California: Claim Against UR Physician Not Preempted by Workers’ Compensation Law

Noting that a utilization review physician has a doctor-patient relationship with the person whose medical records are being reviewed, a California appellate court held that in at least some circumstances an injured worker and his wife could maintain a civil action against a physician for a workers’ compensation utilization review company who determined that a psychotropic medication was medically unnecessary without warning the worker that the weaning process from the drug should be gradual and not abrupt. The worker alleged that he suffered seizures and further physical injury from the sudden cessation of the medication. The trial court sustained defendants’ demurrer without leave to amend, finding the worker’s exclusive claim (and that of his spouse) was solely under California’s workers’ compensation law. The appellate court reversed in part. It said that to the extent the worker and his wife were arguing that the medication was medically necessary until the worker was weaned, and thus that a particular number of pills should have been authorized for weaning, the claims were preempted. That part of the claim was a direct challenge to the doctor’s medical necessity determination. To the extent, however, that plaintiffs were faulting the doctor for not communicating a warning, the claims were not preempted by workers’ compensation law. The court said that the trial court should have allowed plaintiffs to amend their complaint.

Thomas A. Robinson, J.D., the Feature National Columnist for the LexisNexis Workers’ Compensation eNewsletter, is the co-author of Larson’s Workers’ Compensation Law (LexisNexis).

LexisNexis Online Subscribers: Citations below link to Lexis Advance. Bracketed citations link to lexis.com.

See King v. CompPartners, Inc., 2016 Cal. App. LEXIS 2 (Jan. 5, 2016) [2016 Cal. App. LEXIS 2 (Jan. 5, 2016)]

See generally Larson’s Workers’ Compensation Law, §§ 94.03, 112.02 [94.03, 112.02]

Source: Larson’s Workers’ Compensation Law, the nation’s leading authority on workers’ compensation law.

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