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Showing posts with label California. Show all posts
Showing posts with label California. Show all posts

Monday, August 25, 2014

Chicago and 2 California Counties Sue Over Marketing of Painkillers

Today's post is shared from the nytimes.com

As the country struggles to combat the growing abuse of heroin and opioid painkillers, a new battlefield is emerging: the courts.
The City of Chicago and two California counties are challenging the drug industry’s way of doing business, contending in two separate lawsuits that “aggressive marketing” by five companies has fueled an epidemic of addiction and cost taxpayers millions of dollars in insurance claims and other health care costs.
The severity of drug abuse is well documented: Use of prescription opioids contributed to 16,651 deaths in the United States in 2010 alone, and to an estimated 100,000 deaths in the past decade. When people cannot find or afford prescription painkillers, many have increasingly turned to heroin.
The lawsuits assert that drug makers urged doctors to prescribe the drugs far beyond their traditional use to treat extreme conditions, such as acute pain after surgery or injury or cancer pain, while underplaying the high risk of addiction. Such marketing, the plaintiffs say, has contributed to widespread abuse, addiction, overdose and death.
Taking the drug makers to court recalls the tobacco liability wars of the 1990s, with government entities suing in the hope of addressing a public health problem and forcing changes from an industry they believed was in denial about the effects of its products. The tobacco settlement led to agreements by the tobacco industry to change marketing practices, which is a goal of the opioid lawsuits.
...
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Medicare Star Ratings Allow Nursing Homes to Game the System

Today's post was shared by The New York Times and comes from www.nytimes.com



CARMICHAEL, Calif. — The lobby of Rosewood Post-Acute Rehab, a nursing home in this Sacramento suburb, bears all the touches of a luxury hotel, including high ceilings, leather club chairs and paintings of bucolic landscapes.
What really sets Rosewood apart, however, is its five-star rating from Medicare, which has been assigning hotel-style ratings to nearly every nursing home in the country for the last five years. Rosewood’s five-star status — the best possible — places it in rarefied company: Only one-fifth of more than 15,000 nursing homes nationwide hold such a distinction.
But an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes.
The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify. Only one of the three criteria used to determine the star ratings — the results of annual health inspections — relies on assessments from independent reviewers. The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value.


The ratings also do not take into account entire sets of...
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Restoring Faith

Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com
That was just one work comp group and happened to be the most prolific. Plenty of other comments have been made in other venues.
I never in my wildest dreams would have imagined that my little, slightly sarcastic, muse on being both an employee and employer dealing with the same work injury and ultimately deciding that work comp was the worst of all worlds for dealing with it would create such interest, controversy, engagement and interaction.
But it did.
Some disputed that it could be labeled industrial since it was only a back sprain. Others said to stay out of the work comp system at all costs. And others simply demonstrated a lack of understanding of work comp, at least relative to California law.
No one, though, said that I should file a claim as an employee or report the claim as an employer.
Perhaps that's because everyone is a professional in the system, an insider, and everyone knows that once a claim comes into the system both the employer and the employee lose control to the gaming that every single vendor - insurance company, doctor, lawyer, etc. - will engage in to "do the right thing" according to their special interest.
Certainly there were more "claim denied" or "services denied" responses than I thought would occur.
Just like real life work comp.
The California Workers' Compensation Appeals Board on Thursday designated a case a "Significant Panel Opinion" because a carrier that had approved nurse case manager services prior...
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Friday, August 22, 2014

