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Medical reports from out-of-network doctors are admissible as evidence in California workers compensation cases, the California Supreme Court has ruled.
In Elayne Valdez v. Workers' Compensation Appeals Board et al., Ms. Valdez was injured when she fell while working for Warehouse Demo Services Inc., court records show. She initially was treated by a doctor in her employer's medical provider network but was unsatisfied with that provider's care.
Ms. Valdez later was treated by another physician who was recommended by her attorney, but was not in her employer's provider network, records show. Reports from the non-network doctor were used as evidence in Ms. Valdez's application for temporary disability workers comp benefits.
Warehouse Demo Services, which was insured by Zurich North America, argued that reports from Ms. Valdez's out-of-network doctor were inadmissible in workers comp hearings, records show. However, a California workers comp judge ruled that “records from treating doctors have always been admissible” and awarded benefits to Ms. Valdez.
An en banc panel of the California workers comp appeals board reversed the judge's decision, saying that only reports from network providers can be admitted in workers comp cases, records show. That ruling was overturned by the California Court of Appeal, which found that barring reports from any “privately retained physicians would eviscerate employees' right under (California law) to consult with any doctor at their own expense.”
In a unanimous decision Thursday, the California Supreme Court upheld the appellate court ruling. In its ruling, the court said California law states that “no party is prohibited from obtaining any medical evaluation or consultation at the party's own expense,” and that all “comprehensive medical evaluations obtained by any party shall be admissible in any proceeding before the appeals board.”
“The employer's attempts to transform (California comp law) into a general rule of exclusion rest largely on its insistence that (provider networks), when established, must be the exclusive source of diagnosis and treatment for injured employees,” the ruling reads. “The Legislature has imposed no such requirement.”
The case was remanded to the state workers comp appeals board for further proceedings.
California's Workers' Compensation Insurance Rating Bureau is expected to propose an 8.6% pure premium rate increase effective Jan. 1, 2014, subject to the approval of its governing committee, which meets on Wednesday.