Title: King v. CompPartners, Inc.

State: california

Issuer: California Supreme Court

Document:

1 
 
SEE CONCURRING OPINIONS 
Filed 8/23/18 
 
 
 
IN THE SUPREME COURT OF CALIFORNIA 
 
 
 
KIRK KING et al., 
) 
 
 
) 
 
Plaintiffs and Appellants, 
) 
 
 
) 
S232197 
 
v. 
) 
 
 
) 
Ct.App. 4/2 E063527 
COMPPARTNERS, INC., et al., 
) 
 
 
) 
Riverside County 
 
Defendants and Respondents. ) 
Super. Ct. No. RIC 1409797 
 
____________________________________) 
 
By statute, California’s workers’ compensation system provides an injured 
employee’s “exclusive” remedy against an employer for compensable work-
related injuries.  (Lab. Code, § 3602, subd. (a).)  Here we consider the application 
of workers’ compensation exclusivity to claims arising from the workers’ 
compensation utilization review process.  Through that process, utilization 
reviewers, acting on behalf of employers, determine whether the plan 
recommended for the treatment of an employee’s industrial injury is medically 
necessary after consulting a schedule of uniform treatment guidelines.  If the 
utilization reviewer concludes that a recommended treatment is not medically 
necessary, he or she may modify or deny the treatment request.  (Lab. Code, 
§ 4610.) 
In this case, a utilization reviewer denied a treating physician’s request to 
continue prescribing certain medication for an injured employee.  Alleging that the 
utilization reviewer caused him additional injuries by denying the request without 
2 
authorizing a weaning regimen or warning him of the possible side effects of 
abruptly ceasing the medication, the employee filed a lawsuit seeking recovery in 
tort.  We conclude that the workers’ compensation law provides the exclusive 
remedy for the employee’s injuries and thus preempts the employee’s tort claims. 
I. 
A. 
First created more than a century ago, California’s workers’ compensation 
system is now governed by the Workers’ Compensation Act (WCA), “a 
comprehensive statutory scheme governing compensation given to California 
employees for injuries incurred in the course and scope of their employment.”  
(Charles J. Vacanti, M.D., Inc. v. State Comp. Ins. Fund (2001) 24 Cal.4th 800, 
810 (Vacanti); see Mathews v. Workmen’s Comp. Appeals Bd. (1972) 6 Cal.3d 
719, 729−731; Lab. Code, §§ 3200 et seq.)  At the core of the WCA is what we 
have called the “ ‘ “compensation bargain.” ’ ”  (Vacanti, supra, at p. 811.)  Under 
this bargain, “ ‘the employer assumes liability for industrial personal injury or 
death without regard to fault in exchange for limitations on the amount of that 
liability.’ ”  (Ibid.)  The employee, for his or her part, “ ‘is afforded relatively swift 
and certain payment of benefits to cure or relieve the effects of industrial injury 
without having to prove fault but, in exchange, gives up the wider range of 
damages potentially available in tort.’ ”  (Ibid.) 
Under the WCA, an employer must provide an injured worker with all 
medical treatment reasonably required to cure or relieve the effects of his or her 
injury.  (Lab. Code, § 4600.)  When an injured employee suffers an industrial 
injury, the employee reports the injury to his or her employer and then seeks 
medical care from a treating physician.  After examining the worker, “the treating 
physician recommends any medical treatment he or she believes is necessary and 
3 
the employer is given a treatment request to approve or deny.”  (State Comp. Ins. 
Fund v. Workers’ Comp. Appeals Bd. (2008) 44 Cal.4th 230, 238 (State Fund).) 
For many years, if an employer wished to challenge a treating physician’s 
recommendation, it had to invoke a “cumbersome, lengthy, and potentially costly” 
dispute resolution process involving review by qualified medical evaluators, 
litigation before a workers’ compensation judge, and a right of appeal to the 
Workers’ Compensation Appeals Board.  (State Fund, supra, 44 Cal.4th at p. 238; 
see id. at p. 239.)  To increase efficiency and reduce costs, the Legislature enacted 
several major reforms that took effect in 2004.  These reforms included a process 
of mandatory utilization review, under which a reviewer assesses a treating 
physician’s recommendation according to a schedule that establishes uniform 
guidelines for evaluating treatment requests.  (Lab. Code, § 4610; see State Fund, 
at p. 240; see also Smith v. Workers’ Comp. Appeals Bd. (2009) 46 Cal.4th 272, 
279.)1 
Under the statute as amended, every employer is required to establish a 
utilization review process, “either directly or through its insurer or an entity with 
which an employer or insurer contracts for these services.”  (Lab. Code, § 4610, 
former subd. (b), now subd. (g).)  The utilization review process is 
“comprehensive,” covering “any and all” treatment requests.  (State Fund, supra, 
44 Cal.4th at pp. 236, 243.)  “If the treatment request is straightforward and 
                                              
1  
Section 4610 was added to the Labor Code effective January 1, 2004.  
(Stats. 2003, ch. 639, § 28.)  The Legislature later amended the section effective 
January 1, 2013.  (Stats. 2012, ch. 363, § 43.)  This is the version of section 4610 
that was in effect at the time of the events at issue in this case.   
 
The Legislature has since made additional amendments to section 4610, 
effective January 1, 2017 (Stats. 2016, ch. 868, § 3; Stats. 2016, ch. 885, § 1.5), 
and January 1, 2018 (Stats. 2017, ch. 240, § 1).  Neither amendment affects our 
analysis in this case.  Unless otherwise specified, we refer to the version of section 
4610 that was in effect in 2013. 
4 
uncontroversial, the employer can quickly approve the request—utilization review 
is completed without any need for additional medical review of the request.”  (Id. 
at p. 241; see id. at p. 240.)  But while an employer can unilaterally approve a 
treatment request, only a licensed physician competent to evaluate the “specific 
clinical issues” can modify, delay, or deny a treatment request.  (Lab. Code, 
§ 4610, former subd. (e), now subd. (g)(3)(A).)  The central issue for the 
utilization reviewer is whether the requested treatment is medically necessary.  
(Id., § 4610, subd. (a).)  This medical necessity determination is to be made after 
consulting the schedule for medical treatment utilization (id., § 4610, former 
subds. (c), (f), now subds. (g)(1), (h)), which is presumed to be “correct on the 
issue of extent and scope of medical treatment” (id., § 4604.5, subd. (a); see ibid. 
[explaining that the presumption can be rebutted]). 
Labor Code section 4610 specifies the information on which utilization 
reviewers are to rely in making medical necessity determinations (Lab. Code, 
§ 4610, former subd. (d)), as well as the timing of the determinations (id., § 4610, 
former subd. (g)) and the nature of the explanations that must accompany the 
determinations (id., § 4610, former subd. (g)(4)).  When, for example, a utilization 
reviewer decides to deny the recommendation of a treating physician in the midst 
of treatment, that determination must be communicated to the requesting physician 
within 24 hours of the decision.  (Id., § 4610, former subd. (g)(3)(A), now subd. 
(i)(4)(A).)  In these so-called concurrent review cases, the statute provides that 
“medical care shall not be discontinued until the employee’s physician has been 
notified of the decision and a care plan has been agreed upon by the physician that 
is appropriate for the medical needs of the employee.”  (Id., § 4610, former subd. 
(g)(3)(B), now subd. (i)(4)(C).)  The decision to deny the request must “include a 
clear and concise explanation of the reasons for the employer’s decision, a 
description of the criteria or guidelines used, and the clinical reasons for the 
5 
decisions regarding medical necessity.”  (Id., § 4610, former subd. (g)(4), now 
subd. (i)(5).) 
 
