Daily Blast November 14, 2013

Today, the California Supreme Court issued an opinion in Valdez v. Workers’ Compensation Appeals Board and Warehouse Demo Services, et al. (November 14, 2013, S204387) __ Cal.4th __, analyzing whether “[Labor Code] section 4616.6 applies only in proceedings to resolve diagnosis and treatment disputes under article 2.3, or more broadly in proceedings to determine disability benefits.” (Slip opn., p. 3.) The Supreme Court held “that section 4616.6 restricts the admission of medical reports only in proceedings under article 2.3 to resolve disputes over diagnosis and treatment within [a medical provided network].” (Id. at p. 11.)

The employee sustained injury from a fall while at work. (Slip opn., p. 4.) The employee began treatment with a physician in her employer’s medical provided networks (“MPN”), but was dissatisfied. (Ibid.) The employee did not exercise her right to change physicians within the network or seek a second or third opinion from an MPN doctor, but rather undertook treatment with Dr. Nario, a doctor outside the network. (Ibid.) The employee applied for temporary disability benefits relying on reports by Dr. Nario. (Ibid.) “Her employer objected that reports from non-MPN doctors were inadmissible under section 4616.6 for purposes of the disability hearing.” (Ibid.) The worker’s compensation judge (“WCJ”) overruled the objection, “stating that ‘records from treating doctors have always been admissible.’” (Ibid.) The Workers’ Compensation Appeals Board (“the Board”) granted reconsideration en banc and rescinded the WCJ’s decision. (Ibid.) The Board “held that section 4616.6 precluded the admission of reports from any doctor outside the MPN.” (Ibid.) On review, the Court of Appeal annulled the Board’s decision and concluded that “section 4616.6 pertains only to the independent medical review process for resolving controversies over treatment and diagnosis within an MPN.” (Id. at p. 6.) The California Supreme Court granted review. (Id. at p. 7.)

The Supreme Court stated that “section 4616.6 broadly to apply to all compensation proceedings is a manifest distortion.” (Slip opn., p. 9.) The Legislature specified that “‘additional examinations shall be ordered by the appeals board and no other reports shall be admissible to resolve any controversy arising out of this article.’” (Id. pp. 8-9.) Thus, the Legislature limited “the evidentiary exclusion to proceedings under article 2.3.” (Id. at p. 9.) Further, the recent reforms enacted by the Legislature indicate that it ”did not revise section 4616.6 to extend its reach beyond article 2.3 proceedings.” (Id. at pp. 9-10.) Although the “statutory changes may encourage employees to use MPN services … they do not foreclose other avenues of treatment, or bar the Board from considering medical reports generated outside of an MPN when it reviews applications for disability benefits.” (Id. at pp. 10-11.) Accordingly, the Supreme Court affirmed the Court of Appeal’s judgment. (Id. at p. 11.)

Related Practices

• Appellate