Despite the best efforts to carefully draft Stipulations with Request for Award to limit liability for medical treatment to only the specific body parts and/or conditions accepted, it may not be enough to stop an award for medical treatment to additional body parts that have been deemed a compensable consequence of the original injury. 

The case Shaw v. Automobile Club of Southern California, 2023 Cal. Wrk. Comp. P.D. LEXIS 253 (Appeals Board noteworthy panel decision), reminds us of the WCAB’s jurisdiction to award medical treatment for new conditions that are compensable consequences of the original injury despite the language contained in the stipulations.

In Shaw, applicant suffered an industrial injury to her cervical spine, bilateral wrists and psyche/adjustment disorder on April 2, 2012. The case settled by Stipulations with Request for Award on January 14, 2016 and included the language: “This Stipulated Award specifically limits the defendant’s liability for future medical care to only the body parts of psyche/adjustment disorder, cervical spine, and bilateral carpal tunnel syndrome post release surgery.” 

More than five years after the Stipulated Award was issued, applicant’s doctor submitted a request for treatment for the bilateral knees, with a diagnosis of bilateral knee pain and gait disorder. Defendant issued a “Notice of Deferred RFA” noting that the only accepted body parts are the cervical spine and bilateral wrists. The parties proceeded to hearing on the issue of medical treatment and the trial judge found jurisdiction to determine applicant’s entitlement to medical treatment and awarded the requested treatment. Defendant sought reconsideration primarily arguing that the treatment should be found non-industrial, and the issue of medical necessity submitted to UR.

Addressing the issues of the UR deferral, the panel concluded that the notices were defective and untimely since there was no indication that they were served in the applicant per Cal. Code Reg., tit. 8, § 9792.1(b), which requires the deferral to be served upon the applicant where the applicant is represented by counsel. 

The panel then turned to the reporting from the primary treating physician’s opinion that the applicant’s knee pain/gait was a compensable consequence of the injury to the accepted cervical spine. The panel noted that “Future medical care in a stipulated award must always necessarily include future medical care for treatment that is found to be a compensable consequence resulting from the original industrially injured parts.” They went on to state “This right cannot be bargained away by the parties.”

Finally, the panel reminded the parties that there have been several cases that have found the WCAB to have jurisdiction to award treatment for new conditions that are compensable consequences of the initial injury, even if the condition was not part of the original award and if the first request for treatment is more than five years after the date of injury. Pirelli Armstrong Tire Co. v. WCAB (Van Zant) (2003) 68 CCC 970 (writ denied) concluded that Labor Code §4600 makes an employer liable for all “medical, surgical, chiropractic, acupuncture, and hospital treatment . . . that is reasonably required to cure or relieve from the effects of the injury . . .” This may include treatment for non-industrial conditions that must be treated to address the industrial injury.

Although this decision does not address any new or novel issues, it does serve as a reminder that not even the most carefully drafted stipulated award can limit the scope of further medical treatment and that the WCAB retains jurisdiction to award the treatment, even after the five years post injury has run, if the new condition is found to be a compensable consequence of the original injury and the treatment is necessary to cure or relieve the effects of the injury.