A classic example of the Law of Unintended Consequences was born out of the decision last week by a California Workers' Compensation Administrative Law Judge, who ruled, in a case of first impression, that the "free medical treatment" clause of Labor Code section 5402(c) applied retroactively.5402(c) states:"Within one working day after an employee files a claim form under Section 5401, the employer shall authorize the provision of all treatment, consistent with Section 5307.27...
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Comments (4):
“Below you will find an article from WCC regarding a case involving a WCJ deciding that LC 5402 (c) (the $10k in "free" treatment while the claim is in delay statute) applies to all cases retroactively wherein a lien claimant is seeking payment on their lien for treatment procured previous to the passing of SB 899. The logic of the judge follows many of the retro active statute cases such as Marsh, Scheftner, Kleeman etc., however in my opinion the WCJ failed to address legislative intent. The WCJ relies heavily on the following section of SB 899:
Section 47 states: "The . . . repeal of, any provision of law made by this act shall apply prospectively from the date of enactment of this act, regardless of the date of injury, unless otherwise specified, but shall not constitute good cause to reopen or rescind, alter, or amend any existing order, decision, or award of the Workers' Compensation Appeals Board."
So far so good, here is where I believe things start to fall apart of this particular decision. Let's get back to basics on legislative intent and take a look at some interesting language frm the Rea case:
When interpreting or applying statutes to the facts, the Legislatures intent should be determined and given effect. [Citations.] The intent of the Legislature is generally determined from the plain or ordinary meaning of the statutory language, unless the language or intent is uncertain. [Citations.] Interpreting or applying statutes to the facts should be consistent with the purpose of the statute and the statutory scheme as a whole. (Rea v. Workers Comp. Appeals Bd. (2005) 127 Cal.App.4th 625, 641.)
On it's face I believe LC 5402(c) was made specifically to protect an injured worker's right to seek treatment while their claim is in delay. I do not see anything that would lead me to believe that this statute was enacted in whole or in part to allow a lien claimant to seek payment for services rendered prior to the passing of SB 899, so I would draw our attention back to the original intent of SB 899 and specifically to section 49 of SB 899 which I believe sums up the legislative intent of SB 899 quite well:
"In order to provide relief to the state from the effects of the current workers' compensation crisis at the earliest possible time, it is necessary for this act to take effect immediately." (Stats. 2004, ch. 34, § 49.)
Ahhh, so the intent of SB 899 was to provide relief to the state form the effects of the w/c crisis. How exactly is a chiropractor's bills related to the relief of the "current worker's compensation crisis?" That I don't know, but if someone could possibly enlighten me on where the WCJ is coming from in the decision I would sure love to hear it!”
By: LaTrina Cole, 10/24/2005 07:11:59 pm
“Maybe the intent of the legislature was to get injured workers treated and
back to work A.S.A.P. So, the insurance carriers have to provide treatment
during the delay period consistent with ACOEM Guidelines in an amount not to exceed $10K. The lien claimant comes into play where the carrier refuses to provide the treatment and the IW is forced to seek treatment elsewhere. I have not had any carriers provide the statutorily required Sec. 5402 treatment. It seems that they want to pick and choose what sections of SB 899 they will comply with and when. How many IWs have gotten worse before they have gotten better due to failure of the carrier to provide treatment initially and then later being overturned at trial or by an AME? This results in more
lost time, more treatment, more disabilty, more pain, more stress and
many 2ndry psyche claims.
”
By: Joanna Losee, 10/25/2005 10:16:34 am
“Great...that means ACOEM applies retroactively as does the 24 visit limit!
I will trade that 'unintended consequence' for med treatment during the delay period.”
By: Richard Hertzog, 10/25/2005 11:35:42 pm
“I have no issue with the legality of providing treatment under LC 5402 and have done so on every delayed claim wherein the worker sought treatment. I concede that most likely the intent of the legislature was to get legitimately injured worker's back to work, but this decision has nothing to do with that. This is a decision for a lien holder not an injured worker, which seems to have nothing to do with legislative intent.”
By: LaTrina Cole, 10/27/2005 04:05:58 pm
