In King v. CompPartners, the California Supreme Court held that the exclusive remedy provisions under California Labor Code § 3602(a) limit one’s ability to proceed outside the Workers' Compensation Appeals Board for injuries alleged to have occurred as a result of the utilization review process.

David Kim

After his medication, Klonopin, was not certified through UR, Kirk King suffered four seizures. King filed a civil action against UR vendor CompPartners and UR physician Dr. Sharma, alleging that he suffered the seizures as a result of the abrupt termination of his medication.

King brought claims of professional negligence, intentional infliction of emotional distress and loss of consortium against CompPartners and Sharma.

At the trial court level, both defendants demurred on the basis of exclusive remedy provisions under Cal. Lab. Code § 3602(a), and Sharma for lack of a duty of care. The Court of Appeal affirmed the trial court’s order sustaining the demurrer except that it concluded Sharma owed a duty of care to King and viewed his failure to provide a warning as to the risks of abrupt termination of the medication as a separate act and not part of the UR process.

The Court of Appeal could not determine based on the information provided whether Sharma breached his duty of care, and allowed for leave to amend. The Supreme Court upheld the demurrer and indicated that the complaint failed to state a cause of action. It reversed the Court of Appeal ruling allowing leave to amend and stated:

[W]here the remedy is available as an element of the compensation bargain, it is exclusive of any other remedy to which the worker might otherwise be entitled from the employer.

The Supreme Court stated that King sought to recover civilly for injuries that arose during the treatment of his industrial injury, but because the injury arose out of an alleged error in the UR process, a process that employers are statutorily required to establish to determine medical necessity for an applicant’s industrial injury. Per Cal. Lab. Code § 4610, King’s remedy could be sought only through the WCAB.

The court explained that insurance carriers are “alter egos” of the employer, and claims administrators and adjusters are hired by carriers to handle workers’ compensation claims. Just like claims adjusters and administrators, Cal. Lab. Code 3602(a) pre-empts tort claims against utilization reviewers hired by employers to carry out their statutory duty of determining medical necessity under Cal. Lab. Code § 4610.

Cal. Lab. Code § 4610.5(a) defines an “employer” to include employer, insurer of an employer, a claims administrator or UR organization acting on behalf of any of them. This definitional provision reinforces the notion that the Legislature considers UROs an extension of the employer, and the decision in King v. CompPartners should provide relief to employers and carriers alike, knowing that the extent of their exposure in workers’ compensation cases such as this will be limited to the remedies available through the WCAB.

David Kim is an attorney in Bradford & Barthel’s Fresno office. This entry from Bradford & Barthel's blog appears with permission.