About a decade after it first instituted mandatory utilization review, the 
Legislature enacted a second set of reforms designed to streamline the resolution 
of disputes concerning utilization review determinations.  (Stats. 2012, ch. 363, 
§ 1, pp. 3719−3720.)  The Legislature found that the then-existing dispute 
resolution system was “costly, time consuming, and [did] not uniformly result in 
the provision of treatment that adhere[d] to the highest standards of evidence-
based medicine,” all of which “adversely affect[ed] the health and safety of 
workers injured in the course of employment.”  (Id., § 1, subd. (d), p. 3719.)  To 
remedy these ills, the Legislature crafted a system of “independent medical 
review,” or “IMR,” for resolving utilization review disputes.  (Lab. Code, 
§ 4610.5, subd. (d).) 
 
Following this second set of amendments, the IMR process is the exclusive 
mechanism for review of a utilization review decision.  (Lab. Code, § 4610.5, 
subd. (e); see also id., § 4062, subd. (b) [“If the employee objects to a decision 
made pursuant to Section 4610 to modify, delay, or deny a request for 
authorization of a medical treatment recommendation made by a treating 
physician, the objection shall be resolved only in accordance with the independent 
medical review process established in Section 4610.5.”].)  Independent medical 
review “is performed by an independent review organization, which assigns 
medical professionals to review pertinent medical records, provider reports, and 
other information submitted to the organization or requested from the parties.”  
(Stevens v. Workers’ Comp. Appeals Bd. (2015) 241 Cal.App.4th 1074, 1090; see 
generally Lab. Code, § 4610.6.)  The independent reviewer is tasked with 
determining whether the requested treatment is “medically necessary based on the 
specific medical needs of the employee and the standards of medical necessity as 
6 
defined in subdivision (c) of Section 4610.5.”  (Id., § 4610.6, subd. (c).)  If an 
employee disputes an adverse decision on independent medical review, he or she 
may appeal that decision to the Workers’ Compensation Appeals Board (id., 
§ 4610.6, subd. (h)); decisions of the Board may in turn be appealed to a Court of 
Appeal (id., § 5950).  (See Stevens, supra, 241 Cal.App.4th at p. 1091.) 
B. 
In February 2008, plaintiff Kirk King sustained a back injury while he was 
at work.2  King suffered chronic pain as a result of the injury, which in turn caused 
him anxiety and depression.  In July 2011, a mental health professional prescribed 
several psychotropic drugs, including Klonopin, to treat these latter conditions. 
Defendant Dr. Naresh Sharma is an anesthesiologist who was employed by 
defendant CompPartners, Inc. (CompPartners), a licensed workers’ compensation 
utilization review management company.  In July 2013, Dr. Sharma conducted a 
utilization review of King’s Klonopin prescription.  Dr. Sharma determined that 
the Klonopin was medically unnecessary and decertified the prescription.  
Dr. Sharma’s decertification did not provide for a weaning regimen, nor did 
Dr. Sharma warn King of the risks of abruptly ceasing Klonopin.  King 
immediately stopped taking the medication and suffered a series of four seizures 
as a result. 
                                              
2  
Because we are reviewing an order sustaining a general demurrer, we 
accept as true all the material allegations of the complaint.  (Shoemaker v. Myers 
(1990) 52 Cal.3d 1, 7.)  Plaintiffs’ briefs include factual assertions that were not 
included in the complaint, and so we have not considered them in deciding 
whether the demurrer was properly sustained.  (United Bank & Trust Co. v. 
Fidelity & Deposit Co. (1928) 204 Cal. 460, 461; Harris v. King (1998) 60 
Cal.App.4th 1185, 1187.)  We have, however, considered the new assertions in 
deciding, post, whether plaintiffs should have been granted leave to amend the 
complaint.  (Connerly v. State of California (2014) 229 Cal.App.4th 457, 460.) 
 
 
7 
In September 2013, King sought a new prescription for Klonopin.  A month 
later, Dr. Mohammed Ashraf Ali, a psychiatrist employed by CompPartners, 
performed a utilization review of the prescription.  Dr. Ali, like Dr. Sharma, found 
that King’s Klonopin prescription was medically unnecessary.  And again, like 
Dr. Sharma, Dr. Ali neither authorized a weaning regimen nor warned King of the 
risks of abruptly stopping the medication. 
In October 2014, King and his wife filed a complaint in superior court 
against CompPartners and Dr. Sharma, among others.3  The Kings asserted claims 
of negligence, professional negligence, intentional and negligent infliction of 
emotional distress, and loss of consortium.  Defendants demurred, arguing that the 
Kings’ claims were preempted by the WCA.  In the alternative, they argued that 
the negligence claims failed because Dr. Sharma owed no duty of care to King.  
The trial court agreed with both arguments and sustained the demurrer without 
leave to amend. 
The Court of Appeal affirmed the order sustaining the demurrer but 
reversed the denial of leave to amend.  The Court of Appeal agreed with 
defendants that the Kings’ challenge to Dr. Sharma’s decision to decertify the 
Klonopin prescription is subject to the exclusive remedies of the workers’ 
compensation system.  But insofar as the Kings instead challenge Dr. Sharma’s 
failure to warn King of the risks of Klonopin withdrawal, the court concluded, the 
claim is not preempted because it does not directly challenge Dr. Sharma’s 
medical necessity determination.  Finally, the Court of Appeal held that 
Dr. Sharma owed King a duty of care, though it also held that the scope of the 
duty could not be determined on the basis of the facts alleged in the Kings’ 
complaint. 
                                              
3  
The Kings also sued two other defendants, but only CompPartners and 
Dr. Sharma are parties to this appeal. 
8 
We granted review.  “In reviewing an order sustaining a demurrer, we 
examine the operative complaint de novo to determine whether it alleges facts 
sufficient to state a cause of action under any legal theory.”  (T.H. v. Novartis 
Pharmaceuticals Corp. (2017) 4 Cal.5th 145, 162.)  If the demurrer was sustained 
without leave to amend, we consider whether there is a “reasonable possibility” 
that the defect in the complaint could be cured by amendment.  (Hendy v. Losse 
(1991) 54 Cal.3d 723, 742 (Hendy).)  The burden is on plaintiffs to prove that 
amendment could cure the defect.  (Ibid.) 
II. 
To give effect to the compensation bargain underlying the system, the 
WCA generally limits an employee’s remedies against an employer for work-
related injuries to those remedies provided by the statute itself.  Labor Code 
section 3600, subdivision (a) provides that workers’ compensation liability “shall, 
without regard to negligence, exist against an employer for any injury sustained by 
his or her employees arising out of and in the course of the employment . . . in 
those cases where the . . . conditions of compensation concur.”4  Subject to certain 
enumerated exceptions not relevant here, this liability is “in lieu of any other 
liability whatsoever.”  (Lab. Code, § 3600, subd. (a).)  Labor Code section 3602 
underscores the point:  “Where the conditions of compensation . . . concur, the 
right to recover such compensation is . . . the sole and exclusive remedy of the 
employee . . . against the employer . . . .”  (Id., § 3602, subd. (a), italics added.) 
                                              
