*1 Dist., B056619. Second Div. Four. Mar. [No. 1992.] GOULD, Petitioner, SAM C. BOARD, OF LOS
WORKERS’ COMPENSATION APPEALS CITY al., ANGELES et Respondents.
Counsel
Kathe R. Moore and Satzman Barry for Petitioner. Click, Kumetz, Katznelson,
Kumetz & Fred J. Steven N. Catherine I. Gregory Hanson and M. Abrams as Amici Curiae on behalf Petitioner. Hahn, Kuehn, James K. Garrett Attorney, City Attorney, Assistant Unruh, Robert M. Deputy City Attorney, for Respondents.
Haworth, Bradshaw & C. Gordon Mullen & William Chaney, Taylor, Filippi, Aceituno, J. Armstrong, Thomas Allen Jeanlaurie Ainsworth and Bruce C. Wood as Amici Curiae behalf on of Respondents.
Opinion (A. M.), WOODS P. J.Joseph Mayo and Allebe sustained Christopher *4 industrial psychiatric injuries their officers during employment police of City Angeles Los and obtained treatment (City) from psychiatric Gould, M.D., Sam C. petitioner, West Los Angeles.
The issue presented is whether a of the physician who excess official medical fee schedule must make a cir- showing “extraordinary of cumstances” order to that fee. We conclude he justify does not set forth factors which considered whether fees excess determining of the fee schedule are reasonable. 5307.1,
Pursuant to Labor Code section the Administrative Director of the (now Division of Industrial Accidents the Division of Workers’ Compensa- tion) an official adopted medical fee schedule unit values for containing 8, 4.5, specified procedures. (Cal. Code tit. Regs., ch. 9791.1 § [rule 4.5, In 9791.1].) California Code of Regulations, title section 9792 chapter (rule 9792), conversion are factors When the unit values a specified. specified procedure, such as are psychotherapy, multiplied by conversion factor for the pertinent section of the the administrative director’s recommended fee is obtained. Labor Code section Although 5307.1 provides that the schedule shall be revised “no less than frequently biennially,” schedule and rule were last amended in 1987.
The fee for a 45- to 50-minute session under the schedule psychotherapy 9792; $98.40.1 (Rules Institute, currently 9791.1 & Cal. Workers’ Comp. Schedule, Official 20.) Medical Fee Dr. Gould evidence that he presented should receive a fee because he higher has extensive experience treating Gould, 1 In when Mayo began Officer receiving treatment from Dr. the fee 45- psychotherapy 50-minute (Former $93.60. session under the schedule was Cal. Admin. Code, 4.5, 9791.1, 9792; tit. ch. Register Former Cal. Admin. Register, §§ Notice tit. No. than much more officers, charge Angeles Los West psychiatrists police Angeles Los West session, business doing of and the cost per $98.40 Compensation Workers’ Respondent fee be allowed. that a higher requires evidence did not present that Dr. Gould (WCAB) concluded Board Appeals he is fee and higher justify that would circumstances extraordinary the WCAB’s We conclude the schedule. the fee under limited to therefore showing in that a 5307.1 Code section with Labor is inconsistent analysis therefore annul We will is not required. WCAB. to the remand the matters WCAB’s decisions
Facts (1979) MON 17367 7,1979, Angeles of Los City Mayo On March (WCJ) judge 17367), the workers’ compensation MON (hereafter No. 77 in 30.5 percent resulted injury psychiatric Officer industrial Mayo’s found Dr. Gould medical treatment. need for further and the disability permanent May May from Mayo to Officer treatment psychiatric provided MON 19, 1984, (1984) 82 Angeles in Allebe v. of Los On January had Officer Allebe 51280), the WCAB found (hereafter No. 82 MON to April the 1968 injury during psychiatric sustained a cumulative industrial subsequently by City. parties of his employment period *5 On May medical treatment. in the need for that the resulted injury stipulated 8, 1984, to the stipu- treatment pursuant the WCJ awarded further medical he Thereafter, which filed application Officer Allebe a second lation. .in during injury he cumulative industrial psychiatric that sustained alleged 1, 1982, 9, 1989, officer as a police of his employment to March May period (WCAB, MON 122192 (Allebe of Los 89 City. City Angeles [hereafter Officer treatment to 122192].) MON Dr. Gould provided psychiatric No. 89 from to March Allebe 1988 September and with Mayo psychotherapy
