Avalon Bay Foods v. Workers' Compensation Appeals Board

959 P.2d 1228, 77 Cal. Rptr. 2d 552, 18 Cal. 4th 1165, 63 Cal. Comp. Cases 902, 98 Daily Journal DAR 8955, 98 Cal. Daily Op. Serv. 6489, 1998 Cal. LEXIS 5149
CourtCalifornia Supreme Court
DecidedAugust 20, 1998
DocketS065546
StatusPublished
Cited by24 cases

This text of 959 P.2d 1228 (Avalon Bay Foods v. Workers' Compensation Appeals Board) is published on Counsel Stack Legal Research, covering California Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Avalon Bay Foods v. Workers' Compensation Appeals Board, 959 P.2d 1228, 77 Cal. Rptr. 2d 552, 18 Cal. 4th 1165, 63 Cal. Comp. Cases 902, 98 Daily Journal DAR 8955, 98 Cal. Daily Op. Serv. 6489, 1998 Cal. LEXIS 5149 (Cal. 1998).

Opinions

Opinion

MOSK, J.

In this matter, an injured employee sought a penalty against his workers’ compensation insurance carrier, contending that it unreasonably [1168]*1168delayed payment of his medical treatment transportation benefits. The Workers’ Compensation Appeals Board (hereafter the board) determined that the delay, amounting to less than 60 days, was unreasonable and ordered the carrier to pay a 10 percent penalty, pursuant to Labor Code section 5814.

We granted review to address two related questions of law: (1) whether the penalty for unreasonable delay in payment of medical treatment transportation expenses properly applies to the full amount of the award for medical treatment expenses, and (2) whether the employer, or its insurer, has 60 days after receipt of documentation in which to reimburse the injured worker for medical treatment transportation costs, pursuant to Labor Code section 4603.2, subdivision (b).

We conclude that the answer to both questions is yes. Medical treatment transportation benefits are an element of overall medical treatment benefits under Labor Code section 4600, not a different class of benefits. For that reason, they are subject to the 60-day time limit for payment applicable to other medical treatment benefits.

Because the insurer in this matter reimbursed the injured employee within 60 days of receiving documentation itemizing his medical treatment transportation costs, its payment was timely; no penalty should have been applied. Accordingly, we affirm the judgment of the Court of Appeal annulling the board’s order.

I

In February 1995, petitioner Robert Moore, while employed as a food production worker for Avalon Bay Foods, suffered injury to his left leg ultimately resulting in amputation below the knee.

On May 23, 1996, Moore submitted a claim through his attorney to ITT Hartford Accident and Indemnity (hereafter ITT Hartford) for medical treatment transportation expenses for 12 trips from Marysville to Sacramento, between December 21, 1995, and May 8, 1996. The claim, prepared by a legal assistant for Moore’s attorney, included a handwritten mileage log indicating that Moore had traveled a total of 1,270 miles in order to obtain medical treatment; it also noted at the bottom that he “[h]ad to pay $20.00 every trip to get a ride down to Sacramento.”

On May 28, ITT Hartford received the claim. The following day, the legal assistant for Moore’s attorney sent another copy of the mileage log, by facsimile, to ITT Hartford, along with a cover sheet stating: “Applicant is [1169]*1169having financial difficulties and we would very much appreciate anything you can do in speeding up the reimbursement process.”

On June 12, the legal assistant for Moore’s attorney spoke with the claims adjuster for ITT Hartford, who explained that she “had problems” because Moore was only entitled to mileage expenses and she could not pay those expenses because he had someone else drive him. Apparently under the impression that each of the drivers used his own vehicle, she requested their names, addresses, and Social Security numbers. According to the legal assistant, the claims adjuster indicated that she would not pay either the mileage or the $20 per trip. Be that as it may, following the conversation, the legal assistant sent a letter by facsimile to the claims adjuster, stating: “Regarding mileage submitted—yes [Moore] is paying the driver the 24 cents per mile he gets but he has to prepay this. One person [charges] $20.00, another [charges] $30.00. They will get names addresses, etc. of drivers.” In fact, Moore had engaged the service of a driver to transport him in his own van and he paid for the gasoline.

On June 17, the claims adjuster authorized payment of $240 for medical treatment transportation benefits, at a rate of $20 per trip, and payment was issued on June 26. She believed that she had 60 days to process the claim, pursuant to Labor Code section 4603.2, which requires that payment of medical treatment expenses provided for, or authorized by, a treating physician be paid within 60 days of proper documentation.

On June 28, Moore’s attorney filed a declaration of readiness, requesting “medical mileage” and seeking a penalty against ITT Hartford. The matter was scheduled for a pretrial conference on July 23. A hearing representative for ITT Hartford spoke with a receptionist for Moore’s attorney and asked why a hearing had been set. The receptionist explained that it was “set on penalties.” After the hearing representative stated that ITT Hartford had paid $240, the receptionist noted that the mileage sheet requested $20 per trip and indicated that “she could see why $240 was paid.”

