In a continuing effort to make your life easier, an applicant’s attorney is claiming that a treating physician’s recommendation of medical treatment, in this case in-home care, dates back to the date of injury, five years ago!
What are you to do?
Well, in a turn that has left your somewhat-less-now-than-before cynical blogger a bit surprised, a Workers’ Compensation Judge and the Workers’ Compensation Appeals Board have sided with justice, fairness, and (the third of this wonderful trio) the employer!
In the case of Gloria Arana v. Hawthorne School District, a teacher’s aide sustained an injury in the year 2000 which, after a surgery in 2002, rendered her 100 percent permanently disabled.
The treating physician, and it appears there were no qualified or agreed medical evaluators used in this case, recommended in-home support eight hours per week and out-of-home support, such as grocery shopping, four hours per week. This was a 2007 report, and the treatment recommendation was for 2002 and ongoing.
Defendant was faced with a demand for reimbursement of roughly 3000 hours of home care, and the continuing award of treatment for the “foreseeable future.”
The defense did not dispute the obligation to provide medical treatment in the future, but naturally objected to liability for treatment “prior to the date of a medical report establishing [the medical treatment’s] need.”
Any other result would have been ridiculous – the employer would have had no opportunity to contest the necessity of the medical treatment, negotiate a cheaper price from one of its providers, or rely on any of the other defenses usually available in such situations. Unfortunately, history has shown that a preposterous result is not one to make the workers’ compensation system flinch.
Let a full-fledge WCDefenseCA salute issue to the WCJ and the WCAB for their wise and proper decision in this case.
Greg,
Not having read the decision, I wonder, who provided over 3000 hours of care and never billed for it? Was it provided by friends, neighbors or relatives just to help out? Did the employer pay for any of the care that was provided prior to the decision? If not, were liens filed? I don’t disagree with the decision per se, but there’s something missing here. Seems to me the treating physician blew it by not asking for the care during the course of treatment. Maybe the treating physician was afraid they’d be kicked out of the MPN?
Steve,
Generally, the in-home care is provided by a spouse or family member. In some cases, I have seen the medical recommendation of 24 hour in-home care, where the non-injured family member is able to quit his or her job and work “full time” taking care of the injured family member.
In this case, the in-home care was for chores around the house (cooking, cleaning) and the out-of-home care was for things like grocery shopping, dry-cleaning, etc. It looks like applicant’s husband was taking care of these things for those five years and after the date of the report as well.
I don’t know if the doctor would have been afraid to get kicked out of the MPN. The opinion doesn’t go over whether or not the defendants had an MPN at all, and the doctor made the award eventually, suggesting MPN membership was not a major concern. From what I gather, the employer was paying for medical treatment in general, just not this particular recommendation until the date of the report.
Would you like me to e-mail you a copy of the panel opinion?
He stole this page directly from the Michigan Attendant Care Playbook. If you want a good read on where CA is going with this, look no further than Michigan Attendant Care case law and the insane case profferred in that jurisdiction in the same vein.
Where can we find the case of Gloria Arana v. Hawthorne School District? What is the citation?