Dr. Officers Allebe and provided Gould each listing itemized statements medication and submitted psychotropic cases, $125 billed at In Officer Dr. Gould session. Allebe’s psychotherapy In Officer $150 at session. per session 1989 and thereafter billed per through case, however, $125 session.3 at consistently per Dr. Gould billed Mayo’s fees charging did a written for explanation Dr. Gould not provide in the exceeded amount set forth schedule. Assn., 736.2.6.5, 736.2.6.5-736.2.6.6; Revision Register pp. No. Cal. Medical
p. (rev. ed.) 26.) Cal. Relative Value Studies 5th of the 1969 monitoring are not in issue. 2Charges providing for and medication customary fee for each usual and presented 3Dr. Gould unrebutted evidence that his evidence, 31, 1989, conflicting $125. was There is psychotherapy through session December however, after customary $150 fee per session was Dr. Gould’s usual and as whether Juñe and 82 MON 51280 on in Nos. 77 MON 17367 hearings At he has been psychiatrist testified he is a board-certified Dr. Gould He since 1972. in cases compensation workers’ treating injured employees 1,000 more than and has evaluated treated 300 to 400 officers police has officers. police he bills fee private patients he the same charges
Dr. Gould asserted it with discussing He arrived at his fee by industrially injured patients. considering Angeles and Los Angeles other West Los psychiatrists 31, 1987, the December his Since about running the cost of business. $150 individual per area has been fee average charged by psychiatrists $125 he session charged per session. Dr. Gould testified psychotherapy He was late $150 session. charged through subsequently per his fee. raising in Los and West Angeles
Dr. that the cost of treatment explained Gould He treatment other areas. than the cost of Angeles generally greater Los in the the amount does not know of individual his area who any no evidence. City fee schedule. presented lien claims the WCJ allowed Dr. Gould’s testimony,
Based on Dr. Gould’s the hourly by City their The WCJ stated there was no entirety. proof area in which Dr. Gould prac- charged by treating psychiatrists The WCJ found Dr. tices were less than the amounts Dr. Gould. charged by services indicated the reasonable value of Dr. Gould’s testimony Gould’s $125 $150 was between session. per However, listed No. for reconsideration both cases.
City petitioned of its MON rather than 82 MON 51280 the caption No. *6 in the Allebe matter. petition 29, 1990, for reconsidera-
On the WCAB August granted City’s petitions Vega MON and MON on Relying tion Nos. 82 51280 77 Neffv. (1969) (in bank) McMurray Comp. 34 v. Workmen’s 333 Cal.Comp.Cases 81, (1971) that the Appeals Bd. 36 the WCAB concluded Cal.Comp.Cases fee of a showing official medical schedule should be used the absence “[i]n Dr. Gould of factors fees.” The WCAB stated extraordinary justifying higher no evidence and his presented testimony of extraordinary the and Los Angeles fee other West Los regarding average charged by $125 77 per since Dr. Gould billed at session sessions in in No. psychotherapy remand, $150 usual MON 17367. On the WCAB should determine whether was Dr. Gould’s and customary psychotherapy fee for a 45- to 50-minute individual session after 1989. facie reasonableness the prima did not rebut Angeles psychiatrists schedule. in both decision of the WCAB’s reconsideration
Dr. Gould petitioned MON 173673 Nos. “77 Gould listed Dr. petition, In the of his caption cases. and MON 122192. [sic]” MON in No. 89
