GETTING PAID FOR NON-INDUSTRIALLY CAUSED INJURY
There are several circumstances where a provider must treat a non-industrial injury in order to treat an admitted industrial injury. The
law recognizes the fact that a provider in certain cases cannot treat a industrial injury without treating the preexisting conditions or non-
industrial injuries and knowing that it would be difficult if not impossible to divide or apportion the cost between industrially related
and non-industrially related treatment. Therefore cases have held that under certain circumstances the provider will get paid for treating
the non-industrially related injury when treating for an industrial injury
Granado v. Workmen’s Comp. App. Bd. (1968) 69 Cal. 2d 399, 404 [71 Cal. Rptr. 678, 445 P.2d 294]; states as follows:
“There can be no doubt that medical expense is not apportionable. Neither section 4600 nor any of the succeeding sections in the article
of the code dealing with medical and hospital treatment state or even suggest that the employer may pay part of the expense. So long as
the treatment is reasonably required to cure or relieve from the effects of the industrial injury, the employer is required to provide the
treatment, and treatment for nonindustrial conditions may be required of the employer where it becomes essential in curing or relieving
from the effects of the industrial injury itself. Medical treatment unrelated to the industrial injury need not be furnished by the
employer. If medical expenses reasonably necessary to relieve from the industrial injury were apportionable, a workingman, who is
disabled, may not be able to pay his share of the expenses and thus forego treatment. Moreover, the uncertainties attendant to the
determination of the proper apportionment might cause employers to refuse to pay their share until there has been a hearing and a
decision on the question of apportionment, and such delay in payment may compel the injured workingman to forego the prompt
treatment to which he is entitled.”
Ernestina Molina, Applicant v. Den-Mat, Zenith Insurance Company, Defendants, 2004 Cal. Wrk. Comp. P.D. LEXIS 80, Opinion
Filed October 4, 2004
“We find substantial evidence in the record, including the above-excerpted portions of the reports of Dr. Ritchie and Dr. Proctor, that
applicant is in need of medical treatment for her non-industrial psychiatric condition in order to cure or relieve the effects of her
admitted industrial orthopedic injury. The relevant and considered opinion of one physician may constitute substantial evidence. ( Place
v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 372, 35 Cal.Comp.Cases 525.) Here, we find the relevant and considered opinions of
two physicians, Dr. Proctor and Dr. Ritchie, substantial and persuasive evidence.”
There are several circumstances where a provider must treat a non-industrial injury in order to treat an admitted industrial injury. The
law recognizes the fact that a provider in certain cases cannot treat a industrial injury without treating the preexisting conditions or non-
industrial injuries and knowing that it would be difficult if not impossible to divide or apportion the cost between industrially related
and non-industrially related treatment. Therefore cases have held that under certain circumstances the provider will get paid for treating
the non-industrially related injury when treating for an industrial injury
Granado v. Workmen’s Comp. App. Bd. (1968) 69 Cal. 2d 399, 404 [71 Cal. Rptr. 678, 445 P.2d 294]; states as follows:
“There can be no doubt that medical expense is not apportionable. Neither section 4600 nor any of the succeeding sections in the article
of the code dealing with medical and hospital treatment state or even suggest that the employer may pay part of the expense. So long as
the treatment is reasonably required to cure or relieve from the effects of the industrial injury, the employer is required to provide the
treatment, and treatment for nonindustrial conditions may be required of the employer where it becomes essential in curing or relieving
from the effects of the industrial injury itself. Medical treatment unrelated to the industrial injury need not be furnished by the
employer. If medical expenses reasonably necessary to relieve from the industrial injury were apportionable, a workingman, who is
disabled, may not be able to pay his share of the expenses and thus forego treatment. Moreover, the uncertainties attendant to the
determination of the proper apportionment might cause employers to refuse to pay their share until there has been a hearing and a
decision on the question of apportionment, and such delay in payment may compel the injured workingman to forego the prompt
treatment to which he is entitled.”
Ernestina Molina, Applicant v. Den-Mat, Zenith Insurance Company, Defendants, 2004 Cal. Wrk. Comp. P.D. LEXIS 80, Opinion
Filed October 4, 2004
“We find substantial evidence in the record, including the above-excerpted portions of the reports of Dr. Ritchie and Dr. Proctor, that
applicant is in need of medical treatment for her non-industrial psychiatric condition in order to cure or relieve the effects of her
admitted industrial orthopedic injury. The relevant and considered opinion of one physician may constitute substantial evidence. ( Place
v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 372, 35 Cal.Comp.Cases 525.) Here, we find the relevant and considered opinions of
two physicians, Dr. Proctor and Dr. Ritchie, substantial and persuasive evidence.”
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