Groundbreaking Measure Gives Female First Responders Equal Protection

 The California Applicants’ Attorneys Association (CAAA), whose members represent Californians hurt at work, and the California Nurses Association’s (C.N.A.) measure to eliminate gender bias against female first responders in California workers’ compensation insurance passed the Assembly today by a vote of 46 - 23. AB 2616 goes now to the governor for action. AB 2616 (Skinner) is the first measure passed by the Legislature to extend any of the fifteen existing presumptions that male first responders enjoy to first responder occupations dominated by women. “California recognizes that some jobs are so inherently dangerous that those workers should not have to prove that certain injuries were job related,” said CAAA Women’s Caucus Co-Chair Christel Schoenfelder. “First responders like firefighters and police officers who are required to protect the public are presumed to be injured on the job when they get cancer or an infectious disease. There is one group of first responders who do not receive this protection from dangerous conditions. These are hospital employees, 80% of whom are female. Like police officers and firefighters, they are routinely exposed to conditions that can lead to major health problems.” AB 2616 intends to correct this gender imbalance by extending a presumption covering MRSA skin infections to hospital employees who provide direct patient care. MRSA infections are a major health problem in hospitals around the world.
“Nurses and other hospital employees are required to assume great risk, but unlike public safety officers we are not given the same legal protections when we get sick on the job,” said Redding Registered Nurse Kathryn Donahue in a statement urging the governor to sign AB 2616. “MRSA is a virulent antibiotic-resistant staph infection. It’s a job hazard for nurses providing direct patient care in acute care hospitals. MRSA can kill you. Just like police officers and firefighters, nurses put our lives on the line everyday. We don’t know if the patient we are treating has HIV, or MRSA, that we could be exposed to. We just do our job.”

“Assembly member Skinner deserves credit for doggedly pursuing this bill year after year and finally succeeding in her final year,” said Schoenfelder. “Thanks must also go to C.N.A. for making this a priority.”
One out of every six deaths in the US can be attributed to an infection acquired in a hospital. A first responder has an obligation to perform their duties in an emergency. Female workers are often forced to testify to personal details of their lives in an effort by insurance companies to deny claims. As female workers experience this, it has a chilling effect on the willingness of other female workers to come forth with their claims.
“If nurses or other hospital workers who provide direct patient care get MRSA, we have to prove that it didn’t come from any place but our work,” said Donahue. “That’s an almost impossible burden to meet. It exposes nurses to invasive questioning about our personal lives – even our sexual lives – by insurers’ defense attorneys trying to defeat our claims for medical care and disability compensation.”
Schoenfelder said, “The lack of equal protection for health care workers is, in part, due to gender inequity. Public safety first responders are a predominantly male workforce, but hospital employees providing patient care are a predominantly female workforce. The Labor Code currently provides 15 categories of presumptions for various first responders, and all of them are for male dominated workforces. There is not one presumption for first responders like nurses, which is primarily a female workforce. AB 2616 intends to address this gender imbalance by extending equal protection to female-dominated hospital first responder jobs.”
For more information on AB 2616 Support including a video from a Registered Nurse and an applicant’s attorney perspectives can be viewed here.

Wednesday, August 20, 2014

Cal/OSHA fines aviation company in death of LAX baggage worker

Today's post is shared from the latimes.com

State officials fined an aviation services company $77,250 on Wednesday for five safety violations related to the death of a baggage worker in February at Los Angeles International Airport.

The California Division of Occupational Safety and Health leveled the penalty against Menzies Aviation, whose employee, Cesar Valenzuela, 51, died after being thrown from a baggage tug that did not have a functional seat belt.

Cal/OSHA investigators said seatbelts were required for the vehicle and that Menzies' safety policies related to baggage tugs did not require and even discouraged the use of restraints in certain areas of LAX.

"This fatality could have been prevented with a well thought out and implemented safety plan as is required for all worksites in California," said Christine Baker, director of the state Department of Industrial Relations.

Menzies and other aviation service companies contract with airlines to provide cabin cleaners, security personnel, custodians, wheel-chair assistants and baggage handlers.

The citations prompted union officials and service company employees to renew their calls for improvements to working conditions at LAX, the nation's third-busiest airport.

"Workers punching in at the start of a shift ought to be able to finish the day without risking their health or losing their life,"...