Thereafter, City, between Allebe on stipulations based industrial a cumulative Allebe sustained that Officer the WCJ found 1989, 9, 1, 1982, of his period March during May injury psychiatric injuries industrial two cumulative that Officer Allebe’s by City, employment cumulative and that the second disability, in 47½ percent permanent resulted 1990, 23, On October medical treatment. in a need for further resulted injury to the stipulations. treatment pursuant further medical the WCJ awarded in Nos. 77 the WCAB reconsideration granted On November the WCAB January On MON and 82 MON 51280.4 the reasons The WCAB adopted its decisions both cases. affirmed prior that, on by relying concluded The WCAB further prior stated its decisions. City presented 5307.1 and rules 9791.1 Labor Code section title Regulations, California Code of facie case under former prima 4.5, were unreasonable that Dr. Gould’s section chapter and that Dr. Gould rate the schedule because exceeded the set forth they evidence in rebuttal. did not sufficient present Vega, supra, Cal.Comp.Cases under WCAB declared that Neff absent will exceeding not be allowed amounts he charged testimony circumstances. Because Dr. Gould’s extraordinary with the amount his usual and fee and that his fee is consistent customary was not evidence of fellow the same location charged by practitioners circumstances, did not that Dr. Gould the WCAB determined justify a sufficient under Labor Code section 5307.1 present explanation fee the scheduled rate. exceeding
Discussion Mayo in the Allebe and contends the WCAB’s decisions Dr. Gould language WCAB disregarded cases should be annulled because the and the WCAB’s rules. Labor Code section 5307.1 *7 1965, provided: amended in Labor Code section 5307.1 previously As an official hearings, adopt “The after may, administrative director public case, 4However, MON the WCAB listed No. 89 in the of the decision in the Allebe caption rather than No. 82 MON 51280. 122192 1965, 1513, 127, (Stats. 3587.) minimum medical fee p. schedule.” ch. § in Section 5307.1 was further amended The amendment changed the name of the schedule to the official medical fee schedule and stated the schedule was to be revised at least The amendment biannually. provided the schedule would be facie evidence of the reasonableness of fees prima for medical charged industrially injured services to The amend- employees. ment further that a fee in provided physician charge could excess of that reasonable, set forth in the schedule when the fee did exceed the was not fee, physician’s usual and was and accompanied by itemization explanation. 1976, 1017, 7, (Stats. 4596.) In ch. amended statute was § provide (Stats. that the schedule must be revised at least ch. biennially. 34-35.)5 pp. § Labor Code section 5307.1 currently as follows: provides pertinent part director, “(a)(1) The administrative after shall public hearings, adopt revise, frequently biennially, no less than fee an official medical schedule prima evidence which charged the reasonableness shall be facie of of fees medical Nothing (b) services this provided pursuant division. . . . [¶] prohibit this section shall provider a medical charging employer an or from carrier in excess those set on the fees of forth official fee reasonable, when accompanied by explanation; provided, itemization however, that in no event physician shall a her charge excess his or usual . . .” (Italics added.) fee. Vega, 333, 336-337,
