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(c) 2010-2024 Jon L Gelman, All Rights Reserved.
Showing posts with label independent medical review.. Show all posts
Showing posts with label independent medical review.. Show all posts

Thursday, November 29, 2012

The Devil is in the Details California Style

When Workers Compensation was adopted in the United States after the European model of a benefit system for injured workers in the early 1900's, it was supposed to be a simple remedial system, The unfolding California regulatory process is highlighting, yet again, that the system is in major trouble, and that the glimmer of hope, in the name of reform, to revived it from live-support, is lacking credibility.

The administrative system of Workers' Compensation was built upon simplicity, efficiency, as a social insurance system, It was a process encouraged by Industry to avoid litigation in the civil justice system. Giving up the right to a trial by a jury was a big trade off for Labor back in early 1900's. The adoption of the system, through its poster child, the tragic Triangle Shirt Waist Fire in New York City, was emblematic of the need for a practical system to make things work, and preserve justice in doing so.

The California reform effort of this summer, SB 863, was pushed through by some elite and self-serving lobbying groups, to try to "level the playing field" in a State where economic upheaval forced it to the verge of bankruptcy. As it edged closer to its own fiscal cliff, it was about to take an ailing workers compensation program with it.

Those who practice workers' compensation law in California have just gotten used to complexity. They spend enormous time and effort navigating a a maze of bureaucratic regulations that are generated each reform cycle in the name of simplicity and efficiency.

In promulgating Utilization Review Standards noted commentator David DePaolo, points out, "The fear of course is that regulations will end up either ineffective or unduly burdensome thus mitigating potential savings due to excess complexity."

The equation offered by the Rules simply just doesn't add up. They add more costs, fees and "independent extra-judicial parties," without time restrictions, to what is supposed to be a free and speedy process. Outsourcing justice is just taking another step away from the civil justice system and due process rights embodied in our Constitution.

After all these emergency regulations are promulgated, the California Legislature will again visit the system, and a new wave of reform will need to be considered. The devil in the details of the regulations will need to be reviewed. The next legislative cycle is anxiously awaited. Hopefully it will allow the legislature to be open to the suggestions and ideas of all stakeholders and a creatively new system will be entertained to handle medical delivery in the workers' compensation process.

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Jon L.Gelman of Wayne NJ, is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson).  

More about California and workers' compensation

Sep 13, 2012
Injured workers are voicing opposition to recently passed legislation in California to enact austerity measures to save the California workers' compensation from rising costs and expenses. The injured workers group is voicing ...
Aug 15, 2012
Rumors spread like wildfire this week as alleged secret back-room dealing continued in an effort to reform the failing California workers compensation system, yet again. The great trade-off of 2012 appears to be a major move ...
Sep 01, 2012
Tonight the California Legislature took an axe to its ailing workers' compensation system, as part of major election year austerity measures. Targeting both medical and legal costs of operating the program, at the ...
Jul 12, 2012
Insurance Commissioner Dave Jones today announced that a statewide joint task force in the fight against California's underground economy has netted contractors allegedly operating illegally, resulting in 104 enforcement ...