Frances Stevens v Workers’ Compensation Appeals BoardDoes Independent Medical Review Violate an Employee’s Due Process?

The California First District Court of Appeal this week upheld the constitutionality of the independent medical review (IMR) process, stating that the process comports to the state constitution to allow due process and equal protection by being “fundamentally fair and affording workers sufficient opportunities to present evidence and be heard.”

Frances Stevens was permanently disabled by an industrial injury and coverage for her workers’ compensation benefits by her employer were provided by the State Compensation Insurance Fund (SCIF). A SCIF utilization reviewer denied Stevens’ doctor’s recommendation that she receive home health care assistance and medication management and Stevens appealed through the IMR process which upheld the UR decision. Stevens then requested a judicial review of the IMR decision, claiming that the IMR process is unconstitutional since the IMR decision maker is anonymous, and appeals of the IMR decision are meaningless because there is limited judicial review of the IMR decision.

SCIF argued this claim, stating that the process puts important medical decisions “in the hands of unbiased medical experts… to administer justice expeditiously to more injured employees” and that IMR is producing faster, less expensive and more high quality treatment decisions than the predecessor process by which treatment dispute decisions were made by workers’ compensation judges.

The Court of Appeal ruled that IMR falls within the scope of the State Legislature’s absolute power to create a workers’ compensation system and that no grounds exist for the claim that a lack of an enforcement system for statutory time limits for the IMR contractor to return a decision makes the process unconstitutional. Specifically, the Court opined, “that her state constitutional challenges fail because the Legislature has plenary powers over the workers’ compensation system under article XIV, section 4 of the state Constitution (Section 4). And we conclude that her federal due process challenge fails because California’s scheme for evaluating workers’ treatment requests is fundamentally fair and affords workers sufficient opportunities to present evidence and be heard.”

Larkin v Workers’ Compensation Appeals Board
Do LC §4458.2 Benefits Extend to Regularly Sworn Peace Officers?

The California Supreme Court has upheld a decision by the Court of Appeal that workers’ compensation benefits provided under Labor Code §4458.2 extend only to volunteer peace officers and not to regularly sworn officers.
John Larkin, a sworn police officer for the City of Marysville, was injured in the line of duty and was awarded $1,008.47/week by a workers’ compensation judge (WCJ), or two-thirds of his average weekly earnings. Larkin challenged the award, claiming that the plain language of LC §4458.2 provides the maximum temporary disability (TD) rate for sworn, salaried peace officers.

Of note, LC §4458.2 provides workers’ compensation benefits to any active peace officer of any department as described in LC §3362 who suffers death or injury when in performance of his or her duties as a peace officer. Those benefits are provided at the maximum TD or permanent disability rates. Of importance, LC §3362 specifies that any active police person of any regularly organized police department fully or partially supported by a public agency where the department is located must, upon adoption of a resolubtion by the governing body, be considered an employee of that jurisdiction and can receive compensation.

The WCAB disagreed with Larkin’s argument, upholding the WCJ decision and denying Larkin’s petition to reconsider the award. The Court of Appeal then affirmed the WCAB decision, stating that it interpreted the underlying policy considerations of LC §4458.2 to reflect legislative interest in encouraging volunteer service for public agency fire and policing services because, it concluded, LC §3362 “performs a limiting function” to LC §4458.2, which does not explicitly exclude its application to sworn officers.