In supra, the WCAB Cal.Comp.Cases Neff that, circumstances, stated absent extraordinary excess of the official minimum medical fee schedule In should not be allowed. an anesthesi- Neff ologist claimed he had rendered services he extraordinary provided because $112, anesthesia during an emergency. The a fee anesthesiologist requested of that set excess forth schedule. WCAB stated: “It should be indicates, emphasized that the Minimum Fee Schedule as its title speaks, terms of If mínimums. the physician’s services are under extraor- performed circumstances, dinary the schedule itself is amenable to appropriate adjust- ment. Perhaps matter before us good illustration. The appli- cant-physician’s fee determined strict adherence to the schedule was $82.50. a claim Upon services the carrier fact paid $99.00, $16.50 more than the schedule would have allowed. We make no as to ruling whether required petitioner these drcumstances was to make such an over-payment, since petitioner does not allege it overpaid applicant. However, these facts demonstrate that to the adjustments schedule can be 5Although section (Stats. 5307.1 was further amended in ch. § 2285-2286; pp. 54.5), Stats. ch. those amendments are not relevant to the § present case. *8 336-337, pp. at (34 Cal.Comp.Cases are made where appropriate.” and italics original.) should ordi- services emergency In the WCAB that fees for opined Neff schedule, be an increase otherwise because there would be under the
narily constitutionally required expe- impede that would litigation collateral their workers and employ- injured between adjudication disputes ditious Const., Cal. citing at (Neff supra, p. Vega, Cal.Comp.Cases ers. v. Const., XIV, XX, 4].)6 The WCAB declared: Cal. art. § former art. § [now rendering persons “In we note that and other passing applicant, services, If reason this remedy. applicant physician, are not without for any deems generally, specific the medical any group physicians, profession or Fee or deems fees allowed the Minimum Schedule to be inadequate, their for provide compensation schedule to them with insufficient generally services, [sic], time-consuming litiga- their remedies lie not with piece-meal Board, of the Division before with the Administrative Director tion this but him for Accidents an to through petition specific of Industrial appropriate Vega, (Neff Minimum Schedule itself.” general modifications to the Fee 337.) supra, 34 at Cal.Comp.Cases Bd.,
In McMurray Comp. supra, v. Workmen’s Appeals Cal.Comp.Cases 81, the decided to the according WCAB a should be reimbursed physician summary California official minimum medical fee schedule. editorial evidence, indicate if was introduced Compensation Cases does not what any, support to fee. higher Labor Mc- Code section 5307.1 was revised after and substantially Neff
Murray were decided. requirement Section 5307.1 has no express be a fee than greater circumstances must shown to justify set forth in inferred from the and no such requirement may that the present language requires of the statute. Section 5307.1 simply reasonable, charged fee be accompanied by explanation, itemization of a greater no than the The WCAB’s imposition usual fee. physician’s Constitution, XIV, pertinent part: Legislature “The 6 California article section 4 create, hereby system vested expressly plenary power complete with ... to and enforce legislation system A of workers’ compensation, appropriate complete of workers’ .... medical, hospital and other compensation surgical, includes . . . provision full for such injury; requisite remedial treatment as is to cure and the effects of industrial] relieve from [an provision coverage liability pay compensa full to or furnish adequate against for insurance tion; . and full provision regulating coverage aspects full in all its . . such insurance body all the provision vesting power, authority jurisdiction in an with administrative arising governmental under such requisite any dispute or matter functions determine accomplish legislation, legislation the end that substantial the administration of such shall of any cases without character justice expeditiously, inexpensively, all incumbrance »> *9 jus- the demonstrate that requirement physician with the fee is statute’s lesser tifying greater requirement inconsistent the fee be merely be shown to reasonable.