On July 23, the day of the pretrial conference, apparently after learning that Moore sought full mileage reimbursement, ITT Hartford issued a further payment of $68.40, for the balance of the requested mileage, at a rate of $0.24 per mile.

On August 5, the matter proceeded to hearing on the issue of penalties. The workers’ compensation judge ruled that ITT Hartford unreasonably delayed payment of the medical treatment transportation benefit. Although it acknowledged that there was some confusion on the part of the claims [1170]*1170adjuster about the documentation, which indicated mileage but also referred to an expense of $20 per trip, it concluded that ITT Hartford “had a duty and legal obligation to pay at least one or the other within a reasonable time, and not refuse or fail to pay anything.” It observed that ITT Hartford was incorrect in assuming that it had 60 days to pay, concluding that Labor Code section 4603.2 was inapplicable. It ordered ITT to pay a 10 percent penalty for “all past, present, and future medical costs, including mileage . . . less 10 [percent] of said penalties on past and present [costs] applicable to applicant’s attorney.” The board denied ITT Hartford’s petition for rehearing.

The Court of Appeal annulled the order. It concluded that the finding of unreasonable delay was supported by substantial evidence, but determined that the penalty for delay applied only to the total expenses for transportation to appointments for medical treatment.

We granted review. We now affirm the judgment.

II

In Gallamore v. Workers’ Comp. Appeals Bd. (1979) 23 Cal.3d 815 [153 Cal.Rptr. 590, 591 P.2d 1242] (hereafter Gallamore), we considered the proper computation of penalties in workers’ compensation cases under Labor Code section 5814 when a payment of benefits has been unreasonably delayed or refused.1

There, the applicant requested assessment of three separate penalties under Labor Code section 5814, for delay in payment of permanent disability payments, claim of an unauthorized overpayment credit, and failure to pay travel expenses incurred in submitting to medical examinations by two physicians. (Gallamore, supra, 23 Cal.3d at pp. 819-820.) The board had affirmed an award of only a single penalty based solely on the carrier’s delay in advancing permanent disability payments, ruling, inter alia, that the amount of benefits for travel expenses was de minimis. (Id. at pp. 820-821.)

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Paternostro v. City of Lodi
E.D. California, 2021
Cleveland Nat'l Forest Found. v. Cnty. of San Diego
250 Cal. Rptr. 3d 305 (California Court of Appeals, 5th District, 2019)
People v. McClane CA4/2
California Court of Appeal, 2015
Meeks Building Center v. Workers' Compensation Appeals Board
207 Cal. App. 4th 219 (California Court of Appeal, 2012)
Brooks v. Workers' Compensation Appeals Board
75 Cal. Rptr. 3d 277 (California Court of Appeal, 2008)
State Compensation Ins. Fund v. WCAB
50 Cal. Rptr. 3d 860 (California Court of Appeal, 2006)
Pebworth v. Workers' Compensation Appeals Board
10 Cal. Rptr. 3d 832 (California Court of Appeal, 2004)
Robertson v. Workers' Compensation Appeals Board
112 Cal. App. 4th 893 (California Court of Appeal, 2003)
Department of Rehabilitation v. Workers' Compensation Appeals Board
70 P.3d 1076 (California Supreme Court, 2003)
General Reinsurance Corp. v. St. Jude Hospital
132 Cal. Rptr. 2d 540 (California Court of Appeal, 2003)
County of San Luis Obispo v. Workers' Compensation Appeals Board
112 Cal. Rptr. 2d 246 (California Court of Appeal, 2001)
California Highway Patrol v. Workers' Compensation Appeals Board
89 Cal. App. 4th 1201 (California Court of Appeal, 2001)
Moulton v. Workers' Compensation Appeals Board
101 Cal. Rptr. 2d 175 (California Court of Appeal, 2000)
Del Taco v. Worker's Compensation Appeals Bd.
94 Cal. Rptr. 2d 825 (California Court of Appeal, 2000)
Kopitske v. WORKERS'COMP. APPEALS BD.
88 Cal. Rptr. 2d 216 (California Court of Appeal, 1999)
Kopitske v. Workers' Compensation Appeals Board
74 Cal. App. 4th 623 (California Court of Appeal, 1999)
Kim v. Workers' Compensation Appeals Board & California Compensation Insurance
87 Cal. Rptr. 2d 382 (California Court of Appeal, 1999)
Neel v. Workers' Compensation Appeals Board
79 Cal. Rptr. 2d 353 (California Court of Appeal, 1998)

Cite This Page — Counsel Stack

Bluebook (online)
959 P.2d 1228, 77 Cal. Rptr. 2d 552, 18 Cal. 4th 1165, 63 Cal. Comp. Cases 902, 98 Daily Journal DAR 8955, 98 Cal. Daily Op. Serv. 6489, 1998 Cal. LEXIS 5149, Counsel Stack Legal Research, https://law.counselstack.com/opinion/avalon-bay-foods-v-workers-compensation-appeals-board-cal-1998.