THE BURDEN OF PROOF ON MEDICAL-LEGAL COSTS
In
Colamonico v. Secure Transportation (2019), Med-Legal LLC submitted copy service bills in 2014 which were reviewed and paid late with an Explanation of Benefits. Med-Legal sought the remaining balance at a lien trial, with the Judge deciding any objections not expressly noted in the EOBs were deemed to be waived, and ordered payment of the remaining balance plus penalty and interest.
On reconsideration, the WCAB held in a binding en banc decision that:
1) A medical-legal provider has the initial burden to prove that their services were reasonably incurred in connection with a contested claim (LC 4620 and 4621);
2) Defense objections not noted in an EOB are not deemed waived; and
3) The lien claimants' reliance on LC 4601.5 (pay 100% unless an objection is filed within 60 days) was moot since LC 4601.5 was repealed in 1984.
[COMMENT: The case confirms that med-legal providers need to do more than just present their bills, they must also prove the services were both timely and legally appropriate, and only thereafter is the cost then addressed.]
