In King v. CompPartners, Inc., the Supreme Court today holds that an employee cannot sue in tort, but is limited to workers’ compensation benefits, for harm allegedly caused by a workers’ compensation reviewer’s negligence in denying the continuation of medication recommended by the employee’s treating physician for an industrial injury. The court’s unanimous opinion by Justice Leondra Kruger concludes that the alleged harm falls within the workers’ compensation system because it is “derivative of a compensable workplace injury.” This is so, the court explains, because the harm allegedly “resulted from errors in the utilization review process — a process that [the employee’s] employer, in its capacity as an employer, was required to establish for the review of the treatment recommended for [the employee’s] prior industrial injury.”
The court affirms in part and reverses in part the Fourth District, Division Two, Court of Appeal. The Court of Appeal affirmed the sustaining of a demurrer, but concluded the employee could amend his complaint to state a valid claim based on the reviewer’s failure to warn of adverse effects from stopping the medication. The Supreme Court, however, says that the workers’ compensation statutes “govern not only the substance of a utilization review decision, whether based on medical necessity or otherwise, but also the content of the responses communicating the decision.”
In addition to signing the court’s opinion, Justice Goodwin Liu writes a concurring opinion that Justice Mariano-Florentino Cuéllar joins, and Justice Cuéllar also issues his own concurrence that pro tem Justice Adrienne Grover signs. Justice Liu says that “the undisputed facts in this case suggest that the workers’ compensation system, and the utilization review process in particular, may not be working as the Legislature intended” and suggests that “[t]he Legislature may wish to examine whether the existing safeguards provide sufficient incentives for competent and careful utilization review.” Justice Cuéllar writes “to emphasize the importance of the common law remedies that ordinarily protect the public, and why courts must continue to proceed with caution when considering –– as in this case –– whether a statute abrogates tort causes of action that ordinarily serve to incentivize good behavior, compensate for injuries, and right moral wrongs.”
