California: Reviewers Under State's Utilization Review Procedure are Immune from Tort Liability; Exclusive Remedy is Workers’ Compensation

The exclusive remedy provisions contained in Cal. Labor Code § 3602 extend their shield against tort liability to utilization reviewers performing their services under the state’s workers’ compensation utilization review process. Accordingly, where a utilization reviewer denied a treating physician's request to continue prescribing a certain medication — Klonopin — for an injured employee, that employee could not maintain a tort action against the utilization reviewer based upon allegations that the reviewer caused him additional injuries by denying the request without authorizing a weaning regimen or warning him of the possible side effects of abruptly ceasing the medication. Here, the Court of Appeal had concluded that the tort claim was not preempted because it did not directly challenge the reviewer’s medical necessity determination, but rather had alleged that the reviewer owed the injured worker a duty of care and had failed to provide necessary medical care to the worker. The Supreme Court stressed that in performing their statutory functions, utilization reviewers effectively stood in the shoes of employers. As such, reviewers were to be provided with the same immunity from tort liability as employers.

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

LexisNexis Online Subscribers: Citations below link to Lexis

See King v. Comppartners, Inc., 2018 Cal. LEXIS 6268 (Aug. 23, 2018)

See generally Larson’s Workers’ Compensation Law, § 112.02.

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