Two years ago the Court of Appeal opened the Pandora’s box of potential litigation against utilization review physicians in a published decision. The California Supreme Court agreed to review the case, and just reversed the Court of Appeal in Kirk King v Comppartners, Inc..
Kirk King suffered anxiety and depression due to chronic back pain resulting from the back injury at work in 2008. In 2011, he was prescribed an anti-anxiety medication known as Klonopin to be provided through Workers’ Compensation. The request for this medication was sent to Utilization Review.
Naresh Sharma, M.D, an anesthesiologist who conducted the utilization review determined the drug was unnecessary and decertified it. As a result, Kirk was required to immediately cease taking the Klonopin. Typically, a person withdraws from Klonopin gradually by slowly reducing the dosage. Due to the sudden cessation of Klonopin, King suffered four seizures, resulting in additional physical injuries.
In September 2013 another request for Klonopin was made by the PTP. Ali, a psychiatrist, conducted a second utilization review and also determined Klonopin was medically unnecessary. Neither Sharma nor Ali examined Kirk in-person, and neither warned Kirk of the dangers of an abrupt withdrawal from Klonopin. Sharma and Ali were employees of CompPartners a Workers’ Compensation utilization review company.
King then sued CompPartners, Inc. and Sharma for (1) professional negligence; (2) negligence; (3) intentional infliction of emotional distress; and (4) negligent infliction of emotional distress. Kirk’s wife, Sara King, sued for loss of consortium. The trial court sustained defendants’ demurrer without leave to amend. The Court of Appeal sustained the demurrer but reversed the denial of leave to amend.
The Court of Appeal decision concluded that the trial court “should have granted the Kings leave to amend because it is possible… that, when more details are provided they could support a conclusion that, under the circumstances, the scope of Sharma’s duty included some form of warning Kirk of or protecting Kirk from the risk of seizures.”
However, the California Supreme Court viewed the case differently. It concluded that the workers’ compensation law provides the exclusive remedy for the employee’s injuries and thus preempts the employee’s tort claims.
The Supreme Court said it is by now well established that the exclusivity provisions preempt not only those causes of action premised on a compensable workplace injury, but also those causes of action premised on injuries collateral to or derivative of’ such an injury. Such collateral or derivative injuries include injuries stemming from conduct occurring in the workers’ compensation claims process.
In performing their statutory functions, utilization reviewers, much like independent claims administrators, effectively stand in the shoes of employers. Thus, the Court concluded that “the exclusive remedy for the Kings’ injuries lies within the workers’ compensation system.”