Worker's medical history justifies treatment from out-of-state surgeon

In California, a worker may be entitled to treatment by an out-of-state physician if he has a complicated medical history and in-state physicians would run the risk of failure with additional complications and expenses.

Case name: Thomas v. Safeway Stores, Inc., No. ADJ532181 (Cal. W.C.A.B. 2011).

Ruling: The California Workers' Compensation Appeals Board held that a worker was entitled to seek surgery by an out-of-state orthopedic surgeon.

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What it means: In California, a worker may be entitled to treatment by an out-of-state physician if he has a complicated medical history and in-state physicians would run the risk of failure with additional complications and expenses.

Summary: The board held that a worker could seek shoulder surgery from an out-of-state orthopedic surgeon. The employer was willing to authorize treatment by 11 surgeons in the worker's metro area, as well as "any other surgeon within a reasonable geographic distance." The board considered a report by the worker's treating physician, who said that the out-of-state surgeon did more total shoulder revisions per year than all 11 of the in-state surgeons collectively. The treating physician's patients that were referred to the in-state surgeon with the most experience previously had complications. The treating physician also said that if the worker was his family member, he could send him to the out-of-state surgeon. The board found that the out-of-state surgeon was located within a reasonable geographic area to act as the treating surgeon.

The board pointed out that the worker had a complicated medical history that ruled out the in-state surgeons. The board concluded that the out-of-state surgeon was the "obvious choice" among the available doctors offering treatment reasonably required to cure or relieve the worker from the effects of his injury.

Read more at the WorkersComp Forum homepage.

March 19, 2012

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