Panel Decision Denies Industrial Psychiatric Treatment Notwithstanding Medical Evidence That Such Treatment Was Medically Necessary.
The Workers’ Compensation Appeals Board, in a panel decision issued July 7, 2010, determined that there was insufficient evidence to support an award of psychiatric care to an applicant who sustained multiple orthopedic injuries and industrial headaches.
The applicant had been employed by the defendant for less than six months; however he strategically did not claim psychiatric injury which would otherwise have been barred by Labor Code §3208.3(d). Rather, the applicant claimed that he was entitled to psychiatric care on a compensable consequence theory.
Defendant rejected that argument setting forth that the claim for psychiatric benefits was not timely made and that there was no medical evidence to support the claim that psychiatric treatment was necessary to cure or relieve from the effects of the admitted industrial injury.
Recognizing that it has long been the law in California that a defendant must provide all reasonable and necessary care for non-industrial medical conditions to the extent that they impede the recovery of the accepted industrial injury, the defendant was clearly facing an uphill battle.
Moreover, defendant did not dispute that such psychiatric care was necessary, but resisted provision of psychiatric care as there was no showing in the medical record that the psychiatric treatment was made necessary by the industrial injury.
The WCAB panel rejected the applicant’s request for treatment and remanded the matter to the trial court to further develop the record on whether or not a relationship existed between the need for psychiatric care and the admitted body parts.
What this means for you
While provision of psychiatric treatment remains a hot button issue in workers’ compensation litigation, GMK's victory in demonstrating a lack of supporting evidence tying any portion of the need for psychiatric care to the industrial injury in question is reassuring.
Applicants who file claims for psychiatric treatment where the proof for such care is not strictly met will be faced with vigorous advocacy at trial and on appeal by GMK attorneys. This decision is exemplary of the tenacity, preparation, and professionalism you can expect from our firm.
GMK extends our congratulations to San Diego partner Jeff Cohen and the entire GMK San Diego team for their efforts in vigorously pursuing our client’s interests.
© Copyright 2010 Goldman, Magdalin & Krikes, LLP. All rights reserved. Reprinted with permission.