4  
The conditions of compensation relevant to this case are as follows:  
“(1) Where, at the time of the injury, both the employer and employee are subject 
to the compensation provisions of this division.  [¶]  (2) Where, at the time of the 
injury, the employee is performing service growing out of and incidental to his or 
her employment and is acting within the course of his or her employment.  [¶]  
(3) Where the injury is proximately caused by the employment, either with or 
without negligence.”  (Lab. Code, § 3600, subd. (a).) 
9 
The WCA instructs that its provisions are to be “liberally construed by the 
courts with the purpose of extending their benefits for the protection of persons 
injured in the course of their employment.”  (Lab. Code, § 3202.)  This rule of 
liberal construction applies even though a particular plaintiff might prefer to forgo 
a workers’ compensation remedy in favor of a remedy at law:  We construe the 
Act “ ‘in favor of awarding work[ers’] compensation, not in permitting civil 
litigation.’ ”  (Arriaga v. County of Alameda (1995) 9 Cal.4th 1055, 1065, italics 
omitted.) 
In addressing the application of the WCA’s exclusivity provisions in this 
case, we confront two main issues:  First, are the injuries the Kings allege in this 
case the sort of injuries that are covered by the workers’ compensation exclusive 
remedy?  And second, are the defendants in this case entitled to the protections of 
workers’ compensation exclusivity?  We address each issue in turn. 
A. 
It is by now well established that the WCA’s exclusivity provisions 
preempt not only those causes of action premised on a compensable workplace 
injury, but also those causes of action premised on injuries “ ‘collateral to or 
derivative of’ ” such an injury.  (Vacanti, supra, 24 Cal.4th at p. 811, quoting 
Snyder v. Michael’s Stores, Inc. (1997) 16 Cal.4th 991, 997 (Snyder).)  Such 
collateral or derivative injuries include injuries stemming from conduct occurring 
in the workers’ compensation claims process.  In Vacanti, for example, we held 
that the exclusivity provisions applied to claims brought by medical providers 
against workers’ compensation insurers for the alleged mishandling of lien claims.  
Because the medical providers sought to recover compensation for medical 
services provided to workers injured in the course of their employment, we 
reasoned, their claims fell within the scope of workers’ compensation exclusivity.  
And to the extent the acts alleged by the providers constituted a “ ‘normal part of 
10 
the employment relationship’ [citation] or the workers’ compensation claims 
process,” the claims were barred.  (Id. at p. 820.)  “[I]njuries arising out of and in 
the course of the workers’ compensation claims process,” we explained, “fall 
within the scope of the exclusive remedy provisions because th[e] process is 
tethered to a compensable injury.”  (Id. at p. 815.) 
This conclusion follows from the unique causation principles underlying 
Labor Code section 3600.  As we recently explained in South Coast Framing, Inc. 
v. Workers’ Comp. Appeals Bd. (2015) 61 Cal.4th 291, 297 (South Coast 
Framing), section 3600 provides a workers’ compensation remedy for an injury 
linked “ ‘ “in some causal fashion” ’ ” to employment.  This causation requirement 
differs markedly from ordinary tort principles, in that “ ‘ “ ‘[a]ll that is required is 
that the employment be one of the contributing causes without which the injury 
would not have occurred.’ ”  [Citation.]’ ”  (Id. at pp. 297−298.)  Because of this, 
“industrial causation has been shown in an array of scenarios where a work injury 
contributes to a subsequent nonindustrial injury.”  (Id. at p. 300.)  California courts 
have held, for example, that “[a]n employee is entitled to compensation if a new or 
aggravated injury results from medical or surgical treatment for an industrial 
injury.”  (Ibid. [citing cases]; see id. at p. 294 [workers’ compensation remedy 
available to family of worker who died from the combination of drugs prescribed 
following a fall at work].)  This is true regardless of “ ‘whether the treatment [was] 
provided by a physician selected by the employee or by the employer or the 
employer’s compensation carrier.’ ”  (Id. at p. 306.)  And where the remedy is 
available as an element of the compensation bargain it is exclusive of any other 
remedy to which the worker might otherwise be entitled from the employer:  “The 
employer’s compensation obligation is ‘in lieu of any other liability whatsoever to 
any person.’ ”  (Snyder, supra, 16 Cal.4th at p. 996, quoting Lab. Code, § 3600, 
italics omitted.)   
11 
These established principles lead to a straightforward answer here.  The 
Kings seek to recover for injuries that arose during the treatment of King’s 
industrial injury and in the course of the workers’ compensation claims process.  
Because the Kings allege injuries that are derivative of a compensable workplace 
injury, their claims fall within the scope of the workers’ compensation bargain and 
are therefore compensable within the workers’ compensation system. 
The Court of Appeal agreed with this conclusion insofar as the Kings are 
proceeding against defendants on a theory that Dr. Sharma made an erroneous 
medical necessity determination regarding King’s Klonopin prescription.  But the 
court concluded that the exclusivity provisions of the WCA do not apply to the 
extent the Kings complain of Dr. Sharma’s failure to warn King of the adverse 
consequences of abruptly stopping Klonopin.  This was error; focusing on 
Dr. Sharma’s failure to warn does not alter the analysis.  On either theory of 
liability, King’s injury arose out of and in the course of utilization review—a 
statutorily required part of the workers’ compensation claims process, to which he 
would not have been subject had he not suffered a work-related back injury.  The 
injury is thus compensable under the WCA.   
In reaching its contrary conclusion regarding the Kings’ failure-to-warn 
theory, the Court of Appeal relied on Vacanti’s observation that “courts have 
allowed tort claims in cases where the alleged injury—the aggravation of an 
existing workplace injury—did not occur in the course of an employment 
relationship.  (See, e.g., Weinstein v. St. Mary’s Medical Center (1997) 58 
Cal.App.4th 1223, 1235−1236 [allowing a medical malpractice claim against the 
employer because the resulting aggravation of the workplace injury did not arise 
out of the employment relationship].)”  (Vacanti, supra, 24 Cal.4th at p. 814.)  The 
Court of Appeal read this passage to mean that “if something goes wrong in the 
claims process for [a] workplace injury,” then the WCA’s exclusivity provisions 
12 
apply, but “if a new injury arises or [a] prior workplace injury is aggravated, . . . 
the exclusivity provisions do not necessarily apply.”  (King v. CompPartners, Inc. 
(2016) 243 Cal.App.4th 685, 694.)  This is not a fair reading of the passage.  
Vacanti did not attempt to draw a distinction between claims that “something 
[went] wrong in the claims process,” on the one hand, and claims of a new or 
aggravated injury, on the other.  Vacanti instead simply noted that cases have held 
that the WCA does not preempt claims of new or aggravated injuries arising 
outside “the employment relationship.”  (Vacanti, supra, at p. 814, italics added.) 
Vacanti’s reference to Weinstein v. St. Mary’s Medical Center offers some 
insight into what this court had in mind.  The plaintiff in Weinstein was a hospital 
employee who was injured on the job.  She voluntarily sought treatment for her 
workplace injury at the hospital where she worked.  While on the premises to 
receive treatment, she was injured in a slip and fall.  (Weinstein v. St. Mary’s 
Medical Center, supra, 58 Cal.App.4th at p. 1226 (Weinstein).)  The hospital 
argued that tort remedies for the slip and fall injury were barred by workers’ 
compensation exclusivity.  The Court of Appeal rejected the argument, invoking 
the so-called “dual capacity doctrine” first enunciated by this court in Duprey v. 
Shane (1952) 39 Cal.2d 781 (Duprey).  That doctrine, as we have later described 
it, “posits that an employer may have or assume a relationship with an employee 
other than that of employer-employee, and that when an employee seeks damages 
for injuries arising out of the secondary relationship the employee’s claim is not 
subject to the exclusive remedy provisions of the Workers’ Compensation Act” 
(Hendy, supra, 54 Cal.3d at p. 730).  The court in Weinstein reasoned that the 
plaintiff’s slip and fall injury was entirely independent of her employment 
relationship with the hospital; she had freely chosen to receive treatment at the 
13 
hospital, and her claims invoked the hospital’s duty toward her in its capacity as a 
landowner, not as an employer.  (Weinstein, at pp. 1235−1236.)5 
This case presents no comparable circumstances.  Certainly King, like the 
plaintiff in Weinstein, seeks recovery for injuries following his initial industrial 
injury.  But unlike the injuries at issue in Weinstein, King’s injuries occurred 
within the scope of the employment relationship:  King alleges the injuries 
resulted from errors in the utilization review process—a process that King’s 
employer, in its capacity as an employer, was required to establish for the review 
of the treatment recommended for King’s prior industrial injury.  (See Lab. Code, 
§ 4610.) 
 
