Smith v. W.C.A.B.

• Decision Date: 11 May 2009
• Docket Number: No. S150528.,S150528.
• Citation: 92 Cal.Rptr.3d 894,206 P.3d 430
• Court: California Supreme Court
• Parties: Dwight SMITH, Petitioner, v. WORKERS' COMPENSATION APPEALS BOARD and Department of Corrections and Rehabilitation, Juvenile Justice et al., Respondents. David Amar, Petitioner, v. Workers' Compensation Appeals Board and Mel Clayton Ford et al., Respondents.

206 P.3d 430

92 Cal.Rptr.3d 894

Dwight SMITH, Petitioner, v. WORKERS' COMPENSATION APPEALS BOARD and Department of Corrections and Rehabilitation, Juvenile Justice et al., Respondents.

David Amar, Petitioner, v. Workers' Compensation Appeals Board and Mel Clayton Ford et al., Respondents.

No. S150528.

Supreme Court of California.

May 11, 2009.

William A. Herreras, San Luis Obispo, for Petitioner Dwight Smith.

Ghitterman, Ghitterman & Feld, Allan S. Ghitterman, Russell R. Ghitterman and Benjamin P. Feld, Santa Barbara, for Petitioner David Amar.

No appearance for Respondent Worker's Compensation Appeals Board.

Robert W. Daneri, Suzanne Ah-Tye, San Francisco, Don E. Clark and David M. Goi for Respondents Department of Corrections and Rehabilitation, Juvenile Justice, Mel Clayton Ford and State Compensation Insurance Fund.

Raymond G. Fortner, Jr. County Counsel (Los Angeles), Patrick A. Wu, Assistant County Counsel, Leah D. Davis, Principal Deputy County Counsel, Eugenia W. Der, Deputy County Counsel, Rita A. Tchavdarian and Jason E. Waller, Associate County Counsel, for County of Los Angeles as Amicus Curiae on behalf of Respondents Department of Corrections and Rehabilitation, Juvenile Justice, Mel Clayton Ford and State Compensation Insurance Fund.

Law Offices of Saul Allweiss and Michael A. Marks, San Francisco, for California Workers' Compensation Institute as Amicus Curiae on behalf of Respondents Department of Corrections and Rehabilitation, Juvenile Justice, Mel Clayton Ford and State Compensation Insurance Fund.

MORENO, J.

In these consolidated workers' compensation cases, we consider the scope of Labor Code section 4607, which provides: "Where a party to a proceeding institutes proceedings to terminate an award made by the appeals board to an applicant for continuing medical treatment and is unsuccessful in such proceedings, the appeals board may determine the amount of attorney's fees reasonably incurred by the applicant in resisting the proceeding to terminate the medical treatment, and may assess such reasonable attorney's fees as a cost upon the party instituting the proceedings to terminate the award of the appeals board." (Lab.Code, § 4607.¹)

Petitioners obtained awards for future treatment of their industrial injuries. Sometime thereafter, they submitted medical treatment requests, but their employers' insurance carrier disputed their entitlement to the requested care. Petitioners initiated proceedings to obtain the treatment and, ultimately, were determined to be entitled to the requested care. The insurer thereafter authorized the treatment requests. Petitioners subsequently sought attorney fees pursuant to section 4607. Based on the statutory language, the Workers' Compensation Appeals Board (Board) denied the fee requests, but the Court of Appeal reversed. We granted review to resolve whether section 4607 permits an award under these circumstances. In light of the statute's unambiguous language, we conclude it does not. An employer or insurer that disputes a specific treatment request cannot be said to have "institute[d] proceedings to terminate an award ... for continuing medical treatment ..." (§ 4607). Accordingly, we reverse the contrary judgment of the Court of Appeal.

I. FACTS AND BACKGROUND

Smith's Request for Medical Treatment

Dwight Smith sustained industrial injuries from cumulative trauma to his right shoulder, neck and psyche while working for the former California Youth Authority (now the Juvenile Justice section of the Department of Corrections and Rehabilitation).² In 1997, by stipulation, Smith was awarded partial permanent disability indemnity and future medical treatment.

Eight years later, State Compensation Insurance Fund (SCIF) refused to authorize a request for epidural injections to his back. Smith contacted the attorney who filed his original workers' compensation claim and the attorney sought utilization review (§ 4610). Pursuant to court order, Smith was examined by an agreed medical examiner, who concluded he needed the injections to relieve his back pain, which was precipitated by his industrial injuries. SCIF authorized the injections without a formal hearing.

Citing section 4607, Smith subsequently sought attorney fees. The workers' compensation judge denied the request, concluding the statute did not authorize an award because SCIF had not instituted proceedings to terminate Smith's award of medical treatment. In a split decision, the Board denied Smith's petition for reconsideration. The majority concluded fees would be available to an applicant who is forced to challenge an insurer's complete refusal to authorize future treatment covered by an award. But, because SCIF disputed only part of Smith's care, the statute did not authorize an award of fees.

