AI Generated Opinion Summaries

This summary was computer-generated without any editorial revision. It is not official, has not been checked for accuracy, and is NOT citable.

Facts

A worker sustained injuries to her neck, shoulder, and left wrist in a workplace accident on March 13, 1992. She had not reached maximum medical improvement for her wrist injury by the time of the formal hearing. The employer's insurer contracted with a medical case management company, whose consultants sought to have ex parte communications with the worker's treating physician, which the worker's attorney opposed (paras 2-3).

Procedural History

• Workers' Compensation Administration, 1994: The Workers' Compensation Judge (WCJ) awarded the worker temporary total disability benefits until further order, as she had not reached maximum medical improvement. The employer appealed, and the order was affirmed in an unpublished opinion (para 2).
• Workers' Compensation Administration, July 5, 1994: The WCJ issued an order allowing the employer's insurer's agent to have ex parte contact with the worker's treating physician, outside the presence of the worker's attorney (para 4).

Parties' Submissions

• Worker-Appellant: Argued that the insurer's medical case management consultants should not have ex parte contact with her treating physician without her attorney's presence, citing the confidentiality of the physician-patient relationship and the precedent set in Church's Fried Chicken v. Hanson (paras 3, 12).
• Employer/Insurer-Appellee: Contended that their medical case management consultants were not adversaries and should be allowed ex parte contact with the treating physician to facilitate efficient case management and ensure timely delivery of benefits (paras 12, 18).

Legal Issues

• Is an insurer's agent, retained for medical case management, entitled to ex parte contact with a worker's treating physician over the objection of the worker's attorney?

Disposition

• The Court of Appeals reversed the WCJ's order allowing ex parte communications and remanded the matter for entry of an order consistent with the decision (para 21).

Reasons

Per Wechsler J. (Donnelly and Black JJ. concurring):

• The Court held that the insurer's agent, as an agent of the insurer, is subject to the same constraints as the insurer itself regarding ex parte communications with a worker's treating physician. The Court emphasized that public policy prohibits doing indirectly what cannot be done directly (paras 13, 21).
• The Court rejected the insurer's argument that employer-based case management systems are entitled to the same latitude as the Workers' Compensation Administration's independent case management system. The statutory and regulatory framework does not support such equivalence (paras 14-17).
• The Court found that the insurer's ability to obtain necessary information was not unduly restricted, as it could access medical records, request independent medical examinations, and conduct informal meetings with the treating physician with the worker's attorney present (paras 19-20).
• The Court awarded the worker $2,500 in attorney fees (para 21).