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Monday, August 18, 2014

State Sen. Leland Yee allegedly solicited bribes for NFL Workers’ Compensation Law

The NFL controversy involving workers' compensation claims continues to heat up. Today's post by Brett Gowen of the California Bar is shared from fbgslaw.com
Brett Gowen


As part of the ongoing saga of State Senator Leland Yee, a new charge for racketeering was given by a federal grand jury. As part of the indictment, Sen. Yee allegedly solicited $60,000 for Yee’s vote and another senator’s vote on a bill dealing with limiting workers’ compensation benefits for NFL players. According to the indictment, Sen. Yee believed the money would be paid by a NFL team owner according to an LA Times article.

Attorney, Melissa Brown at Fraulob Brown Gowen & Snapp, has a connection to the NFL and their treatment of injured players. Ms. Brown was retained as an expert witness for the NFL Players’ Association at an arbitration hearing involving a workers’ compensation law dispute with NFL owners. The arbitration, and the flurry of lawsuits involving NFL injuries, is part of the growing recognition of the impact the game has on the long-term health of the players. 

California Medical Fraud Investigation Continues

"Follow the money." The investigation of fraud in the California Workers' Compensation system continues. Today's post of Julius Young of the California Bar
is shared from workerscompzone.com

You might have thought that news of bad behavior in California’s workers’ comp system was hitting bottom.

After all, could it get worse? Allegations of legislators taking money to help charlatans who profited off of the backs of injured workers (literally). Scads of doctors alleged to have taken kickbacks for prescribing questionable compound medicines one of which allegedly killed a baby.

It appears that law enforcement authorities are now focusing on relationships between some applicant attorney firms and medical groups.

In Southern California the Riverside County DA has executed a search warrant against a workers’ comp firm, California Injury Lawyers (CIL). Apparently this is a result of a long investigation into suspected workers’ comp fraud, targeting operations allegedly connected to an individual named Peyman Heidary who is said to have a financial interest in as many as nine medical clinics in the Los Angeles area.

The details of the alleged bad behavior or fraud is unclear, and it must be noted that any allegations are currently just that, allegations.

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Thursday, August 7, 2014

ROTTEN IN DENMARK

Today's post was shared by Julius Young and comes from www.workerscompzone.com

July 29 2014
You might have thought that news of bad behavior in California’s workers’ comp system was hitting bottom.
After all, could it get worse? Allegations of legislators taking money to help charlatans who profited off of the backs of injured workers (literally). Scads of doctors alleged to have taken kickbacks for prescribing questionable compound medicines one of which allegedly killed a baby.
It appears that law enforcement authorities are now focusing on relationships between some applicant attorney firms and medical groups.
In Southern California the Riverside County DA has executed a search warrant against a workers’ comp firm, California Injury Lawyers (CIL). Apparently this is a result of a long investigation into suspected workers’ comp fraud,  targeting operations allegedly connected to an individual named Peyman Heidary who is said to have a financial interest in as many as nine medical clinics in the Los Angeles area.
The details of the alleged bad behavior or fraud is unclear, and it must be noted that any allegations are currently just that, allegations.
But this case has the potential to involve a number of  Southern California health care providers as well as some lawyers.
Meanwhile, last year’s workers’ comp bill AB 1309 seems to be the focus of new allegations in the federal case against State Senator Leland Yee. A grand jury indictment contains allegations that Yee suggested that in...
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The Alzheimer's Risk

Today's post is shared from David DePaolo at daviddepaolo.blogspot.com
As you likely are aware, Mom is in a memory care facility, so the California Supreme Court's ruling on whether a patient (or the family of a patient) may be liable for injuries to an Alzheimer's care worker caught my attention.
Mom is in a top quality memory care facility and I am fortunate enough to be able to visit her on average of twice a week, so I have become quite familiar with (and friends with) many of the residents and their families at the facility.
Dementia and Alzheimer's (a subset of dementia) are odd afflictions - some folks, like my mom, just don't remember much of anything, but they're pleasant. They smile, joke and are overall convivial.
Others though get the worst of the disease and can be aggressive, combative and sometimes a bit scary. These folks may be old, but can be very strong - mind over matter is not just a saying!
I've seen workers hit by patients, and I, myself have been the subject of aggressive behavior by an Alzheimer's patient.
Work injuries are a very real part of the Alzheimer's care worker's occupation.
And the Supreme Court has said that work comp the only remedy for such care workers.
The majority opinion in Gregory v. Cott expressly declared that because agitation and physical aggression are common late-stage symptoms of Alzheimer's, injuries to caregivers are not unusual.
As I noted, my experience would support this observation.
Mom doesn't bite.
The...
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Tuesday, July 29, 2014

