California Court Provides Leave to Amend Complaint When Plaintiff Potentially Alleged Non-Preempted Claim Under Workers Compensation Act

In a recent case before the California Court of Appeal, the court addressed whether personal injury claims against an employer were preempted by the Workers’ Compensation Act.  The injured employee in this case alleged professional negligence, emotional distress, and other causes of action stemming from injuries he suffered after his employer’s physicians both terminated his prescription medication and failed to indicate the need to wean off the medication. Additionally, the court also analyzed whether a duty of care existed between the plaintiff and the physicians reviewing the plaintiff’s use of a prescription medication.

Plaintiff Kirk King brought a lawsuit against CompPartners, Inc. and Naresh Sharma, M.D., alleging negligence, professional negligence, intentional infliction of emotional distress, and negligent infliction of emotional distress. Mr. King’s wife, Sara King, sued the defendants for loss of consortium.  The trial court sustained the defendants’ demurrer without leave to amend.

On appeal, the Kings raised three issues.  First, they alleged that the Workers’ Compensation Act (WCA) did not preempt their claims. Second, they contended the defendants owed them a duty of care. Third, they alleged the trial court erred by denying them leave to amend.

Mr. Kirk had suffered a back injury while at work.  His chronic back pain resulting from the injury led to anxiety and depression.  He was prescribed Klonopin, a psychotropic medication, which was provided through workers’ compensation.

Following a workers’ compensation utilization review, Dr. Sharma concluded that Klonopin was unnecessary, and he decertified it.  Mr. King was required to immediately cease his use of the Klonopin. While patients typically withdraw slowly from Klonopin use, Mr. King immediately stopped his use and suffered four seizures, resulting in physical injuries.

Months later, another utilization review took place to determine whether Mr. King should be permitted to take Klonopin. Neither physician during either review examined Mr. King in person, nor was he warned about the dangers of an abrupt withdrawal from the medication. CompPartners employed both physicians and was a workers’ compensation utilization review company.

In their demurrer, the defendants contended that the claims were preempted by the WCA because they arose out of a utilization review. Additionally, since there was no personal examination of Mr. King, the defendants alleged there was no doctor-patient relationship and no duty of care owed to Mr. King.  In opposition, the Kings stated their claims were based on the failure to provide Mr. King a regime for weaning from the Klonopin, and they were not based on the decision to decertify the Klonopin.

The appellate court stated that the workers’ compensation utilization review process is a process in which employers use their own doctors to review treatment requests for injured workers.  The process includes a procedure for resolving any treatment request disputes, and an employee can request review by an independent medical evaluator.

With regard to preemption, the appellate court stated that California courts hold workers’ compensation proceedings as the exclusive remedy for an injured employee’s claim, if the accident or illness occurred within the course of the employee’s job and was proximately caused by the job.  In other words, tort claims that are not part of the employment relationship may not be preempted by the WCA.

Here, Mr. King suffered a back injury at work, and then Dr. Sharma failed to warn Mr. King about gradually stopping his medication. This failure resulted in Mr. King suffering seizures.  These seizures did not occur in the course of Mr. King’s job, and there were no allegations Mr. King was working when he suffered the seizures.  The injury was not proximately caused by Mr. King’s job, since the cause of the seizures was the failure to warn of a weaning regime for the medications.

The court concluded that if the Kings allege that Dr. Sharma failed to warn of the dangers of stopping medication, that claim is not preempted by the WCA.  It is beyond the “medical necessity” determination made by Dr. Sharma.  However, if the Kings fault Dr. Sharma for incorrectly making the “medical necessity” decision because Klonopin should have been provided for weaning, the WCA preempts the claims because the Kings are directly challenging Dr. Sharma’s medical necessity determination. This decision is part of the claims process and therefore preempted by the WCA.

The appellate court stated that the trial court properly sustained the demurrer, since the allegations in the complaint are uncertain. But the court erred in denying the Kings leave to amend.  There is a possibility the causes of action are not preempted.

Regarding whether Mr. King was owed a duty of care, the court stated that a utilization review doctor has a doctor-patient relationship with the individual whose medical records are being reviewed.  There is a doctor-patient relationship between Mr. King and Dr. Sharma, and therefore Dr. Sharma owed Mr. King a duty of care. The court stated the scope of this duty depends on the facts of the case. Here, the complaint alleged few facts, and it was not clear how Mr. King learned of the decertification of his medication. Furthermore, it was unclear if Dr. Sharma was the only doctor involved in the decision. Due to the lack of factual allegations concerning the duty, the scope cannot be determined from the Kings’ complaint.  The trial court therefore properly sustained the demurrer.  It is possible that if the Kings amend their complaint and provide evidence that Dr. Sharma’s duty included warning Mr. King or protecting him from seizures, they could cure the problems presented by the complaint.

In conclusion, the appellate court sustained the demurrer but remanded the case for the Kings to file an amended complaint.

At Sharifi Firm, our attorneys help victims of workplace accidents throughout Southern California assert their right to compensation. We provide a free, confidential consultation and can be reached by calling 866-422-7222.

More Blog Posts:

California Court Holds State Workers’ Compensation System Provides Injured Employees Ample Opportunity for Review and Does Not Violate State Constitution, Southern California Injury Lawyer Blog, November 17, 2015

California Court of Appeals Holds Cumulative Injuries within the State Provide Legitimate Relationship to Invoke Worker’s Compensation Laws, Southern California Injury Lawyer Blog, October 7, 2015

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