According to a report from Human Resources Director California, Central Concrete Supply Company—a contractor based in San Jose, CA—is challenging an employee’s workers’ compensation claim on the grounds that services were received that were not “reasonable and necessary.” In this article, our Bakersfield workers’ compensation defense attorney provides a more detailed account of the dispute in this case and explains the key things to know about the “reasonable and necessary” standard.
Concrete Supplier Contends Medical Services are Not “Reasonable and Necessary”
The workers’ compensation case in dispute is Erhardt vs. U.S. Concrete dba Central Concrete Supply Company. Based in San Jose, Central Concrete Supply Company is a concrete company that provides materials and services to clients throughout the region. An employee of the company claimed workers’ compensation benefits for a knee injury. The injury was purportedly sustained while he was operating a large truck known as a mixer driver. The injured worker sought medical care through his workers’ compensation insurance coverage. Beyond the initial pre-approved treatment, the doctor who handled the case sought a request for the authorization of two additional procedures:
- Magnetic resonance imaging (an MRI) on the worker’s right knee; and
- A comprehensive arthroscopy on the worker’s left knee.
A dispute arose over the treatment—specifically, the MRI. The employer argued that the procedure was not “reasonable and necessary” and thus not covered by workers’ compensation insurance. At trial, a judge determined that both procedures were reasonable and necessary and should have been authorized and covered. Central Concrete Supply Company challenged the decision. On review, a panel overturned the judge’s initial ruling and sided with the employer. It found that insufficient evidence has, to this point, been provided to prove that the MRI is reasonable and necessary.
California Workers’ Compensation Insurance Only Covers “Reasonable and Necessary” Medical Care
Medical benefits are a key part of workers’ compensation coverage. Under California law (Cal. Lab. Code § 4600), comprehensive medical and health benefits are available to injured workers. However, workers’ compensation insurance is only liable for medical care that is “reasonably required to cure or relieve the injured worker from the effects of the worker’s injury.” California uses the reasonable and necessary standard. A worker must provide evidence that the treatment/care that they are seeking is reasonable and necessary to help them recover from the job-related injury or illness. An employer or insurer can challenge proposed treatment on the grounds that it is not reasonable or necessary.
Speak to Our Bakersfield Workers’ Compensation Defense Lawyer Today
At Yrulegui & Roberts, our Bakersfield workers’ compensation defense attorneys are experienced, solutions-centered advocates for employers, claims adjusters, and insurers. If you are locked in a dispute over whether or not medical services are “reasonable and necessary”, we can help. Contact us now to arrange your strictly confidential case review. From our offices in Bakersfield, Fresno, and Sacramento, we protect the rights and interests of clients throughout the wider region.