Monday, March 26, 2012

One Woman's Struggle for Reimbursement

One of the principal cornerstones of the workers’ compensation system, both in California and abroad, is the right to medical care. California Labor Code Section 4600 states that a broad range of medical care “that is reasonably required to cure or relieve the injured worker from the effects of his or her injury shall be provided by the employer.”

When someone is gravely injured, the level of this necessary care reaches quite far: extensive surgery, hospitalization, and sometimes even constant bed-side care. In a real sense, this is the system working at its best: the level of care matches the workers’ need, not some arbitrary external standard. However, this also means that the costs to defendants reach high levels, and defense attorneys seek creatively destructive arguments to weasel out of providing necessary care.

Recently California has seen a particularly nasty illustration of this sort of defense tactic, which, despite decisive rebukes from the Workers’ Comp Judge and the Workers’ Compensation Appeals Board, is now pending in the California Third Circuit Court of Appeals.

Felix Nino Mota was working as a lawn care worker for Allgreen Landscaping in Orange County when he suffered a brutally debilitating injury in 2001. Virtually his whole body was impacted: his head, neck, jaw, low back, right leg, right shoulder, left wrist, chest, liver, nose, eyes, gums, urinary tract and gastrointestinal system. He wound up settling his claim at 89% permanent disability with the right to ongoing and future medical care.

Mr. Mota required nearly constant care to get through daily life, and according to the uncontested language of Labor Code Section 4600, the defendant had to pay. Faced with this horrible incident, Mr. Mota’s wife Teodora left her home in Mexico to come to California and do what she could to help. She obtained legal permission to enter the country, though she did not maintain proper documentation through the long time in which she was caring for her severely disabled husband.

Defendant did not object to the care Ms. Mota was providing—at least not until she filed a lien to receive reimbursement for her work. As noted, this is nothing more or less than routine when medical providers give care without being paid. When Ms. Mota went forward and requested what was owed to her, Allgreen’s lawyers brain-stormed a series of spurious reasons in an attempt to keep their client’s wallet shut.

They claimed that Ms. Mota had not filed her lien in a timely manner. While the WCJ agreed at first, the Appeals Board shot this argument down, highlighting the continuous nature of the caregiving services. This was not one-time care that was then abandoned; it was (and remains) a process of care. Even the defendant’s lawyers conceded that this area of law is hardly clear.

Second, they claimed that because Mota is not a licensed vocational nurse they didn’t have to pay for the care she provided. (In fact, while not licensed, Ms. Mota had obtained significant training for the more complex tasks she performed.)

Here, again, though, they had to concede that in numerous instances courts have authorized non-experts, including close family members to provide such care. The defense acknowledged such cases, and even cited some of them, albeit to claim that they all involved exceptional circumstances not present in Mota’s case.

Third, and most off-track, they sought to avoid paying Mota because she is an undocumented immigrant.

One might be inclined to ask, what do her immigration papers have to do with her right to reimbursement for medical benefits in a workers’ compensation matter? A fair question, and one for which Allgreen has a rather implausible answer: according to Allgreen, Ms. Mota, by providing nursing care, became an employee of Allgreen’s, and according to the federal Immigration Reform and Control Act of 1986, it is illegal to hire undocumented immigrants. Hence, the argument goes, they do not have to pay medical benefits.

But of course reimbursement for medical benefits does not constitute employment by any stretch of the imagination. By Allgreen’s logic, every doctor that gives care in a workers’ comp case would become an employee of every injured worker’s employer. Doctors’ offices would be overrun with W-2 forms.

The truth is that this argument is just the latest in a series of attempts by the workers’ comp defense bar to drag immigration laws into the domain of workers’ compensation. Unfortunately, they have had some success in denying benefits such as temporary disability and vocational rehabilitation. Now emboldened, they are now trying to expand this campaign beyond employment to medical expenses.

The effort has no justification. Immigration and Customs Enforcement is a mammoth federal agency, which in 2011 commanded well over $5,000,000,000 of our tax dollars. Its operating mission does not in any way require the conscription of workers’ comp judges in California. And there is no reason for the rest of us to respect the repeated perverse attempts by the defense bar to exploit irrelevant areas of law in order to avoid paying their bills.