NPR continues its Special Series “Insult To Injury: America’s Vanishing Worker Protections” arguing that states have nationally eroded workers’ compensation benefits to the point of shifting the burden on taxpayers. The current article features two California workers’ compensation claims it asserts are evidence of how even California has changed its system into an intolerable and unacceptable debacle. One of the claimants, Frances Stevens has her case pending in the Court of Appeal and if successful, will end the IMR process created by SB 863.
NPR reports that “Stevens tripped on a rug and broke her foot as she carried boxes of magazines. The relatively simple break triggered serious nerve damage and she was eventually diagnosed with chronic or complex regional pain syndrome.” She claims to be mostly confined to a wheelchair and the NPR photograph shows her using a custom wheelchair ramp leading to her van. She was awarded total permanent disability.
A dispute arose between Stevens and SCIF about two years ago over her medical care. For several years applicant had the assistance of a home health aide and used certain medications prescribed by Dr. Jamasbi to relieve her symptoms. In late 2012, the home health aide assisting applicant was injured and was unable to continue to provide those services. This led Dr. Jamasbi to submit a Request For Authorization (RFA) to defendant for a new home health aide along with a request to refill four prescriptions which were submitted to UR and denied. The request was also denied after the IMR process which took seven months to complete. In this case, the IMR determination states that that “Medical treatment does not include home maker services like shopping, cleaning, and laundry, and personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care needed.”
The applicant appealed and the WCJ found there was no provision for a reversal of the IMR finding since the labor code provides only limited circumstances upon which IMR can be reversed. The WCAB denied reconsideration in the panel decision of Stevens vs Outspoken Enterprises Inc. One of the key aspects of the Stevens argument was the constitutionality of the IMR process, an issue the California Applicants Attorney Association has been making since passage of SB 863. In response to this challenge, the WCJ found “While the Constitution confers on the Legislature the power to establish a system of workers’ compensation, section 3.5 of article III of the Constitution withholds from administrative agencies the power to determine the constitutional validity of any statute.” The WCAB agreed that it could not rule on the constitutional issue, and denied reconsideration saying “In sum, for purposes of appeal to the WCAB it does not matter whether the reasons given for an IMR determination support the determination unless the appealing party proves one or more of five grounds for appeal listed by the Legislature in section 4610(h) by clear and convincing evidence. Applicant did not do that in this case. The WCJ’s May 27, 2014 denial of applicant’s IMR appeal is affirmed.”
The First District Court of appeal has agreed to hear the case, and this will be the first appellate court to address the constitutional challenge to the IMR process. Briefs have been filed by a great number of Amicus parties including the California Workers’ Compensation Institute, the Property Casualty Insurers Association of America, the California Chamber of Commerce, Voters Injured at Work and the California Applicants’ Attorneys Association.
By the end of January, 2015 the Court of Appeal asked the parties to address some of the constitutional questions. “Under Article XIV, section 4 of the California Constitution, the Legislature “is expressly vested with plenary power, unlimited by any provision of this Constitution, to create, and enforce a complete system of workers’ compensation, by appropriate legislation. . . .” (Cal. Const., art. XIV, § 4 [italics added].) Meanwhile, Article III, section 3 of the California Constitution, governing Separation of Powers, provides: “The powers of state government are legislative, executive, and judicial. Persons charged with the exercise of one power may not exercise either of the others except as permitted by this Constitution.” (Cal. Const., art. III, § 3 [italics added].) And Article I, section 7 of the California Constitution provides: “A person may not be deprived of life, liberty or property without due process of law.” ((Cal. Const., art. I, § 7(a).) With these sections of the California Constitution in mind, the Court invites simultaneous supplemental briefing from the parties and amicus curiae on the following issues: 1. Is the plenary power to enact workers compensation statutes vested in the Legislature by the California Constitution limited by the Separation of Powers Clause of the California Constitution? 2. Does the plenary power to enact workers compensation statutes vested in the Legislature by the California Constitution effect our analysis in evaluating petitioner’s claims under the California Constitution’s Due Process Clause?”
Oral arguments have not yet been scheduled in this case, and it will be months before a resolution. This is however the case to watch for 2015 as the stakes are high. Should IMR be declared unconstitutional a major provision of SB 863 sought by employers will evaporate, and medical disputes will return to the level of the WCAB,