Amar's Request for Medical Treatment

Amar sustained an injury to his right foot while working as a car salesman for Mel Clayton Ford. In 2004, by stipulation, Amar was awarded partial permanent disability indemnity and future medical care. Amar thereafter received treatment for weight loss and diabetes, both of which treatments were related to alleviating his foot injury.

Based on further utilization review, SCIF refused to pay for additional medical care for the diabetes or weight loss program. Amar, assisted by the attorneys who had filed his original workers' compensation claim, instituted proceedings to obtain the sought treatment. A workers' compensation judge found the weight loss program remained medically necessary to relieve the effects of the injury, but that continued treatment for diabetes was unnecessary for that purpose. The judge ordered the weight loss program reinstated.

Citing section 4607, Amar sought an award of attorney fees. The workers' compensation judge ruled the statute was inapplicable and denied the request. On reconsideration, the judge found SCIF had made a good faith denial of medical care, had not refused to provide necessary medical care or engaged in unreasonable delay in providing care, and had not improperly denied previously awarded treatment. The judge recommended section 4607 fees be denied. The Board adopted the workers' compensation judge's report, and denied reconsideration.

Smith and Amar filed petitions for review. The Court of Appeal granted, and consolidated, the two petitions. It reversed the Board's decisions and concluded section 4607 authorizes an award of attorney fees to an employee who successfully challenges an employer or insurer's denial of a specific request for medical treatment. We granted respondents' petition for review.

II. DISCUSSION

We independently review the construction of workers' compensation statutes. (State Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (2008) 44 Cal.4th 230, 236, fn. 6, 79 Cal.Rptr.3d 171, 186 P.3d 535.) We typically give great weight to the Board's construction of the statutes it is charged to enforce and interpret; we will, however, annul clearly erroneous interpretations. (Ibid.)

When interpreting any statute, it is well-settled that we begin with its words "because they generally provide the most reliable indicator of legislative intent." (Hsu v. Abbara (1995) 9 Cal.4th 863, 871, 39 Cal. Rptr.2d 824, 891 P.2d 804.) If the language is clear and unambiguous, there is ordinarily no need for judicial construction. (Murphy v. Kenneth Cole Productions, Inc. (2007) 40 Cal.4th 1094, 1103, 56 Cal.Rptr.3d 880, 155 P.3d 284.) In construing a provision, "we presume the Legislature meant what it said" and the plain meaning governs. (People v. Snook (1997) 16 Cal.4th 1210, 1215, 69 Cal. Rptr.2d 615, 947 P.2d 808.) We remain mindful, however, that workers' compensation statutes are to be liberally construed in favor of the injured worker. (§ 3202; Claxton v. Waters (2004) 34 Cal.4th 367, 373, 18 Cal.Rptr.3d 246, 96 P.3d 496.) With these principles in mind, we consider the scope of section 4607.

The statutory language is unambiguous. It only authorizes an award of attorney fees when a party "institutes proceedings to terminate an award. ..."³ (§ 4607, italics added.) Petitioners nonetheless argue the language also permits an award of fees to an employee who successfully challenges the denial of a particular treatment request. We disagree. When a party institutes termination proceedings, it challenges the continuing necessity for the Board's award of future treatment. By contrast, when an employer or insurer denies a specific treatment request, it challenges whether the sought medical care is "reasonably required to cure or relieve the injured worker from the effects of his or her injury ...." (§ 4600, subd. (a).) The difference between the two concepts is illustrated by our decision in Barnes v. Workers' Compensation Appeals Board (2000) 23 Cal.4th 679, 97 Cal.Rptr.2d 638, 2 P.3d 1180 (Barnes).

In that case, an injured employee obtained an award for future treatment in 1982. (Barnes, supra, 23 Cal.4th at p. 682, 97 Cal. Rptr.2d 638, 2 P.3d 1180.) Thirteen years later, after an agreed medical examiner concluded the employee's continuing pain was not traceable to the original injury, the employer and its insurer filed a petition to terminate the award. (Id. at pp. 682-683, 97 Cal.Rptr.2d 638, 2 P.3d 1180.) The workers' compensation judge granted the petition and the Board and the Court of Appeal affirmed. (Id. at pp. 683-684, 97 Cal.Rptr.2d 638, 2 P.3d 1180.) We reversed, explaining that section 5804, which contains a five-year statute of limitations for rescinding, altering, or amending an award, deprived the Board of jurisdiction. (Barnes, supra, 23 Cal.4th at p. 686, 97 Cal.Rptr.2d 638, 2 P.3d 1180.) We noted, however, that while it no longer had jurisdiction to terminate the award, the Board retained jurisdiction "to determine whether a particular medical treatment ... is justified to treat [an employee's] industrial injury." (Id. at p. 687, 97 Cal.Rptr.2d 638, 2 P.3d 1180.) Thus, we distinguished between...