Case Title: Smith v. WCAB

Citation: 46 Cal. 4th 272

Docket Number: S150528

State: california

Court: California Supreme Court

Date: 2009-05-11T00:00:00Z

Document:
Filed 5/11/09 
 
 
 
IN THE SUPREME COURT OF CALIFORNIA 
 
 
 
DWIGHT SMITH, 
) 
 
 
) 
 
Petitioner, 
) 
 
 
) 
S150528 
 
v. 
) 
 
 
) 
Ct.App. 2/6 B190054 
WORKERS’ COMPENSATION  
) 
APPEALS BOARD and DEPARTMENT 
) 
(W.C.A.B. Nos. 
OF CORRECTIONS AND  
)  
GRO 16225, 16226, 
REHABILITATION, JUVENILE 
)  
16352) 
JUSTICE et al.,   
) 
 
 
) 
 
 
 
Respondents. 
) 
 
 ___________________________________ ) 
 
) 
DAVID AMAR, 
) 
 
 
) 
 
Petitioner, 
) 
 
 
) 
 
 
v. 
) 
 
 
) 
Ct.App. 2/6 B190655 
WORKERS’ COMPENSATION  
) 
APPEALS BOARD and MEL CLAYTON  ) 
(W.C.A.B. No. 
FORD et al.,  
) 
GOL 89438)  
 
) 
 
Respondents. 
) 
 ___________________________________ ) 
 
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 
1 
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 
                                              
1  
All further unlabeled statutory references are to the Labor Code. 
2 
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. 
                                              
2  
The factual and procedural history is largely taken from the Court of 
Appeal’s opinion. 
3 
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.)  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.) 
4 
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.)  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.)  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.)  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.)  
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 (Barnes).   
                                              
3  
While section 4607 does not explicitly state that employers or insurers are 
the only ones that can initiate termination proceedings, it is difficult to imagine an 
employee instituting proceedings to terminate his or her own award of treatment. 
5 
In that case, an injured employee obtained an award for future treatment in 
1982.  (Barnes, supra, 23 Cal.4th at p. 682.)  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.)  The workers’ compensation judge granted the 
petition and the Board and the Court of Appeal affirmed.  (Id. at pp. 683-684.)  
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.)  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.)  Thus, we distinguished between 
efforts to terminate an award (which attack the validity of the Board’s 
determination that an employee may need future medical treatment) and the denial 
of a specific treatment request (which challenges the necessity of a particular 
course of medical care).  (Id. at p. 688.) 
In the cases at issue here, it is clear the insurer was disputing specific 
requests rather than attacking petitioners’ awards of future treatment.  Smith, for 
example, was originally awarded treatment for injuries to his right shoulder, neck, 
and psyche.  A dispute subsequently arose as to whether epidural injections to his 
back were covered by the award.  The insurer was not attempting to terminate all 
future medical care.  The same is true of Amar.  He was originally awarded 
treatment for injuries to his right foot.  Based on further utilization review, the 
employer challenged the necessity of two particular treatments: a weight loss 
program and treatment for diabetes.  As with Smith, the insurer was disputing 
Amar’s specific requests, not challenging the validity of his award.  Thus, the 
6 
plain language of section 4607 does not permit an award of attorney fees to 
petitioners.   
Petitioners claim such a narrow interpretation of section 4607 will result in 
illogical consequences.  In particular, petitioners argue it would be absurd to 
award fees when an employer unsuccessfully seeks to terminate an award, but not 
when an employer unsuccessfully denies a specific treatment request.  Such a 
construction, petitioners warn, will encourage employers and insurers to simply 
deny all treatment requests rather than institute termination proceedings so as to 
avoid being forced to pay attorney fees.4  We are not persuaded for several 
reasons.   
First, it is not irrational that the Legislature might have elected to treat the 
more dramatic step of seeking to terminate an award differently than disputes over 
specific treatment requests.  Termination of all medical treatment can have 
predictably devastating consequences for an employee.  The Legislature could 
have reasonably decided (as the statutory language clearly suggests) to permit fee 
shifting under section 4607 only when an employee has successfully resisted an 
attempt to terminate his or her award for continuing treatment.  Second, the 
specter raised by petitioners ignores the existence of other statutes, such as section 
5814.5, which require the Board to award fees when benefits have been 
unreasonably delayed or refused.5  Indeed, petitioners’ construction of section 
                                              
4  
We note the Court of Appeal cited several of these considerations in 
concluding section 4607 authorized an award here.  However, such policy 
concerns are more properly directed at, and considered by, the Legislature.   
5  
Section 5814.5 provides, “When the payment of compensation has been 
unreasonably delayed or refused subsequent to the issuance of an award . . . , the 
appeals board shall . . . award reasonable attorneys’ fees incurred in enforcing the 
payment of compensation awarded.” 
7 
4607 is so expansive that it would make such statutes largely irrelevant as far as 
the award of medical benefits is concerned.  Third, the potential consequences 
invoked by petitioners — employers issuing blanket denials of medical treatment 
requests to avoid paying attorney fees — ignores the existence of the utilization 
review process. 
As we discussed in State Compensation Ins. Fund v. Workers’ Comp. 
Appeals Bd., supra, 44 Cal.4th at pages 239-240, in response to skyrocketing 
workers’ compensation costs, the Legislature recently established a utilization 
review process for handling employees’ medical treatment requests.  The process 
was intended to provide “quality, standardized medical care for workers in a 
prompt and expeditious manner.”  (Id. at p. 241.)  Employees submit requests for 
medical treatment to their employer.  “If the treatment request is straightforward 
and uncontroversial, the employer can quickly approve the request . . . without any 
need for additional medical review of the request.”  (Ibid.)  However, under the 
statutory scheme, only an employer’s utilization review physician applying 
approved criteria can modify, delay, or deny treatment requests — an employer 
may not, on its own, object to a treatment request.  (§ 4610, subds. (e) & (f).)   
Further, the utilization review scheme contains a procedure for resolving 
disputes over treatment requests that uses doctors, rather than judges, as the 
adjudicators.  (§§ 4610, subd. (g)(3)(A), 4062, 4062.1, 4062.2.)  If an employee 
disagrees with the utilization review physician’s decision to modify, delay, or 
deny treatment, the employee can request review by an independent medical 
evaluator who, after evaluating the evidence, decides whether the sought treatment 
is necessary.  (Ibid.)  Thus, the dispute resolution process does not require the 
employee to obtain counsel (although the employee is allowed to do so).  Indeed, 
holding out the prospect of attorney fees every time an employee successfully 
challenges a denial of a treatment request would likely transform the utilization 
8 
review process, which was intended to be expeditious, inexpensive, and driven by 
uniform standards and the recommendations of treating physicians, into a more 
expensive, adversarial, and cumbersome process.  In short, the utilization review 
process renders highly unlikely the scenario petitioners invoke.6  
 