The Accidents Administrative Director of the Division of Industrial rules 9791.1 and to Labor Code section 5307.1. adopted implement Rule Fee Schedule the provides: adopted by 9791.1 “The Official Medical numbers, Administrative Director shall consist of the procedures, procedure instructions, unit are contained the 1974 descriptions, values as Edition, Studies, the Re- revision of 1969 California Relative Value Fifth vised, Institute reprinted by the California Workers’ Compensation thereto, time time 1982 and and as be from to successive supplements the hearing.” modified Administrative Director following public the use of Rule “The fee is determined part: pertinent of these Official Medical Fee Schedule as defined Section 9791.1 factors rules. For services on after the conversion provided July to be to unit in the Schedule are as follows: applied values Fee
“Determination of $6.15 “Medicine Section fee, “The conversion establish the which shall facie prima factors be evidence An be excess of employer may charged of reasonableness. fees reasonable, Schedule, those set when forth Official Medical Fee however, accompanied by provided, itemization no explanation; event shall be in of his her fee.” physician’s charge excess usual
The introduction to the revision the revised fifth edition of the of (hereinafter 1969 California Relative Revision Value Studies the 1974 of CRVS) “Since unit values and rules explains: accompanying ground reflect medians of California charges by they necessarily do not physicians, reflect the of charges pattern charges individual nor the any physician Assn., any specific (Cal. area Medical Revision of of California.” CRVS, added.) second The p. italics introduction further states: “Individ- ual are physicians establish their for individual services encouraged service, in accordance with their own estimates of the value of the the time spent, materials used and the own particular practices. economics of their fees, Value Relative it Studies not a schedule nor should however, construed as such. It as a may, ‘guide’ by be used physicians fees, assist them as unit values expressed since the relativities establishing that are procedures variations in for those average statewide reflect added.) along listed with a at third italics (Id. relative value.” *10 the 1974 Revision of The official medical of fee schedule is a combination Because rule 9791.1 CRVS and the in rule 9792. conversion factors listed Revision based on the 1974 provides that the official medical fee schedule is CRVS, in to the latter of the the introduction WCAB should consider is schedule reasonable. fee in excess the determining whether a of charged fee similar to fees a charged Evidence that has physician practices in area in which the physician the same service the geographical The introduc in mean the fee is reasonable. does not itself physician’s indicates, however, of that the economics tion the of CRVS to 1974 Revision geo in the general of pattern own the physician’s practice are relevant to a determina in which practices area the graphical physician (Cf. Line v. Peters Truck tion of whether the fee is reasonable. physician’s deter 1319 Comp.Appeals (1982) Cal.Comp.Cases [WCAB Workers’ Bd. 47 were they fees reasonable because mined items were hospital pharmacy geographical similar to area].) stances, same charges by hospital general other pharmacies circum of extraordinary Because the evidence WCAB required he why to it did not Gould’s evidence as consider Dr. adequately fees in excess the schedule. charged Vega,supra, We 34 Cal.Comp. with the conclusion disagree Neff 337, in workers’
Cases at page litigation regarding physicians’ matters the provision be inconsistent with constitutional compensation may California on which the Constitution, is based. system Although workers’ compensation XIV, mat compensation article section states that workers’ industrially it that the ters should be resolved also states expeditiously, worker treatment to cure injured necessary should all medical provided be and relieve the worker the effects the and that substantial injury from Code, 4600.)7 justice (Also should see be Lab. accomplished. § (See An medical care. industrially injured worker is entitled to quality (1983) Comp. Braewood Bd. 34 Hospital Appeals Convalescent v. Workers’ Code . . which is provides pertinent part: 7Labor section “Medical. . . treatment. 4600 reasonably required by be the injury provided to cure relieve the effects of the shall or from so, employer do is employer. neglect seasonably In the case of or to the his or her refusal reasonable employee providing the expense incurred by liable for or behalf of the on added.) (Italics treatment. . . .” determine, may Code board part: appeals Labor section “The provides pertinent determined as against any and allow as sum to as amount any paid compensation, liens be expense The reasonable (a) (i). (b) through set hereinafter forth in subdivisions ...