Medical pot covered by workers' comp, says appeals court

If undefined by statute, workers' compensation provides for an almost limitless delivery of medical benefits. What ever "cures and/or relieves" is authorized and is paid for by the employer/insurance carrier. Today's post is shared from hr.blr.com
The New Mexico Court of Appeals recently ruled that an employer must pay for an injured worker's medical marijuana. This appears to be the nation's first appellate court ruling in a workers' compensation case in which an employer has been ordered to pay for medical marijuana prescribed by an employee's healthcare provider to treat a workplace injury.
George Vialpando injured his back in a workplace accident in 2000 while he was employed by Ben's Automotive Services in Santa Fe. For years, he was unable to find pain relief through conventional drugs and treatment. His physician said Vialpando had "some of the most extremely high intensity, frequency and duration of pain, out of all of the thousands of patients I've treated within my seven years practicing medicine."
In 2013, Vialpando was certified by his healthcare providers to participate in the New Mexico medical marijuana program. The program, authorized by the Lynn and Erin Compassionate Use Act, permits an individual to purchase marijuana after receiving certification from a medical practitioner licensed in New Mexico that states he has a debilitating medical condition and the potential health benefits of the medical use of cannabis would likely outweigh the health...
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Monday, July 28, 2014

Attorneys Who Won Landmark Lead Paint Judgment and Cleanup Named Public Justice Trial Lawyer of the Year



The attorneys who successfully fought for lead paint cleanup in People of California v. Atlantic
Fidelma Fitzpatrick
Richfield were named Sunday as Public Justice’s 2014 Trial Lawyers of the Year.
The 27 attorneys won a $1.15 billion judgment against paint manufacturers last year, successfully arguing that lead paint in homes is a public nuisance that creates a quantifiable risk of harm to children who reside in or visit those homes.
Leading the team of attorneys were (in alphabetical order) Mary E. Alexander of Mary Alexander & Associates, P.C. in San Francisco, Joseph W. Cotchett and Nancy L. Fineman of Cotchett, Pitre & McCarthy, LLP in Burlingame, Calif., Peter Earle of the Law Office of Peter Earle in Milwaukee, Wis., and Fidelma L. Fitzpatrick of the firm Motley Rice in Providence, R.I.
“This is for the children of California,” Mary Alexander said upon accepting the award. Fidelma Fitzpatrick noted that her participation in People of California was the greatest privilege of her professional career.
In California, tens of thousands of children each year have blood lead levels that exceed the Centers for Disease Control and Prevention threshold. There is virtual unanimity in the medical and scientific community that the primary cause of lead poisoning in children is the lead paint in their homes. It is also widely understood that the only way to prevent lead poisoning is to remove or remediate the paint in a child’s environment before a child gets poisoned.
...
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Monday, July 21, 2014

Part-Time Schedules, Full-Time Headaches

Today's post was shared by Steven Greenhouse and comes from www.nytimes.com

A worker at an apparel store at Woodbury Common, an outlet mall north of New York City, said that even though some part-time employees clamored for more hours, the store had hired more part-timers and cut many workers’ hours to 10 a week from 20.
As soon as a nurse in Illinois arrived for her scheduled 3-to-11 p.m. shift one Christmas Day, hospital officials told her to go home because the patient “census” was low. They also ordered her to remain on call for the next four hours — all unpaid.
An employee at a specialty store in California said his 25-hour-a-week job with wildly fluctuating hours wasn’t enough to live on. But when he asked the store to schedule him between 9 a.m. and 2 p.m. so he could find a second job, the store cut him to 12 hours a week.
These are among the experiences related by New York Times readers in more than 440 responses to an article published in Wednesday’s paper about a fledgling movement in which some states and cities are seeking to limit the harshest effects of increasingly unpredictable and on-call work schedules. Many readers voiced dismay with the volatility of Americans’ work schedules and the inability of many part-timers to cobble together enough hours to support their families.


