COURT OF APPEAL: WHERE EE' HAS RTW, NO TD OWED FOR LOSS TIME TO ATTEND MEDICAL TREATMENT APPOINTMENTS
Skelton v. WCAB
(2019 Cal.App.LEXIS 874), the Court of Appeal held that when an injured worker has returned to work, they are not entitled to TD indemnity benefits for loss of time to attend medical treatment appointments. The Court's rationale was that TD was designed to help compensate injured workers for days they could not actually physically work, not days they could work but didn't due to attending medical appointments.
[COMMENT: This appears to be an expansion of the 2003 decision in
Lauher
where the California Supreme Court stated no TD was owed for medical treatment appointments occurring after the worker was deemed permanent and stationary.]
NO MEDICARE REIMBURSEMENT IS OWED BY CIGA TO THE FEDS
The 1965 Medicare Act provides that Medicare is entitled to reimbursement for claims paid where a primary insurance payer exists that should have paid the claim costs.
In
CIGA v. Alez Azar
(2019), the U.S. 9th Circuit Court of Appeals stated that CIGA is not a
primary insurance payer, and therefore CIGA has no legal obligation to reimburse Medicare for any costs paid on a claim.
[COMMENT: Makes sense as CIGA is not a primary insurer but is a statutorily created governmental secondary provider agency, like Medicare itself.]
