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

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.

Supreme Court unanimously ruled on independent contractor issues in a non workers’ compensation case

This is a published supreme court decision

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

This case did not come out of workers’ compensation but dealt with wage and hours. The case of S.G. Borello & Sons Inc. v Department of Industrial Relations still applies in Workers’ Compensation.

This case dealt with delivery drivers. They had been employees and then were reclassified as independent contractors. That is how the dispute arose.

The Supreme Court in a unanimous decision gave a three part test to determine independent contractor status where a worker is considered an independent contractor:

“(A) that the worker is free from the control and direction of the hirer in connection with the performance of the work, both under the contract for the performance of such work and in fact;

(B) that the worker performs work that is outside the usual course of the hiring entity’s business; and

(C) that the worker is customarily engaged in independently established trade, occupation or business of the same nature as the work performed for the hiring entity.”

The burden of proof is on the employer to prove independent contractor status. Failure to prove any aspect means the worker is an employee.

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