|2014 is half done. What were the most significant events/themes in California workers’ comp in the first half of 2014?|
Here, in no particular order, are my top picks:
1. CONTROVERSY OVER UTILIZATION REVIEW AND INDEPENDENT MEDICAL REVIEW CONTINUES
Utilization review and independent medical review continued to generate controversy during the first half of 2014. California injured workers, doctors, and applicant attorneys complained that it was increasingly hard to get consistent treatment for work injuries, as many adjusters used utilization review to deny treatments. Prominent attorney advocates called for reform of utilization review statutes and regulations.
However, there were disputes about the raw numbers. A January 2014 study by CWCI (the California Workers’ Comp Institute) (http://cwci.org/research.html) claimed that only about 4.7% of treatment requests are ultimately denied or modified.
According to the CWCI around 75% of treatment requests were approved without being sent to UR (“elevated review”). These numbers were in line with a 2011 study done by RAND. In response, a January 2014 analysis )of 2013 sample UR audit data prepared by CAAA consultant Mark Gerlach documented that some insurers were denying as much as two of every three treatment requests. Reviewing audit data, Gerlach noted that there was a wide range in approval rates of different claims administrators.
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