California Supreme Court
When a utilization reviewer is alleged to have harmed a plaintiff during the course of an exam under the workers compensation utilization review process, workers compensation is that plaintiff’s exclusive remedy.KING v. COMPPARTNERS, INC.
PLAINTIFF KING USED THE WORKERS COMPENSATION SYSTEM FOR HIS BACK INJURY
Because the court was reviewing the matter after the sustaining of a demurrer, it took the allegations in the complaint to be true.
Plaintiff King injured his back at work in 2008. He experienced pain, anxiety and depression for which he received medication, including psychotropic drugs, since 2013.
THE UTILIZATION REVIEWER DETERMINED THAT THE PSYCHOTROPIC DRUGS WERE NOT MEDICALLY NECESSARY
The Workers Compensation Act provides for a utilization reviewer, a medical doctor acting on the employer’s behalf, to determine if the treating physician’s treatment recommendations are medically necessary. In 2013, a utilization reviewer determined that one of the psychotropic drugs, Klonopin, was unnecessary and decertified the prescription.
PLAINTIFF KING SUED FOR THE SIDE EFFECTS OF STOPPING THE MEDICATION WITHOUT A WEANING PERIOD
According to the complaint, the utilization reviewer did not warn Plaintiff King of the side effects of stopping the medication, nor of the need to be weaned off of it. Plaintiff King suffered seizures as a result of immediately stopping the medication.
Plaintiff King sued the utilization reviewer for professional negligence, among other claims.
THE APPELLATE COURTS SUSTAINED A DEMURRER, BUT FOUND NO PREEMPTION BY WORKERS COMPENSATION
The trial court sustained a general demurrer without leave to amend on the ground of preemption. The appellate court upheld the sustaining of the demurrer. The appellate court stated, however, that leave to amend should have been granted because the utilization reviewer owed a duty of care to Plaintiff King, and it challenged the failure to warn rather than the medical necessity determination.
THE SUPREME COURT FOUND THE CLAIMS PREEMPTED BY WORKERS COMPENSATION
The Supreme Court disagreed. It discussed extensively those provisions of the Workers Compensation Act that preempt, both explicitly and otherwise, claims for damages arising out of workplace injuries.
The court found that the injuries alleged were “collateral to or derivative of” the original back injury because they occurred as a
CONCLUSION
Injuries that come about as a result of a workplace injury will have their exclusive remedies within the workers compensation system, even if the relationship between them is attenuated, if it came about due to conduct occurring in the workers compensation claims process.
Cal. Supreme Ct., Filed 8/23/18, Opinion by Justice Kruger
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