Finally, the available legislative history of section 4607 is consistent with a 
plain language interpretation.  First, according to the Legislative Counsel’s Digest, 
section 4607 permits the Board to award attorney fees when an employee 
successfully resists “proceedings instituted to terminate [the] employee’s award 
for continuing medical treatment . . . .”7  (Legis. Counsel’s Dig., Assem. Bill No. 
138 (1973-1974 Reg. Sess.) 2 Stats. 1973, Summary Dig., p. 91, italics added.)  
Nothing suggests the Legislature intended a broader interpretation.  Second, 
section 4607 was modeled after another attorney fees provision, section 4651.3.  
(Assem. Com. on Finance and Insurance, Analysis of Assem. Bill No. 138 (1973-
1974 Reg. Sess.).)  Section 4651.3 authorizes an award of fees when an employer 
unsuccessfully files a petition alleging that an employee’s disability has decreased 
or terminated.  The fact that the Legislature used both “decrease” and “terminate” 
                                              
6  
We note that this case does not present, and we do not consider, the 
instance of an employer or insurer unilaterally refusing to pay for all further 
medical treatment.  An employer or insurer that decides for itself that an employee 
no longer needs additional treatment and accordingly decides to deny all future 
requests poses a different issue.  At a minimum, such an employer or insurer risks 
sanctions under previously discussed section 5814.5.  Moreover, an employer or 
insurer that fails to comply with the mandates of the utilization review process 
risks the imposition of penalties under section 4610, subdivision (i). 
7  
Although the Legislative Counsel’s summary digests are not binding (State 
ex rel. Harris v. PricewaterhouseCoopers, LLP (2006) 39 Cal.4th 1220, 1233, 
fn. 9), they are entitled to great weight (California Assn. of Psychology Providers 
v. Rank (1990) 51 Cal.3d 1, 17). 
9 
10 
in section 4651.3, but only “terminate” in section 4607 suggests that it knew how, 
if it so chose, to fashion a broader remedy.    
 
Accordingly, in light of the unambiguous statutory language and the 
legislative history, we hold that section 4607 authorizes an award of attorney fees 
only to employees who successfully resist efforts to terminate their award of 
medical treatment.  It does not permit an award of fees to employees who 
successfully challenge the denial of specific treatment requests. 
III.  DISPOSITION 
 
The judgment of the Court of Appeal is reversed.   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
MORENO, J. 
 
WE CONCUR: GEORGE, C. J. 
 
KENNARD, J. 
 
BAXTER, J. 
 
WERDEGAR, J. 
 
CHIN, J. 
 
CORRIGAN, J. 
See next page for addresses and telephone numbers for counsel who argued in Supreme Court. 
 
Name of Opinion Smith v. Workers’ Compensation Appeals Board 
__________________________________________________________________________________ 
 
Unpublished Opinion 
Original Appeal 
Original Proceeding 
Review Granted XXX 146 Cal.App.4th 1032 
Rehearing Granted 
 
__________________________________________________________________________________ 
 
Opinion No. S150528 
Date Filed: May 11, 2009 
__________________________________________________________________________________ 
 
Court: 
County: 
Judge: 
 
__________________________________________________________________________________ 
 
Attorneys for Appellant: 
 
William A. Herreras for Petitioner Dwight Smith. 
 
Ghitterman, Ghitterman & Feld, Allan S. Ghitterman, Russell R. Ghitterman and Benjamin P. Feld for 
Peititoner David Amar. 
 
 
__________________________________________________________________________________ 
 
Attorneys for Respondent: 
 
No appearance for Respondent Worker’s Compensation Appeals Board. 
 
Robert W. Daneri, Suzanne Ah-Tye, 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 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. 
 
 
 
 
 
 
 
 
Counsel who argued in Supreme Court (not intended for publication with opinion): 
 
William A. Herreras 
200 South 13th Street, Suite 212 
Grover Beach, CA  93483 
(805) 473-8550 
 
Russell R. Ghitterman 
Ghitterman, Ghitterman & Feld 
126 East Carrillo Street 
Santa Barbara, CA  93101 
(805) 965-4540 
 
Don E. Clark 
State Compensation Insurance Fund 
1275 Market Street, Room 399 
San Francisco, CA  94103 
(415) 565-1266 
 
Leah D. Davis 
Principal Deputy County Counsel 
350 South Figueroa Street, Suite 601 
Los Angeles, CA  90071 
(213) 974-0062