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“When the walls come tumblin’ down” – The Case of Applied Materials and the Effect of Treater Misconduct.

The Applied Materials case is a history of worker’s compensation theory and application since 1983 starting with Le Beof, then Western Growers and going through Hikida and resting with Fitzpatrick. The bottom line is that the system failed this injured worker by having an unprofessional physician handle the treatment for this applicant; the rest is left for history.

Applicant Must Treat Within the MPN when the Defendant Satisfies Access Standards

While the MPN included nine orthopedic doctors, only one would treat back injuries. Therefore, the applicant claimed the MPN did not meet the access standards in 8 CCR 9767.5 and selected a non-MPN physician approximately 70 miles away. The defendant refused to authorize the treatment. Applicant then agreed to select a neurosurgeon from within the MPN. However, that doctor would not accept the applicant as a patient.

SATURDAY NIGHT’S ALRIGHT FOR FIGHTING (BUT NOT FOR UTILIZATION REVIEW)

Utilization Review has been with us for more than 15 years now, showing up first in 2003 when Governor Gray Davis signed SB 228. Thereafter, Governor Schwarzenegger expanded its role in 2004 with the approval of SB 899. Most recently, SB 863 added Independent Medical Review into the mix.

After all these years, you would think that there could not be any aspect of the Utilization Review process left to litigate. This being California Workers’ Compensation, you would be wrong!

WE DO PRACTICE IN A YELLOW SUBMARINE

While this case did accurately reflect the law, these types of problems can be negotiated with an Applicant’s attorney and should be so negotiated. Such negotiations deal with the extent of mileage reimbursement or for the number of treatments for the applicant.

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