California Appeals Court Upholds Cap on Workers’ Comp Treatments

June 5, 2008

A Court of Appeal in California has rejected a constitutional challenge to the number of visits a worker is entitled to for chiropractic, physical therapy or occupational therapy visits under the state’s workers’ compensation rules.

According to Jose Facundo-Guerrero v. Workers’ Compensation Appeals Board, Nurserymen’s Exchange et al., Facundo-Guerrero received 76 chiropractic treatments following an industrial injury that occurred while he was working for Nurserymen’s Exchange, whose insurer was Argonaut Insurance Co.

California statute limits the number of visits, unless approved by an injured employee’s employer, to no more than 24 visits per industrial injury for chiropractic treatments, physical therapy sessions and occupational therapy.

Facundo-Guerrero argued that the rule violates the state constitution’s mandate to implement a “‘complete system of workers’ compensation,’ including ‘full provision for such medical, surgical, hospital and other remedial treatment as is requisite to cure and relieve from the effects of such injury,'” court documents state. He filed a writ of review after a Workers’ Compensation Appeals Board decision determined that he was entitled to benefits covering only 24 chiropractic visits.

The Court of Appeal said, “By limiting benefits, the [workers’ compensation] reforms had the clear purpose of alleviating ‘a perceived crisis in skyrocketing workers’ compensation costs.’ … The Legislature’s decision to reduce the unlimited availability of chiropractic treatments to workers’ compensation claimants is rationally related to that effort.”

“[I]t is abundantly clear that as a matter of law, Section 4 neither restricts the Legislature’s ability to limit the number of chiropractic treatments for which the workers’ compensation system must be financially responsible, nor does it expand an injured worker’s constitutional rights to include an entitlement to receive unlimited treatments,” the court added. The court said it would not second-guess the Legislature’s wisdom in enacting the workers’ compensation reforms as amendments to the constitution. Thus, it rejected the constitutional challenge and affirmed the decision of the WCAB.

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Source: California Courts

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