Workers can't recoup fees on specific treatment requests

In California, employees who challenge the type of care rather than the continuing necessity of the treatment are not permitted attorney's fees.

Case name: Smith, et al. v. Workers' Compensation Appeals Board, et al., No. S150528 (Cal. 05/11/09).

Ruling: In a consolidated case, the California Supreme Court held that two employees were not entitled to attorney's fees on their successful requests for medical treatment because the carrier sought to limit their treatment options rather than their medical treatment awards.

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What it means: In California, attorney's fees are not permitted to employees who resist the carrier's denial of a specific treatment because the denial challenges the type of care sought rather than the continuing necessity of the treatment.

Summary: Two injured workers were awarded medical care. They then submitted requests for specific medical treatments. One worker petitioned for epidural injections, and the second worker sought to be enrolled in a weight loss program.Their employers' insurance carrier disputed their entitlement to the requested care. After they prevailed on their requests for specific care, the workers sought attorney's fees. The California Supreme Court upheld the denial of attorney's fees in both cases. The court reasoned that the law permits an award of attorney's fees in those cases where a carrier has denied an award of future medical treatment but not in cases where the worker is seeking a specific type of treatment. The court pointed out that in both cases the carrier disputed the specific requests rather than the validity of the workers' awards of future medical care.

The court noted that the state has a utilization review scheme to resolve disputes over specific treatment requests using doctors, rather than judges, as the adjudicators of whether a specific type of treatment is warranted. Thus, the court upheld the finding that the workers were not entitled to recover attorney's fees for the specific type of treatments they chose to pursue.

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August 13, 2009

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