In a comment that was the most highly recommended by others — 307 of them — a reader going by “pedigrees” wrote that workers were often reviled for not working hard enough or not being educated...
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Sunday, July 20, 2014

CCWC at Disneyland


photo

Today's post is authored by Julius Young and shared from workcompzone.com

I’ve been attending the 2014 California Coalition on Workers’ Compensation annual conference at Disneyland, which wrapped up yesterday.
On Wednesday the conference kicked off with a blogger’s panel featuring myself, insurance consultant and blogger Peter Rousmaniere, Workcompcentral.com publisher David DePaolo, and WorkersCompensation.com publisher Bob Wilson.  Mark Walls of Safety National Insurance moderated a lively discussion that got into some “out of the box” discussions about the direction of workers’ comp; in a coming post I’ll reprise some of the thoughts from the panel and offer some further insights.
CCWC is a major player on the California workers’ comp scene. Many of California’s big employers are members. I’m talking companies like Safeway, Walt Disney and UPS. CCWC is one of several prominent employer advocates in Sacramento along with the Cal Chamber and groups like WCAN (Workers Compensation Action Network).
Members of CCWC were pivotal in drafting and pushing through the 2012 SB 863 California comp reforms. Key board members clearly have the ear of Brown Administration policymakers. And the Sacramento lobbyists used by CCWC, Paul Yoder and Jason Schmelzer, are a talented bunch.
In short, the conference attracts many of the key employer and insurer players in California workers’ comp.
Here are some of the more interesting things I heard and some of my random impressions from the...
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Saturday, July 19, 2014

Senate Briefing “Asbestos: The Impact on Public Health and the Environment” a Huge Success!!

Today's post is shared from adao.us.


On July 17, we were proud to continue the Asbestos Disease Awareness Organization‘s efforts to protect asbestos victims’ civil rights and public health by hosting our sixth Congressional Staff Briefing this time on “Asbestos: The Impact on Public Health and the Environment.” This Senate briefing was a huge success with over 60 people attending and 28 states represented.

ADAO would like to extend a big thank you to all the senators who sent staffers.

1. Alabama – Session
2. Arkansas – Pryor
3. California – Feinstein
4. California –Boxer
5. Colorado – Bennet
6. Connecticut – Blumenthal
7. Florida – Nelson
8. Georgia – Isakson
9. Idaho – Crapo
10.Illinois – Durbin
11.Indiana – Coats
12.Indiana – Donnelly
13.Iowa – Harkin
14.Kansas – Roberts
15.Kentucky – Paul
16.Louisiana – Vitter
17.Maine – King
18.Massachusetts – Markey
19.Montana – Tester
20.New Jersey – Booker
21.New Mexico – Udall
22.Ohio – Portman
23.Oklahoma – Inhofe
24.Oregon – Merkley
25.Oregon – Wyden
26.Pennsylvania – Casey
27.Rhode Island – Reed
28.South Dakota – Johnson
29.Utah – Hatch
30.Vermont – Sanders
31.Washington – Murray
The major...
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California Dreamer: Recent Reform Too Good To Be True

California IMR-Source: CA DIR (7-2014)
Reading it is one thing, and believing it is another. As lawyers we all know that there are at least 2 sides to every story.

This week the California Division of Industrial Relations (CA DIR) published a report of the implementation status of recent workers' compensation reform legislation commonly referred to as SB 863 (2012 enactment).