The Court of Appeal at least implicitly recognized the relationship between 
King’s alleged injuries and his employment when it concluded that the Kings’ 
challenge to Dr. Sharma’s medical necessity determination is preempted by the 
                                              
5  
The court in Weinstein acknowledged that the Legislature had amended the 
WCA in 1982 to make clear that “[t]he fact that either the employee or the 
employer also occupied another or dual capacity prior to, or at the time of, the 
employee’s industrial injury shall not permit the employee or his or her 
dependents to bring an action at law for damages against the employer.”  (Lab. 
Code, § 3602, subd. (a).)  But the court concluded that the 1982 amendment did 
not alter the analysis because the plaintiff was seeking compensation for a slip and 
fall injury that occurred after the initial industrial injury and had no connection at 
all with any employment-related duties or obligations she might have toward the 
hospital, or the hospital toward her.  (Weinstein, supra, 58 Cal.App.4th at p. 1237.)  
In other words, at the time of the injury in question, the hospital was acting in only 
one capacity, and that capacity was one of landowner, not employer. 
 
This court has never had occasion to consider what, if anything, remains of 
the Duprey dual capacity doctrine following the 1982 amendment.  (See Hendy, 
supra, 54 Cal.3d at pp. 735−739 [recognizing that the Legislature restricted the 
scope of the dual capacity doctrine when it amended section 3602 in 1982]; id. at 
p. 736, fn. 10 [reserving the question whether “the 1982 amendment of section 
3602 abolished the dual capacity doctrine insofar as it applied to employer 
physicians who provide treatment to their employees for industrial injuries”].)  
The question is not raised here and we express no view on it. 
14 
WCA.  But the court distinguished the Kings’ failure-to-warn theory on the 
ground that such a warning, if given, would fall outside the scope of the workers’ 
compensation claims process.  That distinction is untenable.  The utilization 
review provisions of the WCA govern not only the substance of a utilization 
review decision, whether based on medical necessity or otherwise, but also the 
content of the responses communicating the decision.  (See Lab. Code, § 4610, 
former subd. (g)(4), now subd. (i)(5) [“Responses regarding decisions to modify, 
delay, or deny medical treatment services requested by physicians shall include a 
clear and concise explanation of the reasons for the employer’s decision, a 
description of the criteria or guidelines used, and the clinical reasons for the 
decisions regarding medical necessity.”].)  The statute also specifies when, and to 
whom, the decision must be conveyed.  (Id., § 4610, former subd. (g)(3), now 
subd. (i)(4) [decisions “shall be communicated to the requesting physician within 
24 hours of the decision”].)  Both Dr. Sharma’s decision to decertify Klonopin and 
the manner in which Dr. Sharma communicated that decision fall within the scope 
of the statutory process set up by King’s employer to review recommendations 
concerning the treatment of King’s industrial injury.  The harm the Kings allege is 
therefore collateral to and derivative of that industrial injury and arose within the 
scope of King’s employment for purposes of the workers’ compensation exclusive 
remedy.  (See South Coast Framing, supra, 61 Cal.4th at pp. 299−300.) 
B. 
The Kings argue that even if their injuries were collateral to and derivative 
of King’s work-related back injury, defendants are not entitled to the protections 
of workers’ compensation exclusivity because defendants are not King’s 
“employer” for purposes of the WCA’s exclusivity provisions. 
While the workers’ compensation remedy bars suit against an “employer” 
(Lab. Code, §§ 3600, 3602), the statute expressly preserves the right of employees 
15 
to sue third parties:  “The claim of an employee . . . for compensation does not 
affect his or her claim or right of action for all damages proximately resulting from 
the injury or death against any person other than the employer” (id., § 3852).  The 
statute generally defines the term “employer” to mean, as relevant here, any 
“person including any public service corporation, which has any natural person in 
service” (id., § 3300, subd. (c); see also id., § 3351 [defining “employee” as 
“every person in the service of an employer”])—a definition that would appear to 
exclude CompPartners and Dr. Sharma, neither of whom can be said to have King 
“in [] service.”   
But as the Kings acknowledge, it has long been held that workers’ 
compensation exclusivity preempts tort claims against certain other persons and 
entities as well:  insurers, as “the ‘alter ego’ of the employer” (see Unruh v. Truck 
Insurance Exchange (1972) 7 Cal.3d 616, 625 (Unruh)) and independent claims 
administrators and adjusters hired by self-insured employers to handle workers’ 
compensation claims (Marsh & McLennan, Inc. v. Superior Court (1989) 49 
Cal.3d 1, 4 (Marsh)).  The question is whether the WCA, properly interpreted, also 
preempts tort claims against utilization reviewers hired by employers to carry out 
their statutory claims processing functions.  Viewing the question against the 
backdrop of our precedents, we conclude the answer is yes. 
In Unruh, an injured employee sued her employer’s insurer and others in 
tort, alleging that they negligently and intentionally caused her physical and 
psychological injury while investigating her workers’ compensation claim.  
(Unruh, supra, 7 Cal.3d at pp. 620−621.)  We held that the WCA barred the 
employee from bringing her negligence claim against the insurer.6  (Id. at p. 624.)  
                                              
