California: Interpreters Required for Medical Treatment

The W.C.A.B. has issued an en banc decision that addresses what has been a contentious issue for years. In Jose Guitron v. Santa Fe Extruders; and State Compensation Insurance Fund the W.C.A.B. has determined:

“1) pursuant to the employer’s obligation under Labor Code section 4600[fn1] to provide medical treatment reasonably required to cure or relieve the injured worker from the effects of his or her injury, the employer is required to provide reasonably required interpreter services during medical treatment appointments for an injured worker who is unable to speak, understand, or communicate in English;

2) to recover its charges for interpreter services, the interpreter lien claimant has the burden of proving, among other things, that the services it provided were reasonably required, that the services were actually provided, that the interpreter was qualified to provide the services, and that the fees charged were reasonable.”

In determining interpreter services can be required, the W.C.A.B. analogized interpreter services to transportation services which, while not specifically required under Labor Code § 4600, are still defined as part of medical care based on extensive case law authority. Much like travel expense, the statutory authority for interpreters is sprinkled throughout the labor code and regulations but are not specifically contained in Labor Code § 4600. Nonetheless, the W.C.A.B. found the legal authority sufficient to require interpreter services as a routine part of medical treatment in cases where the injured worker is unable to speak understand or communicate in English:

“While section 4600 does not specifically list interpreter services as an element of medical treatment, section 4600 has been construed to include the costs of transportation to obtain treatment and medication, even though such transportation costs also are not specifically listed in section 4600…” Citing Avalon Bay Foods v. Workers’ Comp. Appeals Bd. (Moore) (1998) 18 Cal.4th 1165, 63 Cal.Comp.Cases 902 & Hutchinson v. Workers' Comp. Appeals Bd. (1989) 209 Cal.App.3d 372, 54 Cal.Comp.Cases 124

                                                        

Like transportation, effective communication between an injured employee and a medical provider is an essential adjunct to treatment. This common sense principle has been recognized in a number of Appeals Board panel decisions”

The W.C.A.B. declined to differentiate between types of treatment whether physician visits, physical therapy, chiropractic visits etc. As long as interpreter services are required to make the treatment effective, the employer is obligated to provide them.

In the case under study, the WCJ declined to award interpreter services for most of the visits to physician, therapists etc. on the assumption the treatment was provided in an area where a large portion of the population was Spanish speaking. The W.C.A.B. rejected this argument, holding there is no substantial evidence to support the assumption by the WCJ and even if correct, there is no evidence such an analysis would necessarily apply to the individual office the employee was treated at for this case. The Board also declined to require an office where there were Spanish speaking employees to take those employees from their other duties to act as interpreters for industrially injured workers.

After ruling interpreter services could be required on a routine basis for treatment, the W.C.A.B. then turned to the requirements for proving the validity of the lien claims, placing a significant burden on the provider of the services to prove the individual elements of the lien burden of proof. The decision discusses various fact patterns that would indicate a need for an interpreter such as the need for one at a deposition or a medical legal examination.

The W.C.A.B. also spent a good deal of time address the potential cost of such services. The board noted for a short physician visit, a minimum 2 hour visit fee many not be required. The W.C.A.B. also suggested once the need for an interpreter is identified, the claims administrator could take the initiative and arrange for interpreter services as part of its provision of medical treatment or else arrange for treatment in offices where interpreting services or Spanish speaking medical providers were provided. However the W.C.A.B. make it clear that an employer cannot limit an employee’s selection of treatment to those speaking the employee’s language as the employee retained the right to control selection of treating physicians.

Proof of actual participation in the employee’s visit is also part of the burden for the interpreter and the W.C.A.B. makes several suggestions about how such proof could be developed. The board also makes it clear the interpreter much meet the criterion of being either a certified or qualified interpreter to be eligible for payment but does provide a curious exception based on Government Code 11435.55 which allows a physician to designate an otherwise unqualified interpreter on a “provisional basis”. The Board suggests the best approach is to arrive at an agreement on provision of interpreting services rather than litigation of the issue.

The decision addresses the Lien claimant’s burden where the treatment itself is disputed. If the treatment itself is not the obligation of the employer, the interpreter will not be able to recover on any services associated with such treatment.

“SCIF further objected to payment of most of the billed services on the following grounds: the medical treatment was unauthorized, the medical provider was not part of defendant’s medical provider network, and the treatment exceeded the 24-visit limitation on chiropractic care and physical therapy established in section 4604.5(d)(1).Once these objections were raised by defendant, it fell to lien claimant to rebut them. If the injured worker was not entitled to the underlying medical treatment, the interpreter’s lien must be disallowed for the services in question….”

Where there are issues regarding payment for the underlying treatment, the lien claimant is in the same boat with the medical provider.

COMMENTARY:

This topic has certainly been a hot button issue for many years and some clarifying law on the subject is certainly welcome although I suspect the holding in the decision will be disturbing to many payers, it is difficult to argue the ability to communicate with one’s treating physician is not a necessary part of medical care. As they say, “Forewarned is forearmed”. If claims administrators are aware of the obligation to provide interpreting services, arrangements can be made to provide the services on terms which are more favorable to the claims administrators than have been typically been paying when the physicians and applicant attorney make the arrangements. In the past, interpreters have been provided in the most expensive means possible with a good deal of litigation over the issues.

With the knowledge such services are necessary carriers can make various arrangements to provide the services such as:

1. Providing interpreting services as part of the MPN treatment with negotiated rates including reduced minimum rated, block interpreting services in offices with multiple non-English speaking patients and other cost effective techniques.

2. Contracting with physicians who do have Spanish speaking employees to use those employees to assist in translation (acting as “provisional interpreters) when needed.

3. Arranging that ancillary services (physical therapy etc.) be directed to language appropriate providers.

4. Providing language availability in MPN listings for employee usage.

5. Requiring Occupational Med Clinics have language assistance available as part of their service if they service areas where other languages are common.

Footnote:

1. All further statutory references are to the Labor Code, unless otherwise indicated.

© Copyright 2011 Richard M. Jacobsmeyer. All rights reserved. Reprinted with permission.

 

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