Per the recent decision issued in Hunter v. ACR Systems, Inc./Zenith Ins. Co., ADJ882004 (VNO), Feb. 2, 2026, Decision After Reconsideration, a gentle reminder of the standards for Lien Claimants to rebut and bill in excess of the Official Medical Fee Schedule, or OMFS.

While the case in chief in this matter is not of any particular note or consequence to this discussion, this claim was filed by a Secretary on 02/24/1997 alleging injury in the form of Fibromyalgia. The claim was originally denied and then later found to be compensable.

The applicant had been treated by two different doctors who filed liens claims. The WCJ (Worker’s Compensation Judge), found that the defendants had satisfied all liens properly by previous payment at the OMFS rate.

The lien claimants then filed a Petition for Reconsideration, citing three primary issues for their Petition. Lien claimants asserted that the defendant’s 12 year delay in payment of the lien claimants’ billing was evidence that the doctors had treated on what was essentially a denied claim; the application of OMFS as the maximum level of reimbursement for services provided; the trial judge erred in ruling on whether the lien claimants had been paid by defendant was beyond the scope of the issues submitted at trial.

It was determined that the Lien Claimants had not met their burden of demonstrating, to a preponderance of the evidence, the existence of “extraordinary circumstances related to the unusual nature of the services rendered” to allow award of fees in excess of the OMFS.

The Panel determined that the 12 year delay in payment was evidence of a denial in compensability, and that lien claimants had failed to provide evidence to the contrary. The delay did not constitute extraordinary circumstances nor relate to unusual services provided. A stipulation that the treatment was reasonable and necessary was not sufficient as the record did not reflect extraordinary circumstances or unusual services being necessary.

It was also noted that the education and experience of the providers did not constitute evidence of an extraordinary circumstance.

The Panel did rule that the lien claimants were correct in their argument that the issue of whether payment was actually made, was beyond the scope of the lien trial. This issue was therefore deferred to be adjusted by the parties informally and returned to the trial level in the event of further dispute.

Suffice it to say, that a bulk of the panel’s rationale was contingent on whether the services provided by a lien claimant were unusual in nature and related to an extraordinary circumstance. By default, if a claim is denied, then a provider is entitled to their usual and customary charges when treating injured workers. In the instance where the claim is not denied, regardless of a delay in payment, if the treatment is not unusual in nature and due to an extraordinary circumstance.

This decision does not on its face lend to a better understanding of what does fall under these categories, but it does help to clarify what does not constitute an exception to the OMFS rate for lien claimants.