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California Court Decision Limits Malpractice Liability Of Workers' Comp Doctors

In the Golden State, when you're injured at work, you'll usually pursue any reimbursement for medical expenses, lost wages, and other injury-related costs through your employer's workers' compensation insurer. This setup protects both employers and employees—employers are able to avoid costly (and uncertain) personal injury lawsuits from employees injured at work, and employees are guaranteed a source of income when they're unable to work after an injury.

But in order to receive workers' compensation benefits, injured workers must often go through a utilization review process to ensure the medical treatment being provided is necessary and appropriate. If the physician overseeing this review process commits malpractice, the remedy for this violation may be an unexpected one. Read on to learn more about how a recent California court decision could impact workers' rights when it comes to seeking treatment after a work-related injury.

What did King v. CompPartners hold? 

In this opinion, the California Supreme Court held that the state's Workers' Compensation Act (WCA) provides the only remedy for injured workers who allege the utilization review physician committed medical malpractice. 

Malpractice during the review process can take a number of forms, from misdiagnosis that prevents the workers' compensation insurer from paying to treat the underlying injury to cancelling a prescribed medication. Although a utilization review physician doesn't usually treat the patient directly, they do review the treatment plan and make adjustments accordingly, and these adjustments can sometimes have collateral consequences. 

In King v. CompPartners, an injured employee suffered damaging seizures after his utilization review physician decertified a prescription medication he had been taking. The employee and his wife filed negligence complaints against this physician, but after some intermediate court proceedings, the California Supreme Court held that these tort claims could not proceed outside the WCA. The case was returned to the Court of Appeals for further proceedings under the WCA.  

What does this decision mean for injured California workers? 

While this decision doesn't altogether prevent an injured employee from collecting damages as a result of a physician's negligence,  it does change both the process and the amount that can potentially be recovered. 

For example, if a physician's actions result in a patient's serious injury or death, a medical malpractice lawsuit can be brought by the patient or any surviving family members. If malpractice is established, non-economic (or punitive) damages of up to $250,000 are available, in addition to economic damages like loss of earning power, medical expenses incurred during the treatment, and other related costs. After going through a medical review panel to decide if the malpractice case has merit, the plaintiff can file a malpractice lawsuit and litigate the relevant issues before a state judge. 

But unlike a traditional medical malpractice lawsuit, the WCA has tighter compensation limits in place, and an injured employee may not be able to recover nearly as much as they would have if they'd suffered the same injury (and subsequent physician malpractice) while not on the job. In wrongful death claims, surviving family members may lack access to non-economic damages, which aren't expressly provided for in the WCA. 

In addition, claims brought under the WCA are litigated in the administrative arena, rather than in a state trial court. Although both types of cases will end up before the Court of Appeals and Supreme Court on administrative review, the processes and procedures in an administrative review hearing can be different from the trial process. If you're appealing an adverse decision, the appellate court may defer more to the administrative agency than it would to a trial court. This tough standard of review can also work against claimants who might otherwise prevail in a regular tort claim. 

Contact a workers' compensation attorney for more information.