CA Supreme Court Rules for Injured Workers

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CALIFORNIA SUPREME COURT RULES FOR INJURED WORKERS

On July 7, 2008, the California Supreme Court in Sandhagen v. WCAB

sided with injured workers in an important case concerning insurance

company authorization for medical treatment for an industrial

injury. In Sandhagen, the Supreme Court confirmed the overriding

interest that injured workers receive prompt and proper medical care.

One of the effects of the " reform " of the Workers' Compensation Laws

has been the growing frustration by injured workers and their doctors

regarding their inability to obtain authorization for recommended

treatment. Often a lengthy litigation process has been required to

resolve such issues. The Sandhagen ruling limits an insurance

company's ability to dispute treatment requests.

The " utilization review " process is the process in which an insurance

company refers a treating doctor's medical treatment request to

another physician to review and authorize, reject, or delay (for more

information) the treatment request. The insurance companies must now

complete utilization review within 14 days.

The Supreme Court rejected the insurance company's argument that even

if utilization review was not timely provided under Labor Code

Section 4610, they still had additional time to dispute the treatment

under Labor Code Section 4062. The Court ruled that there is no

other medical basis to dispute a request if the review was not timely

under Section 4610. Therefore, if there is no timely denial, the

insurance company should authorize the requested care, or risk being

penalized for unreasonably delaying the treatment. It is hoped that

this decision will help injured workers receive the timely treatment

that is needed for their injuries.