There are 27 million licensed drivers in California, a state known for its sprawling freeways that transverse nearly 800 miles of deserts, valleys and coastlines.

Michael P. Burns

In the workers’ compensation system, insurers are often asked to provide transportation for injured workers to attend medical appointments. The necessity for transportation frequently results in litigation at the Workers' Compensation Appeals Board, largely due to confusion regarding how to respond. This article discusses the basis for evaluating transportation requests from an insurer’s perspective.

Labor Code Section 4600(a) allows injured workers to receive medical treatment that is reasonably required to cure or relieve the effects of an industrial injury. This section applies to any services that are medically related and are reasonably required to cure or relieve the effects of the injury. These include services such as the cost of transportation to obtain treatment and medication, even though transportation is not specifically identified in Section 4600 as medical treatment. The WCAB has determined that medical treatment transportation benefits "are an element of overall medical treatment benefits under Labor Code Section 4600.”

Given that transportation is subsumed within the larger category of medical treatment, there must be a medical basis — supported by medical reports — showing that transportation is necessary. Specifically, a treating physician must determine that medical transportation is reasonable and necessary to cure or relieve the effects of the industrial injury. The insurer is permitted to defer a request for transportation until there is medical evidence supporting the need for it to cure or relieve the industrial injury.

Typically, this will take the form of a request for authorization for transportation to medical appointments, such as examinations, physical therapy and diagnostic studies. However, the treating physician may indicate that transportation is needed in the body of his report rather than asking for transportation in a request for authorization form. The physician may not understand that transportation is a medical issue and therefore may feel that it is not proper to request transportation in an RFA.

If an insured encounters a request for medical treatment in a report but not in the RFA, it should still be processed by utilization review. In no case should the request be ignored. The physician should identify the basis for requiring transportation. For example, if applicant is immobile — perhaps in a boot or wheelchair — this creates a strong basis for a request for transportation. Alternatively, if the physician simply states that applicant is having difficulty getting to medical appointments, this may be inadequate to evaluate whether transportation is medically necessary.

Insurers are often faced with informal requests from applicants' attorneys for transportation to medical appointments. Such transportation can be approved as a courtesy and may, in fact, facilitate applicant’s medical treatment and therefore help the parties resolve the case more quickly. However, such a request, by itself, is not equivalent to a request from a physician for transportation to treat an industrial injury. The fact that applicant does not own a vehicle or has trouble getting to medical appointments is, by itself, insufficient to trigger a review of the transportation request.

However, if a request for transportation has been approved and has been provided on an ongoing basis, insurers are cautioned not to unilaterally terminate transportation before obtaining a medical opinion stating that transportation is no longer reasonably required to cure or relieve the effects of the industrial injury.

In Rutledge v. Costco Wholesale, the WCAB held that it was not applicant’s burden to obtain an RFA challenging defendant’s termination of transportation services, nor was it appropriate for defendant to unilaterally terminate transportation without first obtaining an opinion from a physician. The WCAB held that once defendant has authorized medical transportation, it is obligated to continue to provide those services until they are no longer reasonably required, and that determination must be based on substantial medical evidence.

The Rutledge decision reminds insurers that in California Workers’ Compensation, no good deed goes unpunished. When an insurer elects to provide transportation to medical appointments, it is effectively committing itself to continue doing so until there is a medical basis to justify termination. Accordingly, defendants are cautioned to avoid providing transportation to medical appointments absent substantial medical evidence, demonstrating that there is a medical basis requiring transportation. An applicant’s difficulty in obtaining reliable transportation to medical appointments, by itself, is likely insufficient to meet this burden.

Moreover, providing courtesy transportation may obligate the insurer to continue transportation until it obtains medical evidence demonstrating that it is no longer needed. In a heavily populated state such as California with millions of drivers, transportation issues are likely to arise. Nevertheless, treating transportation as a medical issue, subject to utilization review and supported by medical evidence, may save insurers time and money if addressed in the same manner as other medical treatment requests.

Michael P. Burns is a Partner at Bradford & Barthel’s San Jose location. This entry from Bradford & Barthel's blog appears with permission.