From the Desk Of: Scott M. Tilley, Esq.
Managing Attorney, San Bernardino
Certified Specialist, Workers' Compensation Law,
The State Bar of California,
Board of Legal Specialization
You might recall the King case from our case law update of several years ago. It was a BIG DEAL. We worried as we told you the decision and we wondered what impact it might have on our workers' compensation system. Well, the California Supreme Court has chimed in and the end of the world has been averted.
As you might recall, Mr. Kirk King was an applicant whose medication (Klonopin) was non-certified by utilization review. The medication was abruptly cut off (no weaning) and Mr. King suffered serious ramifications including four seizures. Mr. King and his wife both filed suit in superior court against the UR vendor, CompPartners, and the UR doctor, Dr. Sharma. The Kings claimed negligence, professional negligence, loss of consortium and intentional and negligent infliction of emotional distress. We were worried that this suit would devastate the utilization review process.
Well, no need to worry any longer. The Supreme Court has found that workers' compensation is the exclusive remedy and that extends to the ramifications of utilization review. So, any adverse effects of the utilization review process is subject to workers' compensation and not the tort remedies found in civil court.
An upside of this lawsuit is that many utilization review organizations have taken a new view on medication denials. Most UR vendors are now incorporating weaning procedures with medications that have a potential for withdrawal symptoms. It was a scary ride for defendants, but the end result is a positive one