King v. CompPartners, Inc.
236 Cal. Rptr. 3d 853
| Cal. | 2018Background
- Kirk King sustained a compensable workplace back injury and was prescribed Klonopin for resulting anxiety/depression.
- CompPartners-employed physician Dr. Sharma performed utilization review in July 2013 and decertified King’s Klonopin as not medically necessary; no weaning plan or withdrawal warnings were given.
- King stopped the medication and suffered four seizures; a later utilization review by another CompPartners psychiatrist again decertified Klonopin without a weaning plan.
- King and his wife sued CompPartners and Dr. Sharma for negligence, professional negligence, intentional/ negligent infliction of emotional distress, and loss of consortium.
- Trial court sustained defendants’ demurrer (no leave to amend); Court of Appeal affirmed demurrer but allowed leave to amend as to failure-to-warn; the Supreme Court granted review.
- The Supreme Court held workers’ compensation exclusivity bars the tort claims arising from the utilization review process and reversed the Court of Appeal’s allowance to amend the failure-to-warn claim.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether injuries from defendants’ utilization review decisions are preempted by workers’ compensation exclusivity | King: injuries (seizures) resulted from review decisions and thus may be pursued in tort | Defendants: injuries are collateral/derivative of a compensable industrial injury and fall within WCA exclusivity | Held: Preempted — injuries arose in course of statutorily required utilization review and are compensable only under WCA |
| Whether utilization reviewers (and their organizations) are protected from tort suits as agents/alter egos of the employer | King: reviewers are third parties and thus subject to tort liability | Defendants: reviewers perform statutorily required employer functions and are treated as acting on employer’s behalf; exclusivity applies | Held: Utilization reviewers act on behalf of employers for WCA purposes; exclusivity bars tort claims against them |
| Whether a failure-to-warn claim is distinct from a medical-necessity decision and escape preemption | King: failure to warn is not a medical-necessity determination and lies outside statutory review process | Defendants: communication/content of denial and warnings are governed by the utilization review statute | Held: Failure-to-warn still arises within the utilization review process and is preempted |
| Whether plaintiffs should have been granted leave to amend to plead facts showing defendants ‘‘stepped outside’’ the statutory role | King: additional factual allegations (e.g., nurse-drafted decision, wrong physician notified) could state a non-preempted tort | Defendants: those alleged procedural errors remain within risks encompassed by WCA | Held: Leave to amend as to failure-to-warn was improper; the alleged errors do not rebut exclusivity absent facts showing defendants stepped outside statutorily defined role |
Key Cases Cited
- Charles J. Vacanti, M.D., Inc. v. State Comp. Ins. Fund, 24 Cal.4th 800 (2001) (WCA exclusivity covers injuries collateral to compensable industrial injuries and claims arising from claims process)
- Snyder v. Michael’s Stores, Inc., 16 Cal.4th 992 (1997) (workers’ compensation liability in lieu of other liability for work-related injuries)
- Unruh v. Truck Ins. Exchange, 7 Cal.3d 616 (1972) (insurer acting within compensation scheme is treated as employer/alter ego for exclusivity)
- Marsh & McLennan, Inc. v. Superior Court, 49 Cal.3d 1 (1989) (independent claims administrators performing statutory WC functions are shielded by exclusivity)
- South Coast Framing, Inc. v. Workers’ Comp. Appeals Bd., 61 Cal.4th 291 (2015) (broad industrial causation principles: compensable injuries include those caused by medical treatment of industrial injury)
- Weinstein v. St. Mary’s Medical Center, 58 Cal.App.4th 1223 (1997) (distinguishing injuries outside employment relationship where employer acts in non-employer capacity)