6  
We held under a narrow exception, not relevant here, that the employees’ 
intentional tort claims against the insurer could proceed.  (Unruh, supra, 7 Cal.3d 
at p. 630.)  We discuss this exception below.  (See part II.C., post.) 
16 
Although the statute’s general definition of employer does not include insurers, a 
special provision defining “employer” for purposes of the WCA’s subrogation 
provisions does expressly include insurers.  (Ibid., citing Lab. Code, § 3850.)  We 
concluded that this special definition applied to the provision authorizing suits 
against any “ ‘person other than the employer.’ ”  (Unruh, at p. 625, quoting Lab. 
Code, § 3852.)  Therefore, we held, when an insurer “act[s] within its proper role 
in the compensation scheme” (Unruh, at p. 627), it “retain[s] immunity from 
lawsuit as the ‘alter ego’ of the employer” (id. at p. 625).  
In Marsh, an injured employee’s surviving spouse sued the employer’s 
independent claims administrator in tort for wrongly stopping the payment of the 
death benefits to which she was entitled.  The plaintiff in that case argued that she 
was entitled to maintain the suit because the independent claims administrator was 
neither an employer, nor an insurer as in Unruh, and therefore was not entitled to 
the protections of workers’ compensation exclusivity.  We rejected the argument.  
The exclusive remedy doctrine, we explained, derives its force from more than the 
special statutory definition of “employer” on which we focused in Unruh.  The 
exclusivity doctrine also derives from other provisions of the WCA:  namely, 
Labor Code section 5300, which establishes the exclusive jurisdiction of the 
Workers’ Compensation Appeals Board over disputes concerning an employee’s 
right to compensation or the liability of an employer, and Labor Code section 
5814, which specifies the penalty for unreasonable delay or refusal of 
compensation.  Taken together, we concluded, these provisions “imply that the 
workers’ compensation system encompasses all disputes over coverage and 
payment, whether they result from actions taken by the employer, by the 
employer’s insurance carrier or, . . . by an independent claims administrator hired 
by the employer to handle the worker’s claim.”  (Marsh, supra, 49 Cal.3d at p. 8.)  
By way of explanation, we noted that independent claims administrators perform a 
17 
statutorily recognized function in the workers’ compensation scheme.  (Id. at p. 9; 
see ibid. [“Administrators must now obtain certification from the Director of 
Industrial Relations [citation] and are subject to fines or revocation of their 
certificates at any time for good cause [citation].  [Citation.]  They must also file 
annual reports with the director.  [Citation.]”].)  They perform this function on 
behalf of employers who “lack[] the expertise to themselves handle the workers’ 
compensation claims of their employees” (id. at p. 8), and they are likely to bear 
ultimate responsibility for any penalty owed because of their misconduct (ibid.).  
We therefore concluded that an independent claims administrator stands in the 
shoes of the employer for the purpose of the claims administration process, and 
thus is entitled to the same protection from tort claims based on an injury 
compensable within the workers’ compensation system.  Concluding otherwise, 
we said, “would vitiate the very purpose of the exclusive remedy provisions of the 
Act.”  (Ibid., fn. omitted.) 
Similar considerations apply in the context of disputes regarding utilization 
review.  The WCA requires employers to engage the services of utilization 
reviewers and regulates utilization review activities in considerable detail.  (See 
Lab. Code, § 4610, former subd. (b), now subd. (g).)  The statute identifies the 
exclusive means by which an employee may dispute a utilization review decision:  
namely, independent medical review.  (Lab. Code, § 4610.5, subd. (e) [“A 
utilization review decision may be reviewed or appealed only by independent 
medical review pursuant to this section.”]; see also id., § 4062, subd. (b) [“If the 
employee objects to a decision made pursuant to Section 4610 to modify, delay, or 
deny a request for authorization of a medical treatment recommendation made by 
a treating physician, the objection shall be resolved only in accordance with the 
independent medical review process established in Section 4610.5” (italics 
added).].)  And the statute prescribes administrative penalties against any 
18 
employer, insurer, or other entity that fails to meet any of the pertinent statutory 
requirements.  (Id., § 4610, former subd. (i), now subd. (p).)7 
Perhaps most importantly, in performing their statutory functions, 
utilization reviewers, much like independent claims administrators, effectively 
stand in the shoes of employers:  they perform utilization review on behalf of 
employers, to discharge the employers’ own responsibilities to their employees.  
Indeed, as the statute acknowledges, the utilization review function can be 
performed by the employer itself, as well as by the insurer or by an independent 
entity with which the employer or insurer contracts.  (Lab. Code, § 4610, former 
subd. (b), now subd. (g).)  The statute contains no suggestion that claims arising 
from the utilization review process should be treated differently depending on 
whether the employer conducts the review in-house or instead contracts with an 
independent utilization review organization.  To the contrary, Labor Code section 
4610.5—which sets out the procedures for resolving “[a]ny dispute over a 
utilization review decision” (id., § 4610.5, subd. (a))—expressly defines the term 
“employer” for that purpose to include the “employer, the insurer of an insured 
employer, a claims administrator, or a utilization review organization, or other 
entity acting on behalf of any of them.”  (Id., § 4610.5, subd. (c)(4), italics added.)  
This special definitional provision tends to reinforce the conclusion that the 
Legislature regards utilization review organizations, like claims administrators, as 
acting on behalf of the employers that contracted for their services.  
We presume that the Legislature was aware of our decision in Marsh when 
it crafted the utilization review provisions in sections 4610 and 4610.5.  (Williams 
                                              
7  
Recent amendments to the act, effective January 1, 2018, call for additional 
regulation of utilization review.  Section 4610, for example, now contains detailed 
requirements for the accreditation of utilization review processes performed by 
physicians.  (Lab. Code, § 4610, subd. (g)(4).) 
 
19 
v. Industrial Acc. Com. (1966) 64 Cal.2d 618, 620.)  And in this case, much as in 
Marsh, those provisions, viewed in the broader context and operation of the WCA, 
evince an intent “that the workers’ compensation system encompass[] all disputes” 
concerning utilization review, “whether they result from actions taken by the 
employer, by the employer’s insurance carrier or” by a utilization review 
organization hired to handle the review on the employer’s behalf.  (Marsh, supra, 
49 Cal.3d at p. 8.)  As a general matter, a contrary conclusion would also 
undermine the Legislature’s apparent purpose in establishing the independent 
medical review process as the exclusive mechanism for review of the utilization 
review decisions of an employer, including a utilization review organization acting 
on the employer’s behalf.  (Lab. Code, § 4610.5, subd. (c)(4).)  Thus, following 
the reasoning of Marsh, we hold that the exclusive remedy for the Kings’ injuries 
lies within the workers’ compensation system. 
C. 
The Kings and their amici raise policy concerns about this conclusion.  
Utilization review has a significant impact on the medical care of injured workers.  
It follows, they argue, that utilization reviewers should be held accountable for 
their mistakes in the same way and to the same extent as treating physicians, who 
may be sued for their malpractice.  (Duprey, supra, 39 Cal.2d at p. 792.) 
The statute’s treatment of utilization reviewers is, however, consistent with 
the basic tradeoff that underlies the workers’ compensation system as a whole:  
The employee is afforded swift and certain payments for medical treatment 
without having to prove fault, but, in exchange, gives up his right to sue in tort for 
those injuries that result from risks encompassed by the employment relationship.  
(See Fermino v. Fedco, Inc. (1994) 7 Cal.4th 701, 708; South Coast Framing, 
supra, 61 Cal.4th at pp. 299−300.)  And the treatment of utilization reviewers is 
also consistent with the Legislature’s apparent aim in crafting the WCA’s 
20 
utilization review provisions.  Those provisions task utilization reviewers, 
operating on behalf of employers, with making judgments on a limited set of 
documents pursuant to defined criteria and subject to further review only through 
statutorily specified procedures.  (See Simmons v. State Dept. of Mental Health 
(2005) 70 Cal.Comp.Cases 866, 874 [noting that a utilization reviewer, unlike a 
treating physician, “does not physically examine the applicant, does not obtain a 
full history of the injury or a full medical history, and might not review all 
pertinent medical records”].)  To permit plaintiffs to bring tort suits against 
utilization reviewers, in the same manner as they might bring tort suits against 
treating physicians, would subject utilization reviewers to a second—and perhaps 
competing—set of obligations rooted in tort rather than statute.  That result does 
not sit easily with the Legislature’s overarching purpose of replacing a dispute 
resolution process that was “ ‘cumbersome, lengthy, and potentially costly’ ” 
(State Fund, supra, 44 Cal.4th at p. 245 (conc. opn. of Kennard, J.)) with one that 
instead “balances the dual interests of speed and accuracy” (id. at p. 241 (maj. 
opn.)). 
The detailed scheme the Legislature enacted does contain several 
safeguards to protect employees from the sort of harm the Kings have alleged.  As 
previously noted, decisions to modify or deny a treatment request must be 
performed by licensed physicians, who must make medical necessity 
determinations in keeping with a uniform schedule of medical treatment 
guidelines.8  (Lab. Code, § 4610, former subds. (c), (e), (f), now subds. (g)(1), 
(g)(3)(A), (h).)  As particularly relevant here, the statute provides that “medical 
                                              
