When was the Last Time a Chiropractor Paid You?
Not only has PKNW successfully defended against payment of chiropractic liens but has also obtained Labor Code section 5813 sanctions and attorney fees against a lien claimant for what the trial judge found to be a violation of Rule 10561 for a meritless claim.
The injured worker sustained a knee injury in the course of her usual and customary job as a field laborer. The initial diagnosis was knee strain with the PTP making a referral to the in-house chiropractor. UR recommended non-certification on two grounds: 1) ACOEM guidelines did not validate application of chiropractic care for a knee strain; and, 2) a chiropractor could not act as a licensed physical therapist in the State of California.
Even though denied, the chiropractor administered 158 chiropractic treatments over the next year eventually filing a lien for $15,083.00.
During the course of the chiropractic involvement, the defense was able to have applicant evaluated by an orthopedic surgeon who, after a clinical examination and an MRI, performed arthroscopic surgery to repair a tear of the medial meniscus.
In deposition, the injured worker testified to telling the chiropractor that his treatments were not helping but she was told she had to continue for her “case to keep going.”
Applicant proceeded through the medical-legal process with the AME agreeing with the UR opinion that physical therapy is seldom recommended for a knee strain concluding that “… ten and one-half months of chiropractic care only served to delay the indicated orthopedic treatment.”
The AME report and the deposition transcript were served on the chiropractor with the chiropractor rejecting a demand that the lien be withdrawn.
At the Mandatory Settlement Conference, the chiropractor rejected a settlement offer which prompted the trial judge to order the chiropractor to appear to explain why the lien was not meritless and why his refusal to settle was not a frivolous, bad faith tactic subject to sanctions. The order to appear was ignored with the trial judge ultimately found the filing of the lien to be sanctionable, entitling defendants to attorney fees for having to defend the lien.
As we all know, Labor Code section 5813(a) is the authority for obtaining costs and attorney fees “… incurred by another party as a result of bad-faith actions or tactics that are frivolous or solely intended to cause unnecessary delay.” 8 CCR 10561(b)(6)(A) specifically defines a bad faith action or tactic as bringing a claim that is indisputably without merit.
The trial judge applied these laws in finding the lien to be without merit which resulted in the chiropractor paying defendant’s attorney fees and sanctions to the General Fund. Therefore, these sections should be kept in mind as they can be key in turning the tables on unreasonable treatment liens and result in you getting paid rather than the other way around.