[¶]... (commencing or with injured employee, provided incurred on behalf of Article 4600) (Italics added.) Section . . . .” claim, (a), charge, Code “No or pertinent part: Labor section subdivision enforceable, agreement (b) of expense for . . . the in subdivision Section mentioned Code, Cal.3d 666 P.2d 4600 should Cal.Rptr. [193 14] [Lab. § workers]; construed extend industrially injured to benefits to liberally App. (1968) Cal.2d 405-406 Comp. Granado v. Workmen’s Bd. [71 678, to cure reasonably P.2d treatment Cal.Rptr. required [medical 294] from relieve effects of industrial not be because injury apportioned as to cause uncertainty employer’s liability might injured forgo worker treatment].) It would therefore be to limit a prompt physician inappropriate amount set forth the official fee schedule in those instances fee, where it is established that excess of the physician’s though is reasonable. If schedule rigidly applied except were circumstances, be denied workers industrially injured might *11 medical adequate treatment. claims,
theAt time of the Gould’s lien former hearings on Dr. 4.5, (former California Code of title Regulations, section chapter 10635) rule the provided: proceeding “When evidence adduced a case or demonstrates that are Section 4600 expenses by which covered Labor Code incurred, were will recovery thereof be as unless: they appear, allowed [¶] (1) the proof contesting of unreasonableness is entered reason party the (2) ableness of the charge, or the of said cause proceeding record or [¶] claimed, the makes manifest or the unreasonableness of an expense expenses When the or parties agree to the of a to stipulate charge [¶] reasonableness release, its payment the will be allowed as it compromise expense Former rule appears.” 10635 was effective repealed January Labor Code section fee schedule provides 5307.1 that a to the is pursuant reasonable, prima facie but fees the schedule recognizes that excess of be may also reasonable. Because section that the Labor Code is liable if employer for reasonable the self-procured expenses did not employer treatment Labor 5307.1 promptly provide Code section reasonable, provides that fees the we excess of schedule construe may former rule 10635 as the to that the requiring produce evidence employer fees were if unreasonable only sufficient evidence that the medical provid 8 Therefore, er’s were reasonable was first under former introduced. rule if sufficient evidence that a was introduced to establish physi reasonable, cian’s fee excess of if the schedule was the it employer, valid, binding or in excess of a appeals reasonable amount. The board determine what (Italics added.) constitutes a reasonable amount.” Bd., 8In Braewood Convalescent v. 34 Cal.3d Hospital Comp. Appeals supra, Workers’ the court construed former rule 10635 as “medical if identified meaning expenses, not, presumed section they are unless employer reasonable the demonstrates that are unless (Braewood their unreasonableness is so blatant as to be Convalescent self-evident.” Bd., Hospital 166-167.) Comp. Appeals Workers’ supra, pp. at Braewood Convalescent Hospital distinguishable weight because there the at reduction medical service issue was clinic, weight assistance at a loss regarding a matter the official medical fee schedule which fact, the contrary. was rebuttal evidence to to required present contested itself, reasonableness, constitute does not evidence of although The schedule former rule In Code section 5307.1 rebuttal. Labor applying evidence Dr. Gould to a burden of on high proof WCAB too placed extraordi it proof his fees since required establish the reasonableness of fee in excess of the schedule. nary justify 5307.1, subdivision Labor Code section mandate of Despite medical fee has not revised the official (a)(1), the administrative director the admin failure of schedule since should consider the 1987. WCAB mandated director to revise the schedule two every years istrative of the a fee excess determining Code section 5307.1 in whether Labor schedule is reasonable. in deciding the WCAB an incorrect burden of proof
Because applied fees of the whether Dr. Gould was entitled in excess payment whether cases remanded for a determination of Mayo Allebe must be Dr. Gould’s fees for sessions were reasonable. psychotherapy reasonable, the
In whether in excess of the schedule are deciding *12 training, WCAB consider evidence the medical may regarding provider’s the qualifications, and time the nature of services length of practice; provided; usually the fees the medical the usually charged by provider; were ren- the area which the services charged general geographical dered; other of the the aspects practice economics of medical provider’s relevant; are emphasize, and the case.10 We any unusual circumstances that, however, although may a factor that unusual are considered, if a fee even may excess of the schedule be reasonable no unusual circumstances are present.
