established lien units, specifically to
deal with liens, an appellate court has
given some guidelines as to
interpretation of Labor Code section
4628 in dealing with those liens.
V. W.C.A.B.
was really an anti-ghostwriting
statute. The statute was for the
purpose of controlling the quality of
the report. The statute enumerates the
responsibilities of the signing doctor.
Subdivision (d) the Court indicated
does not limit or regulate the amount
of legitimate fees a doctor or clinic
can charge.
opinion gave some guidelines as to
what is discoverable from the entity
involved. Defendants do not have an
unfettered access to business records.
AMERI-MED V. W.C.A.B .......... 1
of relevant and unprivileged
information mat will assist them in
determining the medical services
performed by the physician, the
amount of direct charges for me
physician's professional services, and
the amount of costs related for related
medical tests, clerical expenses and
overhead."
indicated that "...the statute merely
limits the types of charges that can be
reimbursed; it does not limit the
amount of the charges that can be
billed." Nothing in 4628 (d) limits
what can be charged and does not
restrict a clinics ability to make a
profit. It is up to the Board to
determine what constitutes reasonable
charges by factors such as those
enumerated in Gould v. WCAB.
sections 4621,4622, 5307.1, and 5307.6
are the appropriate sections for the
defendant to raise to challenge the
reasonableness of the medical-legal
charges. Once challenged, the clinic or
doctor must provide sufficient
justification by way of itemization
under sections 5307.1 and 5307.6.
be entitled to, the Court indicated
that defendants do not have an
unfettered right to books and records
regarding the clinics overall business
operation. The clinic does have a
privacy right in financial and
employment information unrelated to
the preparation of the report. Tax
returns are not discoverable.
and unprivileged information that will
assist them in determining (1) the
medical services performed by the
physician signing the report, (2) the
amount of direct charges for mat
physician's professional services, and
(3) the amount of the reasonable costs
for lab exams, diagnostic studies,
medical tests, and clerical expense
related to producing the report." It is
then up to the Board to determine
what is discoverable in order for
defendants to determine the
reasonableness of the charges.
Firm: SAMUELSEN, GONZALEZ,
VALENZUELA AND SORKOW
Phone: 310 831-0872
Address: 350 WEST FIFTH
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