California Supreme Court indicates utilization review is an exclusive remedy of California Workers’ Compensation

• Posted By: Harvey Brown
• September 1, 2018

This is a published Supreme court decision

This is a very significant case for workers’ compensation principles.

The applicant suffered a compensable back injury. The applicant also claimed anxiety and depression. A mental health physician prescribed a psychotropic drug, Klonopin.

A utilization review company was retained to determine whether Klonopin was necessary. Dr. Sharma on review determined the drug was medically unnecessary and decertified the prescription. Dr. Sharma did not warn of the risks of abruptly ending the drug and when the applicant immediately stopped taking the drug suffered a series of four seizures.

The applicant filed a civil suit against the utilization review company and Dr. Sharma. The defendants filed a demurrer alleging the workers’ compensation board had an exclusive remedy, so no civil suit was indicated. The trial court sustained the demurrer and the court of appeal sustained the demurrer.

The Supreme Court indicated that the injuries were derivative of a compensable workplace injury and within the scope of workers’ compensation. The court reviewed numerous statutes and case law. They also reviewed the exceptions to the exclusive remedy doctrine and found those exceptions were not applicable here.

They indicated the utilization process was within the exclusive remedy of the Workers’ Compensation Appeals Board.

Case: King v. Compartners

• Posted In: Supreme Court