Appellate Case of the Quarter: Esquivel v. WCAB

Tuesday, July 6, 2010 | 0

By Andrea Escalante
Grancell, Lebovitz, Stander, Reubens and Thomas

Recently, the District Court of Appeal granted review to address the issue of whether there is a reasonable geographic limitation on an employer’s risk of incurring liability under the Act with respect to new injuries an employee suffers while en route to or from a medical appointment for examination or treatment of an existing industrial injury. The DCA affirmed the WCAB’s decision to deem non-compensable new injuries arising out of a vehicular accident which occurred outside a “reasonable geographic limitation”.
 
Ms. Esquivel, who lived and worked in San Diego, sustained an industrial injury and was provided treatment by the employer’s designated physician, Dr. Elfenbaum, whose office was a distance of eight miles from the employee’s residence.  She had been visiting her mother in Hesperia on the day of the next regularly scheduled treatment at Dr. Elfenbaum’s office. She began the 130
mile transit to the physician’s office and was barely beyond the Hesperia city limits when she was involved in a serious vehicular accident. The employer denied liability for any indemnity or medical treatment related to this occurrence.  Ms. Esquival claimed that the injuries from the car accident were compensable consequences of her original industrial injury.  The Trial Judge agreed with Ms. Esquivel and, without citing any authority, deemed the car accident injuries compensable.  Defendant appealed and the WCAB reversed the lower Court’s determination.
 
Prior to this decision the law provided virtually unlimited liability on an employer in regards to any injury an employee might suffer en route to any kind of medical treatment relating to the original industrial injury, pursuant to Laines v. WCAB (1975) 40 CCC 365. 

This wide range of liability left the employer with little avail to any successful defense.  The only defense an employer could use was the “deviation standard” adopted by WCAB in Durham Transportation Co. v. WCAB (2003) 68 CCC 469.  Under this standard an injury was not compensable if the employee materially deviated from “a reasonable direct route for a purpose not germane to the medical visit.”  However, this still left the employer with a wide range of liability in geographical terms.
 
It is hardly a surprise that such a blatant display of bias exists in this askew system where the law is designed to favor the employee, but even with that in mind, the employer’s wide range of exposure in regards to this particular issue was beyond the normal bias of the system.  What Esquivel v. WCAB did for employers was to limit this scope of liability and set forth parameters in order to determine if an injury subsequent to an industrial injury is in fact compensable.
 
Ms. Esquivel argued that “no geographic limit” existed for an employer’s liability; however the DCA reasoned that a limitation was implied under LC §4600(c) and CCR §9780(h) which combined to address the reasonable medical treatment owed to an employee and the reasonable geographic area for that treatment, thus indicating that a legislative intent exists to support a reasonable geographical limit on liability.  The DCA determined that an injury sustained subsequent to the original industrial trauma will be compensable if “the employee is traveling a reasonable distance, within a reasonable geographic area, to or from that appointment”. 

This decision by no means creates a balance in the system, but it is a welcome change for the employer community in this state.

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Andrea Escalante is an attorney in the Greater Los Angeles office of the Grancell law firm. This column was reprinted with the firm's permission from its quarterly newsletter, which can be downloaded in its entirity from the firm's website, here: http://grancell-law.com/news.asp