Dr. Gould with an of his for provided City itemization he expla Since did a written psychotherapy. not provide contemporaneous, nation, he failed to the in Labor Code section with comply requirement schedule, provides no unit values. was not Labor Code by Because the service covered the apply, relationship section 5307.1 did not did Supreme and the Court not discuss the between section 5307.1 and former rule 10635. however, schedule, employer promptly pays employer 9If the the the the amount listed in ordinarily delay payment will not be liable for under Code for penalty Labor section 5814 (See Kerley Comp. App. v. Workmen’s (1971) treatment. Bd. 4 Cal.3d [93 as Cal.Rptr. [penalty may imposed pay 481 P.2d not be to amounts to for failure 200] genuine legal which employer liability].) has doubt as to of these supported by 10Consideration the introduction to the Revision of factors Peters Truck Line v. pages by CRVS at 8 and previous practice WCAB reflected in Bd, Comp. Appeals supra, Tri-City Hospital Workers’ District v. Cal.Comp.Cases Comp. Appeals Workers’ Bd (1977) Cal.Comp.Cases 5307.1 that his request for fees excess of the schedule be “accompanied . . . He by explanation.” was allowed to his subsequently present explana- tion at the in the testimony hearings and Allebe matters. Mayo Presentation of an with the bill to the explanation or insurance employer carrier is A section 5307.1. written required by contemporaneous, explana- tion the with notice of the employer basis for a physician’s request a fee in excess of the serve to avoid needless litigation schedule of fees. It that this appears was intended to bar requirement recovery any fee in excess of the schedule when not by a accompanied contemporaneous, written explanation.11
The record before us does not reflect that at the City objected to hearings the lack of a contemporaneous, written explanation, City has not con- tended in its answer for writ of review that a written petition explanation was necessary or that was City by the lack of a prejudiced We, therefore, written explanation. do not find Dr. Gould’s for fees request in excess of the schedule to be barred his failure provide contempo- raneous, written explanation.
Because WCAB erred in circum- requiring proof stances to a fee justify than the higher amount set forth WCAB’s decisions must be annulled and the matters remanded for further proceedings consistent with this opinion.
Disposition The January decisions after reconsideration by respondent Workers’ Compensation Appeals Board Mayo of Los Angeles, *13 17367, (1991) 77 MON Allebe v. City (1991) of Los 82 MON Angeles and Allebe v. (1991) of Los Angeles 89 MON are annulled, and the matters are remanded to the Workers’ Compensation Appeals Board for proceedings consistent with the views herein. expressed *J.,
Cooper, concurred. EPSTEIN, I concurin the I I judgment. write because do not separately J. believe that it is necessary this case for the court appropriate to attempt a list of factors the Workers’ Compensation (WCAB) Board should Appeals 11 Ifcompliance with requirement this represents change past practice, suggested argument, oral Administrative the WCAB and the Director of the Division of Workers’ Compensation have the authority to setting determining establish rules forth the criteria for Code, (Lab. whether there has been compliance. substantial 5307.3.) §§ *Judge Municipal of the Angeles Court for the sitting assign- Los Judicial District under ment the Chairperson of the Judicial Council. fees. reasonable what are about a future determination reaching consider ante, 1071.) I am (Maj. opn., do that. in the decision appears Language list, as “other such factors this some of the concerned about particularly are relevant” practice of the provider’s economics aspects to an expansive be subject ended and italics), which are open (my reading. whether, degree, to what in determining
The WCAB has discretion wishes, exercise its if it It may, in excess of the schedule are reasonable. Code, 5307; Compensa- State (Lab. see this area. rule-making authority § 43, 53 (1979) Cal.App.3d Bd. Comp. Appeals v. Workers’ tion Ins. Fund fee over the any a rule that disallows 153].) But a decision or Cal.Rptr. [152 exigen- related to by extraordinary unless justified treatment, fee provision with the reasonable cannot be reconciled cies of 5307.1. of Labor Code section case, I that is the reason in this
That is what the board has done annulled. us must be agree that its decisions the matters before and respondents’ A was denied rehearing April petition denied May for review the Court was Supreme petition