Workers’ Compensation · Primary-source case analysis

Tapia: A Medical Lien Billing Does Not Prove a Reasonable Charge

By Aneeta Mishra and Timothy Chan

Published May 25, 2026

Maria Tapia v. Skill Master Staffing addressed the proof required when an outpatient surgery center sought the unpaid balance of a lien after the worker’s underlying claim had settled.

The remaining dispute concerned the surgery-center fee

The claim resolved by compromise and release, but SB Surgery Center maintained a lien after billing $23,529 for wrist-surgery facility services. The defendant had paid $1,667.66, and the workers’ compensation judge found $4,700 to be the reasonable value.

The lien claimant held the affirmative burden

Labor Code sections 5705 and 3202.5 placed the burden on the lien claimant to prove each element of its lien by a preponderance. The fact that services were reasonably required did not establish that every amount billed for them was reasonable.

A bill was evidence, not a conclusive measure

Billing could help show what a provider usually charged or accepted, but it did not by itself establish a reasonable fee. The WCAB could consider any relevant evidence, including fee schedules, comparable inpatient or outpatient rates, and the nature and duration of the services.

The reduced award was affirmed

The Board rejected the argument that the entire bill had to be allowed because the defense lacked evidence of fees accepted by neighboring surgery centers. The lien claimant had not carried its burden of proving the much larger claimed amount.

Key takeaways

• Identify every element the lien claimant must prove.
• Separate medical necessity from the reasonable value of the charge.
• Use several relevant market and fee benchmarks rather than a bill alone.
• Preserve the service details, payments, and evidentiary basis for any valuation.