Worker's medical history justifies treatment from out-of-state surgeon
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.
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.
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March 19, 2012
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