8  
The uniform treatment schedule incorporates “evidence-based, peer-
reviewed, nationally recognized standards of care recommended by [the 
Commission on Health and Safety and Workers’ Compensation].”  (Lab. Code, 
§ 5307.27, subd. (a).)   
21 
care shall not be discontinued until the employee’s physician has been notified of 
the decision and a care plan has been agreed upon by the physician that is 
appropriate for the medical needs of the employee.”  (Lab. Code, § 4610, former 
subd. (g)(3)(B), now (i)(4)(C).)  To the extent that a physician or a utilization 
review organization fails to abide by a statutorily required part of the utilization 
review process, the employer, insurer, or utilization review organization may be 
subject to administrative penalties.  (Lab. Code, § 4610, former subd. (i), now 
subd. (p).)  A physician who makes unsound professional judgments in this 
capacity is subject to professional discipline, which may include the loss of his or 
her license.  (See Bus. & Prof. Code, §§ 2221, 2234.)  And, of course, employers 
are ultimately responsible for paying benefits to workers who suffer injuries as a 
result of the utilization review process. 
Moreover, as we have previously held, workers’ compensation exclusivity 
does not bar tort remedies resulting from acts that “fall outside the risks 
encompassed within the compensation bargain.”  (Vacanti, supra, 24 Cal.4th at 
p. 812.)  The Kings have not invoked that exception here, and it would not apply 
in any event; the exception applies when the conduct is “so extreme and 
outrageous that” the defendant “in effect stepped out of its role” as contemplated 
by the workers’ compensation scheme.  (Marsh, supra, 49 Cal.3d at p. 6; see 
Vacanti, supra, 24 Cal.4th at pp. 822−823.)  Where, by contrast, “the acts are ‘a 
“normal” part of the employment relationship’ [citation], or workers’ 
compensation claims process [citation], or where the motive behind these acts 
does not violate a ‘fundamental policy of this state’ [citation], then the cause of 
action is barred.”  (Vacanti, supra, 24 Cal.4th at p. 812.)  Here, there is no 
question that Dr. Sharma’s utilization review decision, the content of the decision, 
and his manner of communicating that decision fall within the scope of the 
statutory utilization review process.  (See Lab. Code, § 4610.)  The Kings have 
22 
alleged that Dr. Sharma was wrong to decertify Klonopin as he did, but an 
allegation of mistake alone is not sufficient to exempt a cause of action from 
preemption.  (Cf. Vacanti, supra, 24 Cal.4th at p. 821 [“Because denying or 
objecting to claims for benefits is also a normal part of the claims process, 
misconduct stemming from the delay or ‘discontinuance of payments . . . is 
properly addressed by the [Workers’ Compensation Appeals Board].’ ”].)  In other 
cases, however, a plaintiff may well argue that a utilization reviewer’s conduct 
exceeds the bounds of its role and that workers’ compensation exclusivity 
therefore should not apply. 
It is undoubtedly true that the availability of additional remedies would 
increase utilization reviewers’ incentives to perform their tasks with appropriate 
competence and care.  But as we read the statute the Legislature enacted, the 
workers’ compensation system provides the exclusive remedy for otherwise 
compensable injuries stemming from alleged mistakes in the utilization review 
process.  Here the Kings’ tort claims concerning Dr. Sharma’s decertification of 
King’s prescription are collateral to and derivative of a compensable injury and 
defendants performed a statutorily recognized utilization review function on 
behalf of King’s employer.  Because the acts alleged do not suggest that 
defendants stepped outside of the utilization review role contemplated by statute, 
the Kings’ claims are preempted.9  
The Kings have not shown that they could amend their complaint in a 
manner that would alter this conclusion.  In their briefing, they do raise some new 
factual assertions about Dr. Sharma’s erroneous handling of the treatment request.  
                                              
9  
This conclusion applies to the Kings’ claims of negligence, as well as the 
claim of intentional infliction of emotional distress (see Cole v. Fair Oaks Fire 
Protection Dist. (1987) 43 Cal.3d 148, 151) and the claim of loss of consortium 
(see Snyder, supra, 16 Cal.4th at p. 997). 
 
23 
Specifically, they assert that Dr. Sharma signed a draft decision that had been 
prepared by a nurse without reviewing King’s medical records or contacting his 
prescribing doctor.  They also assert that Dr. Sharma and CompPartners 
erroneously sent Dr. Sharma’s decertification decision to King’s general physician 
instead of King’s prescribing physician.  But neither of these asserted errors in the 
utilization review process falls outside the risks contemplated by the statutory 
scheme that the Legislature has enacted.  Such allegations, if formally pleaded, 
would not affect our conclusion that the exclusive remedy for the Kings’ alleged 
injuries lies in the workers’ compensation system. 
III. 
We affirm the Court of Appeal’s judgment insofar as it affirmed the trial 
court’s sustaining of the demurrer, but reverse its judgment insofar as it permitted 
the Kings to amend their complaint to bolster their claim that defendants are liable 
in tort for failure to warn.  We remand the case to the Court of Appeal for further 
proceedings consistent with this opinion.  
 
 
 
 
 
 
 
 
KRUGER, J. 
WE CONCUR: 
 
CANTIL-SAKAUYE, C. J. 
CHIN, J. 
CORRIGAN, J. 
LIU, J. 
CUÉLLAR, J. 
GROVER, J.*
                                              
* 
Associate Justice of the Court of Appeal, Sixth Appellate District, assigned 
by the Chief Justice pursuant to article VI, section 6 of the California Constitution. 
1 
 
 
 
 
 
 
 
 
CONCURRING OPINION BY LIU, J. 
 
Today we hold that Kirk and Sara King’s tort claims are preempted by 
California’s workers’ compensation system.  As enacted by the Legislature and as 
interpreted by our court, this system provides the exclusive remedy not only for 
workplace injuries but also for injuries “ ‘ “collateral to or derivative of” ’ ” 
workplace injuries.  (Maj. opn., ante, at p. 9, quoting Charles J. Vacanti, M.D., 
Inc. v. State Comp. Ins. Fund (2001) 24 Cal.4th 800, 811.)  Because “[t]he Kings 
seek to recover for injuries that arose during the treatment of [Kirk] King’s 
industrial injury and in the course of the workers’ compensation claims 
process[,] . . . their claims fall within the scope of . . . the workers’ compensation 
system.”  (Maj. opn., ante, at p. 11; see Vacanti, at p. 815.)  This is true even 
though the Kings are seeking damages against a third-party utilization review 
organization and its employees:  The statutory provisions governing utilization 
review, when “viewed in the broader context and operation of the [Workers’ 
Compensation Act], evince an intent ‘that the workers’ compensation system 
encompass[] all disputes’ concerning utilization review, ‘whether they result from 
actions taken by the employer, by the employer’s insurance carrier or’ by a 
utilization review organization hired to handle the review on the employer’s 
behalf.”  (Maj. opn., ante, at p. 19, quoting Marsh & McLennan, Inc. v. Superior 
Court (1989) 49 Cal.3d 1, 8.) 
2 
But the undisputed facts in this case suggest that the workers’ 
compensation system, and the utilization review process in particular, may not be 
working as the Legislature intended.  As today’s opinion notes, “[t]he detailed 
scheme the Legislature enacted . . . contain[s] several safeguards to protect 
employees from the sort of harm the Kings have alleged.”  (Maj. opn., ante, at 
p. 20.)  For example, “decisions to modify or deny a treatment request must be 
performed by licensed physicians, who must make medical necessity 
determinations in keeping with a uniform schedule of medical treatment 
guidelines.  [Citations.]  As particularly relevant here, . . . ‘medical care shall not 
be discontinued until the employee’s physician has been notified of the decision 
and a care plan has been agreed upon by the physician that is appropriate for the 
medical needs of the employee.’  [Citation.]  To the extent that . . . a utilization 
review organization fails to abide by a statutorily required part of the utilization 
review process, the . . . organization may be subject to administrative penalties.  
[Citation.]  A physician who makes unsound professional judgments in this 
capacity is subject to professional discipline, which may include the loss of his or 
her license.  [Citations.]  And . . . employers are ultimately responsible for paying 
[compensatory] benefits to workers who suffer injuries as a result of the utilization 
review process.”  (Id. at pp. 20–21, fn. omitted.) 
The record in this case does not indicate whether defendants followed the 
relevant statutory and regulatory requirements in discontinuing Kirk King’s 
prescription for Klonopin.  But the seizures King suffered as a result of his abrupt 
withdrawal from the drug provide grounds for skepticism that “a care 
plan . . . appropriate for the medical needs of the employee” was established 
before his prescription was discontinued.  (Lab. Code, § 4610, former subd. 
(g)(3)(B), now subd. (i)(4)(c).)  And even if defendants fully complied with the 
relevant requirements, it is questionable whether those requirements are enough to 
3 
prevent similar injuries from occurring in the future.  The “compensation bargain” 
that underlies the workers’ compensation system may allow for some “mistakes in 
the utilization review process.”  (Maj. opn., ante, at pp. 8, 22.)  But the balance 
that bargain strikes between employers’ interests and workers’ interests presumes 
that utilization review — which is conducted either by the worker’s employer or 
by an entity “stand[ing] in the shoes of [the] employer[]” (id. at p. 18) — will be 
performed “with appropriate competence and care” (id. at p. 22).  The limited 
record here raises doubts as to whether King’s utilization review was handled 
properly.  The Legislature may wish to examine whether the existing safeguards 
provide sufficient incentives for competent and careful utilization review. 
 
