Under current workers compensation law, utilization reviewers, acting on behalf of employers, determine whether the plan recommended for the treatment of an employee’s industrial injury is medically necessary after consulting a schedule of uniform treatment guidelines. If the utilization reviewer concludes that a recommended treatment is not medically necessary, he may modify or deny the treatment request. (Lab. Code, § 4610.) This decision holds that the worker’s compensation system preempts tort claims by a worker against a utilization reviewer for improper denial or modification of his treatment plan.
California Supreme Court (Kruger, J.; Liu, Cuellar & Grover, JJ., concurring); August 23, 3018; 5 Cal. 5th 1039