Appeals Court Applies Reasonableness Test in Esquival

Tuesday, October 20, 2009 | 0

By Richard M. Jacobsmeyer

The 4th Appellate District (San Diego) has upheld a WCAB decision that denied benefits to an employee who sustained injury while traveling to a medical appointment where the employee’s route was much longer than the usual trip from home or work to the medical offices.
 
In Esquival v WCAB, the applicant resided in San Diego and was receiving medical care seven to eight miles from her home.  For personal reasons, she traveled to her mother’s home more than 130 miles away. Upon leaving her mother’s home to travel directly to a medical appointment in San Diego, she was involved in a motor vehicle accident and sustained serious injuries.

At the trial on the issue of whether her injuries constituted a compensable consequence of her original injury, she testified she was heading directly from her mother’s home to her appointment more than two hours and 136 miles away.
 
The workers' compensation judge (WCJ) awarded benefits, finding the applicant was traveling to a medical appointment and concluded the differential in distance between this trip and her usual trip for medical care was an irrelevant consideration holding:

"…one may begin a journey to medical treatment from anywhere, not just one's home or workplace," and "[w]hat matters is the patient's intent, not her starting point."
 
The employer appealed the WCJ’s ruling, arguing several issues, including:
 
(1) the WCJ "[f]ail[ed] to set forth reasons or grounds to support a finding that [Esquivel's] motor vehicle accident, which occurred 136 miles from her home, (was) a compensable consequence of her industrial injuries;" (2) the WCJ "incorrectly applied the burden of proof to (defendants) rather than (to Esquivel);" (3) the WCJ "failed to apply a test which limits the employer's liability to a reasonable geographical area;" (4) the WCJ "failed to recognize Esquivel's negligence of running the stop sign as an intervening act;" and (5) the evidence did not justify the findings  of fact because the WCJ failed to address (Esquivel's) lack of credibility and failure to attend prior group sessions.
 
The WCAB, in its decision, agreed with the employer’s position that such a trip was outside the contemplated travel for medical care:

"...her motor vehicle accident injuries were not a compensable consequence of her industrial injuries for purposes of the Act because the accident "occurred too remotely from her home and her destination . . . to reasonably assign the risk of injury en route to the employer."
 
Applicant appealed, arguing such an interpretations was inconsistent with prior case law including the Laines v. Workmens' Comp. Appeals Bd. (1975) 48 Cal.App.3d 872 (Laines) and Durham Transportation Co. v. Workers' Comp. Appeals Bd. (2003) 68 Cal.Comp.Cases 469 (Durham). Laines is the original appellate decision holding travel during the receipt of medical care was a compensable consequence to a work related injury.  In Durham the WCAB ruled an applicant who took a route from a location other than her home was nevertheless traveling to medical care even though the actual trip was significantly longer (15 miles versus five miles) than travel from her home.  Applicant argued there was no geographic limitation on her ability to travel to medical care and the only consideration was whether she was in a direct route from the time she began the trip to the anticipated end.
 
The Court of Appeal noted neither Laines nor Durham discussed the issue of an outside limit to the distance travel to and from medical care would be in the course of employment.  The Court concluded the Laines Court simply did not address the issue and that Durham, while applying a deviation standard and not setting a specific geographic limitation, still considered the issue when the WCAB noted applicant’s travel never left her general neighborhood of West Oakland.
 
“We are persuaded that although none of the provisions of the Act or the implementing regulations contains an express geographic limitation on an employer's risk of incurring compensability liability for such injuries, such limitation is implied in the provisions of section 4600, subdivision (c), and the related regulation in California Code of Regulations, title 8, section 9780, subdivision (h).
 
The Court found support in the application of a “reasonableness” standard based on language in Labor Code Section 4600 which provided for an employer to pay for the “reasonable” costs of travel to and from medical treatment.  The Court declined to set a specific geographic limitation, instead holding the issue would need to be considered on a case by case basis with the following considerations:
 
“Such determinations should take into consideration all relevant circumstances in a given case, including (but not limited to) (1) the location of the employee's residence; (2) the location of the employee's workplace; (3) the location of the office of the employee's attorney; (4) the location of the medical provider's office, (5) the place where the new travel-related injury occurred; (6) the distance between the employee's point of departure and the medical provider's office along a reasonably direct route to that office; (7) the additional distance the employee travels in the event he or she deviates from that reasonably direct route while en route to the medical provider's office; (8) the availability of medical providers in the fields of practice, and facilities offering treatment, reasonably required to cure or relieve the employee from the effects of the existing industrial injury; and (9) the reason or reasons for the employee's travel beyond a reasonable geographic area within which the employer ordinarily should bear the risk of incurring compensability liability in the event the employee is injured while traveling to or from the medical appointment.”
 
In this case the Court had little difficulting in concluding the travel was far in excess of what would be considered “reasonable” and hence was not compensable.
 
<b>Commentary:</b>
 
While it might have been nice if the court provided a bright line geographic limitation, this case certainly gives enough guidelines that in most cases, the parties should be able to understand how to assess this type of issue.  Given the Court’s comments on the geographic discussion by the WCAB in the Durham case, it seems likely that travel, without significant deviation, within the employee’s own home town, might fall on the side of compensable and travel very much outside the same city limits might fall the other way. Of course if the employee is on the city limits edge, travel to the next town might be covered (especially if the medical provider is in that community).
 
Judicious use of common sense is clearly called for in assessing compensability in such cases and the court seems to be encouraging such an approach.

<i>Richard M. Jacobsmeyer is a partner in the Shaw, Jacobsmeyer, Crain, Claffey & Nix law firm.</i>