 
 
 
 
 
 
LIU, J. 
 
I CONCUR: 
CUÉLLAR, J.
1 
 
 
 
 
 
 
 
 
CONCURRING OPINION BY CUÉLLAR, J. 
 
Employees protected by the Workers’ Compensation Act (WCA; Lab. 
Code, § 3201 et seq.) sometimes allege that their harm arises not only from a 
work-related injury, but from the “utilization review process” affecting their 
access to medical treatment for that injury (id., § 4610).  What today’s majority 
opinion holds is that when these workers seek a remedy for such harms, they must 
find it exclusively in the WCA.  I understand why the majority opinion reaches 
this conclusion, particularly in light of our decisions in Unruh v. Truck Insurance 
Exchange (1972) 7 Cal.3d 616 (Unruh) and Marsh & McLennan, Inc. v. Superior 
Court (1989) 49 Cal.3d 1 (Marsh).  I write separately to emphasize the importance 
of the common law remedies that ordinarily protect the public, and why courts 
must continue to proceed with caution when considering –– as in this case –– 
whether a statute abrogates tort causes of action that ordinarily serve to incentivize 
good behavior, compensate for injuries, and right moral wrongs. 
 
The WCA is a “comprehensive statutory scheme” governing the 
compensation employers must pay employees for injuries suffered in the course 
and scope of their employment.  (Charles J. Vacanti, M.D., Inc. v. State Comp. 
Ins. Fund (2001) 24 Cal.4th 800, 810.)  At the heart of that scheme is a trade-off:  
an employer pays employees less than the full measure of tort compensation for 
the work-related harm, but the payment is certain and provided without regard to 
fault.  (Ibid.)  This trade-off governs the relationship between employers and 
2 
employees who sustain a work-related injury, but keeps tort law relevant to third 
parties who might exacerbate such an injury.  (See Lab. Code, § 3852 [“The claim 
of an employee . . . for compensation does not affect his or her claim or right of 
action for all damages proximately resulting from the injury or death against any 
person other than the employer”].)  So even as the WCA mediates the relationship 
of employers and employees, it explicitly carves out room for the continued 
viability of tort claims — and the application of common law principles — for 
harms involving third parties.   
If it is true that this carve-out could in principle conceivably encompass the 
independent officials and organizations involved in utilization review, it is also 
true that we have previously held this third-party “exception” not to encompass 
insurers (see Unruh, supra, 7 Cal.3d at pp. 623-627) or independent claims 
administrators (see Marsh, supra, 49 Cal.3d at pp. 4-10).  We have so held on the 
basis of explicit, and sometimes implicit, indications of the Legislature’s purpose 
in the WCA.  (See Lab. Code, §§ 3850 [defining employer to include insurers], 
5300, subd. (a) [indicating that the Workers’ Compensation Appeals Board is the 
exclusive forum for the “recovery of compensation, or concerning any right or 
liability arising out of or incidental thereto”].)  The majority today extends the 
reasoning in these cases to cover independent utilization reviewers, when an 
employee’s injuries arise from an incorrect medical necessity decision or the 
failure to warn a patient about the consequences of following such a decision.  
(Maj. opn., ante, at pp. 17-18.)  
Yet this result may be far from obvious –– not only because at least some 
of the statutory scheme likely could be reconciled with a different outcome, but 
also because of the presumption we normally apply against the implied repeal of 
the common law.  Not surprisingly, the common law undergirds our jurisprudence.  
(See, e.g., Li v. Yellow Cab Co. (1975) 13 Cal.3d 804, 818-821 (Yellow Cab) 
3 
[discussing the codification of the common law principle of contributory 
negligence in Civ. Code, § 1714].)  That our society’s long history with the 
common law showcases not only its virtues but its limitations is no reason to 
ignore its distinctive attributes.  In different settings, the common law leverages 
societal experiences to shape incentives, and to develop concepts and categories of 
obligation, that offer lawyers and the public a framework for understanding the 
duties we owe each other.  (See, e.g., Hill v. National Collegiate Athletic Assn. 
(1994) 7 Cal.4th 1, 25, quoting Post, The Social Foundations of Privacy (1989) 77 
Cal. L.Rev. 957, 1008 [describing how the common law right to privacy evolved 
out of a “ ‘normative set of social practices that constitute a way of life’ ” and 
“psychological foundations emanating from personal needs to establish and 
maintain identity and self-esteem by controlling self-disclosure”]; Warren & 
Brandeis, The Right to Privacy (1890) 4 Harv. L.Rev. 193, 193 [“Political, social, 
and economic changes entail the recognition of new rights, and the common law, 
in its eternal youth, grows to meet the demands of society”].)  As society and our 
institutions change, so does the common law.  (See Yellow Cab, supra, 13 Cal.3d 
at pp. 821-823 [finding contributory negligence to have evolved to comparative 
negligence through a common law process].)   
The Legislature’s power to curb the scope of common law causes of action 
is not only beyond question — it’s part of the process that adapts the fabric of the 
common law to a changing world.  But we consider a restriction on the public’s 
access to longstanding common law protections sufficiently fraught to expect a 
clear legislative statement attesting that such change occurred, and rightly so.  (See 
McMillin Albany LLC v. Superior Court (2018) 4 Cal.5th 241, 249 [“we construe 
statutory enactments as consonant with existing common law and reconcile the 
two bodies of law”]; People v. Ah Sam (1871) 41 Cal. 645, 653 [discussing how 
statutes are sometimes “intended to declare what the common law is, for the 
4 
purpose, merely, of making that certain which before was doubtful”]; Brown, A 
Search for Clarity and Consistency in Judicial Process: The Maryland Court of 
Appeals Decides Whether to Change Common-Law Rules (2003) 62 Md. L.Rev. 
599, 603-604 [“requests to change the common law often produce acrimony.  
Someone is asserting that present conditions so differ from the past that an old, 
trusted rule must be discarded”].)  So we apply a presumption against implied 
repeal of common law causes of action.  (California Assn. of Health Facilities v. 
Department of Health Services (1997) 16 Cal.4th 284, 299.)  Unless a statute 
“clearly and unequivocally” demonstrates a purpose different from a rule obtained 
from the common law (Yellow Cab, at p. 815), we make every attempt to find a 
rational means of harmonizing any conflicts between the two bodies of law (see 
McMillin, at p. 249 [requiring harmonization unless “ ‘the language or evident 
purpose of the statute’ ” requires the repeal of the common law rule]; cf. Fuentes 
v. Workers' Comp. Appeals Bd. (1976) 16 Cal.3d 1, 7).  The common law is 
neither substantively perfect nor perfectly efficient.  Yet it makes sense to 
recognize its foundational status in our system, and to take seriously the doctrines 
and presumptions that allow us to make the most of what it has to offer. 
The question here is why this presumption does not apply to independent 
utilization reviewers and the harms they potentially impose on employees like the 
plaintiff in this case.  One answer may be that the presumption we apply against 
repeal of the common law can be easily rebutted in our analysis of the workers’ 
compensation law — an area where the Legislature has explicitly eliminated the 
right to bring a tort suit against employers.  (See Lab. Code, § 3600, subd. (a).)  
Given this explicit repudiation of tort law in the WCA, the question changes from 
whether the common law has been abrogated — it has — to the boundary lines of 
where it’s been eliminated.  The dividing line is many times decided on whether 
we consider a party an “employer” or an alter-ego thereof.  This question must be 
5 
evaluated in the context of the workers’ compensation scheme as a whole through 
explicit or implicit legislative indications of purpose.  Although the presumption 
against implied repeals may still exist to rebuff undue expansions of who is an 
“employer,” the weight of the WCA’s explicit repudiation of tort law in 
combination with other indicators of legislative purpose may serve to rebut the 
presumption in cases like this one.   
Remedies can play a particularly important role as an indicator of 
legislative purpose when courts seek to demarcate the precise distinction between 
who counts as employers and non-employers under the WCA scheme.  A maxim 
of the common law is that every right has a remedy.  (See Marbury v. Madison 
(1803) 5 U.S. 137, 163.)  That maxim imbues our understanding of statutory rights 
as well.  (Collins v. O’Laverty (1902) 136 Cal. 31, 35 [“To deny the remedy would 
be to deny the right . . . , and thus to nullify the statute”].)  Without an explicit 
legislative directive, it would run against this maxim, and the presumption against 
the implied repeal of the common law, to eliminate any remedy for what would 
normally be redressed through a tort cause of action.  We, of course, do not reach 
the question whether a tort duty of care runs between the independent utilization 
reviewer and the employee.  But that is in no small part because the Legislature 
implemented a number of safeguards against, and administrative penalties for, 
what occurred here, as well as a remedy in the form of additional workers’ 
compensation for the injuries incurred.  As the majority points out, when the 
arcana of utilization review results in denial, the process must be performed by 
licensed physicians (Lab. Code, § 4610, former subd. (e), now subd. (g)(3)(A)), 
those decisions must comply with uniform medical treatment guidelines (id., 
§ 4610, former subds. (c) & (f), now subds. (g)(1) & (h)), and an adverse decision 
cannot result in the cessation of care until the employee’s physician receives 
notification of the decision and agrees to a care plan for the employee (id., § 4610, 
6 
former subd. (g)(3)(B), now subd. (i)(4)(C)).  (See maj. opn., ante, at pp. 20-21.)  
And if a utilization reviewer “fail[s] to meet any . . . requirement of this section,” 
the Division of Workers’ Compensation may “assess, by order, administrative 
penalties for each failure” on the utilization review organization.  (Lab. Code, 
§ 4610, former subd. (i), now subd. (p).)  Moreover, the physician utilization 
reviewer may be subject to professional discipline that could result in the loss of 
his or her license or a public reprimand.  (See Bus. & Profs. Code, § 2221, 
2221.05.)  And of course, as the majority opinion holds, the employee has a 
remedy in the form of workers’ compensation benefits.  (See maj. opn., ante, at p. 
14 [finding harm arising from the utilization reviewer’s decision to fall “within the 
scope of King’s employment for purposes of the workers’ compensation exclusive 
remedy”]; see also id. at p. 21.) 
Our understanding of the utilization review statute’s purpose may have 
differed if the Legislature had failed to provide any such safeguards, incentives, or 
remedies.  Even now, those safeguards and remedies may not be set at optimal 
levels, and the Legislature may find it makes sense to change them.  (See conc. 
opn. of Liu, J., ante, at pp. 2-3.)  Nonetheless, they are sufficient to support our 
conclusion –– in light of our decisions in Marsh and Unruh, and the WCA’s 
scheme as a whole –– that any presumption against the implied repeal of common 
law tort remedies otherwise available to protect people from negligent or botched 
utilization review procedures is rebutted in this case.    
 
