Wednesday, October 14, 2009
C.A. Limits Workers’ Compensation for New Injuries
Says Harm Suffered During Travel to Treatment Covered Only if Distance ‘Reasonable’
By STEVEN M. ELLIS, Staff Writer
A San Diego woman on workers’ compensation was not entitled to additional benefits for a new injury suffered during a trip to a medical appointment because it occurred during her return from a family visit nearly 140 miles away, the Fourth District Court of Appeal ruled yesterday.
Div. One held that the Workers’ Compensation Act impliedly sets a geographic limitation on an employer’s risk of incurring compensability liability with respect to new injuries suffered while en route to or from treatment of an existing industrial injury.
Writing for the court, Justice Gilbert Nares said that the determination of the boundaries of the applicable “reasonable geographic area” limitation and what constitutes a “reasonable distance” must be made on a case-by-case basis considering all relevant circumstances.
Correctional officer Tania Esquivel—who was being treated for industrial injuries by medical providers located within eight miles of her home—suffered serious new injuries in 2007 when she drove through a stop sign while en route from her mother’s home in San Bernardino County to the providers’ offices.
Esquivel was visiting her mother in Hesperia for reasons unrelated to her treatment.
A workers’ compensation judge found that Esquivel’s motor-vehicle-collision injuries were a compensable consequence of her existing industrial injuries and awarded her temporary disability indemnity and additional medical benefits.
The Workers’ Compensation Appeals Board then granted a petition for reconsideration by Esquivel’s employer and its insurer, finding that the accident occurred too remotely from Esquivel’s home and her destination to reasonably assign the risk of injury en route to the employer.
Esquivel argued on appeal that there is no geographic limit on risk of liability for new injuries suffered en route to treatment of an existing industrial injury so long as the employee does not materially deviate from a reasonably direct route to the medical appointment, and contended she made no such deviation.
However, the Court of Appeal agreed with the board and affirmed.
Esquivel’s argument, Nares wrote, “[t]aken to its logical conclusion…would render compensable an injury suffered by a San Diego employee who, for reasons unrelated to her need for statutorily required medical care, elects to travel from her home in San Diego to the East Coast, and then substantially increases her risk of injury (and her employer’s risk of incurring compensability liability) by riding a motorcycle back to San Diego—without a material deviation from a reasonably direct route from her East Coast starting point—to attend a medical appointment for treatment of her existing industrial injuries.
“We see no reason why an employer should bear the increased risk of extended travel when it is unrelated to the employee’s need for medical treatment.”
Examining the act and its implementing regulations, Nares also noted that an employee’s qualified right to be treated by a physician or facility of the employee’s choosing after an initial 30-day period, like the employer’s obligation to pay for such treatment, is generally limited under Labor Code Sec. 4600(c) to a “reasonable geographic area.”
He further pointed out that implementing regulations mandate that certain factors—including the employee’s places of residence and employment, and the place where the injury occurred—be considered in determining a “reasonable geographic area,” and that other provisions of the act supported such a limitation.
Concluding that the Legislature intended a rule of geographic reasonableness, Nares declined, however, to adopt a specific test for determining either the boundaries of the reasonable geographic area limitation or what constitutes a reasonable distance.
He commented that relevant circumstances include the locations of the employee’s residence and workplace, the employee’s attorney’s office and the medical provider’s office, and the location where the new injury occurred.
Other circumstances, he said, include the distance between the employee’s point of departure and the medical provider’s office along a reasonably direct route, the additional distance the employee traveled in the event of a deviation from that route, the availability of medical providers, and the reason for the employee’s travel beyond a reasonable geographic area.
Justices Terry B. O’Rourke and Justice Cynthia Aaron joined Nares in his opinion.
The case is Esquivel v. Workers’ Compensation Appeals Board, 09 S.O.S. 5982.
Copyright 2009, Metropolitan News Company