiassoul1@yahoo.com on Mon Jan 10, 2011 3:08 pm

(a) This section shall apply to disputes over the
compensability of any injury. This section shall not apply where
injury to any part or parts of the body is accepted as compensable by
the employer.


not sure what you need explained or what you don't understand -- so with no context here goes -- next time, I would post some context so it is easier to answer your questions.

The applicant or defense is entitled to a Labor Code Section 4060 evaluation when a claim is TOTALLY denied, no admitted body parts, flat out denied.

The procedure for securing such an evaluation is outlined in LC 4062.2 and calls for a written attempt by either party to agree to an AME to resolve such a dispute and if no response to the attempt to agree after 20 days, then the party who wants a medical-legal examination requests a state QME panel using QME form 106 if represented.

The boxes on that form identify you cannot request a LC section 4060 evaluation if the whole claim is not denied. Then it would be a LC 4061 or LC 4062 medical-legal evaluation.
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Re: 4060 (California)

Postby gaiassoul1@yahoo.com on Mon Jan 10, 2011 3:13 pm

I guess I should have added in the context of your prior posts, the parties are not allowed to secure their own medical-legal reporting for dates of injury after 1/1/05. There is no such thing as a self-procurred medical legal.

The parties have two choices agree to an AME or get a panel. If your doctor can't link himself through a joint letter or a panel # as assigned by the medical unit, he/she is NOT a medical-legal reporter for dates of injury after 1/1/05

Everything referred by the primary treating physician is treatment by a consulting physician. Further, until the primary treating physician, reviews adopts and incorporates any consulting physician report, the consulting physician reporting is not admissible or payable.
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