 
 
 
 
 
 
CUÉLLAR, J. 
I CONCUR: 
GROVER, J.* 
_____________________ 
* 
Associate Justice of the Court of Appeal, Sixth Appellate District, assigned 
by Chief Justice pursuant to article VI, section 6 of the California Constitution. 
 
 
See last page for addresses and telephone numbers for counsel who argued in Supreme Court. 
 
Name of Opinion King v. CompPartners, Inc. 
__________________________________________________________________________________ 
 
Unpublished Opinion 
Original Appeal 
Original Proceeding 
Review Granted XXX 243 Cal.App.4th 685 
Rehearing Granted 
 
__________________________________________________________________________________ 
 
Opinion No. S232197 
Date Filed: August 23, 2018 
__________________________________________________________________________________ 
 
Court: Superior 
County: Riverside 
Judge: Sharon J. Waters 
 
__________________________________________________________________________________ 
 
Counsel: 
 
Law Offices of Patricia A. Law, Patricia A. Law, Jonathan A. Falcioni; Arias & Lockwood and Christopher 
D. Lockwood for Plaintiffs and Appellants. 
 
Smith & Baltaxe and Bernhard Baltaxe for California Applicants’ Attorneys Association as Amicus Curiae 
on behalf of Plaintiffs and Appellants. 
 
Francisco J. Silva, Long X. Do, Lisa Matsubara and Stacey B. Wittorff for California Medical Association 
as Amicus Curiae on behalf of Plaintiffs and Appellants. 
 
Charles Edward Clark for California Society of Industrial Medicine and Surgery, Inc., as Amicus Curiae on 
behalf of Plaintiffs and Appellants. 
 
Joshua S. Meltzer; Munger, Tolles & Olson, Fred A. Rowley, Jr., Jeffrey Y. Wu; Murchison & Cumming, 
William D. Naeve, Ellen M. Tipping, Terry L. Kesinger and David A. Winkle for Defendants and 
Respondents. 
 
Law Offices of Alweiss & McMurtry and Michael A. Marks for California Workers’ Compensation 
Institute and American Insurance Association as Amici Curiae on behalf of Defendants and Respondents. 
 
Crowell & Moring, David D. Johnson; Lewis Brisbois Bisgaard & Smith and Raul L. Martinez for National 
Association of Independent Review Organizations, Coventry Health Care Workers Compensation, Inc., and 
ExamWorks, Inc., as Amici Curiae on behalf of Defendants and Respondents. 
 
Mary C. Wickham, County Counsel (Los Angeles), Ralph L. Rosato, Assistant County Counsel, Derrick 
M. Au, Principal Deputy County Counsel, Susan T. Collins and Emily A Grospe, Deputy County Counsel, 
for County of Los Angeles as Amicus Curiae on behalf of Defendants and Respondents. 
 
 
 
 
 
 
 
 
 
 
Page 2 – S231197 – counsel continued 
 
Counsel: 
 
Finnegan, Marks, Theofel & Desmond and Randall G. Poppy for California Chamber of Commerce, the 
National Council of Self-Insurers, Property Casualty Insurers Association of America doing business in 
California as Association of California Insurance Companies (PCI) and CAJPA as Amici Curiae on behalf 
of Defendants and Respondents. 
 
Fred J. Hiestand for the Civil Justice Association of California as Amicus Curiae on behalf of Defendants 
and Respondents. 
 
 
 
 
 
 
 
 
 
 
Counsel who argued in Supreme Court (not intended for publication with opinion): 
 
Patricia A. Law 
Law Offices of Patricia A. Law 
10837 Laurel Street, Suite 101 
Rancho Cucamonga, CA  91730 
(951) 683-8320 
 
Christopher D. Lockwood 
Arias & Lockwood 
1881 South Business Center Drive, Suite 9A 
San Bernardino, CA  92408 
(909) 890-0125 
 
Fred A. Rowley, Jr. 
Munger, Tolles & Olson 
350 South Grand Avenue, 50th Floor 
Los Angeles, CA  90071-3426 
(213) 683-9100