Sandhagen Halts Double Dipping

Thursday, July 10, 2008 | 1

By Julius Young

Double dipping.

That can be good or bad.

One of my favorite things is being on a summer car trip, rolling into a small town just about anywhere (what a peculiarly American, 20th century endeavor!), finding a Tastee Freez or Dairy Queen. Going for a cone of soft ice cream, asking for a double dip.

That's good.

Less appealing are the double dippers at a party. Perhaps you remember the famous Seinfeld episode. George Costanza is caught re-dipping a chip into the dip after he has already taken a bite. Timothy objected, noting that it was like George was putting his "whole mouth in the dip". Defiant, George proclaimed "You dip the way you want to dip, I'll dip the way I want to dip".

What a jerk. Few of us want to kiss everyone we meet at the party food table.

Legally speaking, double dipping isn't usually favored.

Ask State Compensation Insurance Fund.

It's on the losing end of "Sandhagen".

The California Supreme Court has finally issued its opinion in State Compensstion Insurance Fund v. WCAB and Brice Sandhagen. The issue there was whether SCIF was legally entitled to double dip.

Where SCIF had available to it the utilization review process ("UR"), could SCIF use the Labor Code 4062 process instead (or in addition to) the UR process where it wanted to object to a medical treatment recommendation? To have allowed this would have meant that SCIF was entitled to double dip.

No, the California Supremes said. SCIF's process for objecting to a medical treatment recommendation was under Labor Code 4610, not under the QME dispute resolution process of Labor Code 4062. In so holding, the court noted that 4610 is a statutory scheme requiring employers to conduct utilization review when resolving requests for medical treatment where they choose to modify, delay or deny treatment.

In Sandhagen, SCIF did use the UR process, but not within the statutory timeframe. The court noted that Labor Code 4610 requires treatment decisions in a timely fashion, "not to exceed five working days from the receipt of information reasonably necessary to make the determination, and in no event more than 14 days from the date of the request for treatment" (with additional timeframes under limited circumstances).

Had SCIF prevailed, insurers would have been empowered to stall treatment requests in many cases. Even if it blew the UR timeframes (or even if its own UR reviewer approved the treatment), the insurer would have been able to object, forcing the worker to go through a lengthy QME process (requesting a QME, selecting a QME, waiting for the QME exam date, waiting for the QME report, and perhaps waiting for supplemental QME reports, a deposition of the QME, yada yada, yada).

That's why Sandhagen is an important victory for workers.

Kudos to Maugerite Sweeney of Redding, whose compassionate career on behalf of disabled workers now features a victory on their behalf at the California Supreme Court.

Julius Young is an applicants' attorney in Oakland, Calif.