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Friday, August 24, 2018
High Court Rules Exclusive Remedy Precludes Tort Claim Over UR Decision
- State: California
- Topic: Top
- - Popular with: Legal
- - 6 shares
The California Supreme Court ruled that workers’ compensation is the exclusive remedy for disp…
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4 Comments
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Aug 24, 2018 a 12:08 pm PDT
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Aug 24, 2018 a 12:08 pm PDT
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Ron Perelman Aug 24, 2018 a 12:08 pm PDT
As long as UROs are under the employer umbrella, they appear to be biased. This may or may not be true, but as long as employers pay them directly, it is perceived so. The goal of UR is to allow reasonable treatment. The King case is an example of how an incorrect UR decision can cause harm. I think a better way to perform UR, would be to create independent UR, by using state medical organizations to set up UR specialty groups For example, the California Orthopedic Association could use willing members to do UR. All employers could pay into a escrow-like account each year. This money would pay these physicians. The carriers are thus removed from suspicion of bias. The doctors could have an internal review of their reviewing members. Another plus is that all reviewers have California licenses, and all are board certified. The doctors should get sufficient records to make intelligent decisions. If this is done, I believe many of the UR problems would evaporate. Please let me know if my thinking is incorrect.
George Corson Aug 24, 2018 a 1:08 pm PDT
I think that the potential for mistakes and harm are always possible, but keeping the non-egregious issues under the Exclusive Remedy makes sense. I don’t feel that the Carrier should be responsible for resulting UR damage, but do concede that is the policy trade-off with the Workers’ Compensation Act. The more efficient delivery of benefits was the WCA goal. Not more generous, but more efficient.