The report concludes that it is still too early to determine whether or not the legislation produced a positive impact on the system. If delay and denial of benefits is what was intended, then from what has been heard on The Street, the legislation is a win.

Basically, the latest round of reform, crafted with very little public input and enacted in "the dead of night," was intended to curb and contain costs. The "innovative process" to limit escalating medical costs, probably the largest ticket item in the entire package, was to be limited going forward through a process termed Independent Medical Review (IMR). A theoretically system that removes the medical delivery decision from the adversary system, ie. get rid of the lawyers approach.

While it sounded great on paper, the process turned out to be a constitutionally challenged nightmare that ultimately delayed and denied benefits and added insult to injury for disabled workers. Employers and carriers started to challenge everything. No one wanted to take responsibility for medical care and the system suffered from compounding delay as everything seemed to be tossed in the IMR bucket.

California is particularly important as a model for workers' compensation.  It is a national testing ground for innovation. It is a very large and extremely complex system, where even the exceptions to the rule have multiple exceptions. Luckily the California workers' compensation bar  is well organized, educated, knowledgeable and skilled. Unfortunately, the numbers of expert workers' compensation lawyers continues to become fewer as firms backout of the system for lack of economic incentive to participate.

The CA DIR report released this week basically answers nothing about whether the system improved since the SB 863 was enacted. A few charts loaded with caveats only reflect a statistical vision of political hope for improvement that is diluted with a conclusion that it is too soon to tell if it is really working as promised.

The "promise" made by Industry to Labor in 1911 for system of remedial social legislation, ie. workers' compensation, seems broken. Recognizably the cycle after cycle in California of repeated efforts to readjust the system through major systemic efforts continue to compound failures.

It is far time that California stopped dreaming about improvements that appear too good to be true and start thinking creatively on how to craft an innovative system that meets the needs of ALL the stakeholders.

….

Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thompson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson-Reuters). For over 4 decades the Law Offices of Jon L Gelman  1.973.696.7900  jon@gelmans.com  have been representing injured workers and their families who have suffered occupational accidents and illnesses.

Friday, July 18, 2014

FedEx indicted for drug dealing. Not a delivery guy — the whole company.


There might be something more interesting than a tennis ball in that FedEx package.File that illicit drug revenue under “miscellaneous.”
That’s more or less the policy the shipping giant FedEx followed starting in the mid-aughts, according to a 15-count indictment filed in U.S. District Court in California on Thursday. According to prosecutors, the company knew the shipping services it provided to two Internet pharmacies ran afoul of the law.
“FedEx knew that it was delivering drugs to dealers and addicts,” said a press release from the U.S. Attorney’s Office of the Northern District of California.

OAKLAND, CA - DECEMBER 13: FedEx workers sort through a pile of boxes at the FedEx sort facility at the Oakland International Airport on December 13, 2010 in Oakland, California. FedEx Corp. is predicting that Monday will be the busiest day in company history for delivering packages worldwide with an expected 16 million shipments, up close to 13% from last year's biggest shipping day. (Photo by Justin Sullivan/Getty Images)
OAKLAND, CA - DECEMBER 13: FedEx workers sort through a pile of boxes at the FedEx sort facility at the Oakland International Airport on December 13, 2010 in Oakland, California. FedEx Corp. is predicting that Monday will be the busiest day in company history for delivering packages worldwide with an expected 16 million shipments, up close to 13% from last year's biggest shipping day. (Photo by Justin Sullivan/Getty Images)

 FedEx workers sort through a pile of boxes at aFedEx sort facility in 2010. (Justin Sullivan/Getty Images)
The company didn’t just deny the charges — it said that monitoring packages for illegal substances isn’t its job.
In another words: Don’t prosecute the messenger.
“We are a transportation company — we are not law enforcement,” said Patrick Fitzgerald, senior vice president...
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TOP 10 EVENTS IN CALIFORNIA WORKERS’ COMP 1ST HALF 2014

Today's post was shared by Julius Young and comes from www.workerscompzone.com

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.

Overall,...


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