Uncertainty Continues to Dominate the California System

Today's post is shared from David DePaola, After practicing workers' compensation law for nearly 18 years, he founded and grew WorkCompCentral, a respected news and education service in the workers' compensation industry. David discussed a most critical and continuing problem, the delivery of medical care, a continuing experiment in California that continues to remain unsolved.

David DePaola

"The unanswered question is how much was saved by denying unnecessary medical care," the WorkCompCentral story this morning queries, stating that Greg Johnson, director of medical analytics for WCIRB, said the WCIRB simply can't answer that question.

"Honestly, there's no way the WCIRB will ever be able to answer that question because it is not germane to IMR filings - we don't really know that IMR is denying unnecessary medical care. We only know that IMR is upholding Utilization Review denials, which may, or anecdotally more often than we admit, may not, be about appropriate care.

"As I mentioned before, the anecdotal evidence suggests that UR is being used too often for cost containment rather than directing care. And frankly the amount of time it takes to get through a couple of UR denials and appeals, and then IMR review, denial and appeal, is incentive enough not to push for any particular treatment request - it's easier just to go to a general health doctor to get treatment for an ailment of "unknown origin."

Click here to read the entire article.

Read more about California and "workers' compensation:"

Nurses to Jerry Brown: California isn't ready for Ebola

Oct 28, 2014

The union's call – and a rebuttal from the California Hospital Association – came as Brown met privately with nurses, public health officials and medical providers to discuss Ebola. Though there are no known cases of Ebola in ...

http://workers-compensation.blogspot.com/

Workers' Compensation: California Prop. 46, Inspired By ...

Oct 18, 2014

California Prop. 46, Inspired By Tragedy, Pits Doctors Against Lawyers. Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org. This story is part of a partnership that includes KQED, NPR ...

http://workers-compensation.blogspot.com/

Workers' Compensation: California Medical Fraud ...

Aug 18, 2014

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 ...

http://workers-compensation.blogspot.com/

California Commission on Health and Safety and Workers

Aug 21, 2014

Today's post is authored by Julius Young of the California Bar and shared from workerscompzone.com. This past Friday the California Commission on Health and Safety and Workers' Compensation (CHSWC) met in Oakland.

http://workers-compensation.blogspot.com/

Related articles

• Rotten in Denmark (workers-compensation.blogspot.com)
• California Prop. 46, Inspired By Tragedy, Pits Doctors Against Lawyers (workers-compensation.blogspot.com)
• California: Medical Delay and Denial Protested (workers-compensation.blogspot.com)
• WellPoint Sees Small Employers Dropping Health Coverage (workers-compensation.blogspot.com)
• Bill To Give Veterans Private Medical Care Advances In House (workers-compensation.blogspot.com)
• Medicare Seeks To Curb Spending On Post-Hospital Care (workers-compensation.blogspot.com)
• Consumers Beware: Not All Health Plans Cover A Doctor's Visit Before The Deductible Is Met (workers-compensation.blogspot.com)

California: Did Workers' Comp Reform Go Too Far?

Friday October 5, 2007

Did Workers' Comp Reform Go Too Far?

By Alan J. Wax

California employees have borne the entire brunt of the Governor's 2004 Workers' Compensation Reform (SB899). Studies by state agencies confirm that the benefits have been reduced by 50 to 70 percent. Even the U.S. Chambers of Commerce reports that California's benefits are among the lowest in the nation. The average maximum weekly permanent disability benefit for the nation is $595, compared to California, which is $270. Weekly benefits for permanently disabled workers in California are the fourth lowest in the nation. Balance this with the fact that California's cost of living is one of the highest in the nation. The insurance industry reports their profits for the last three years exceed the cost of all benefits combined. (Based on the Workers' Compensation Insurance Rating Bureau July 2007 Rate Filing and Summary of March 31, 2007 Insurer Experience)-

Here are some examples of California's ranking among the lowest in the nation compared to other states:

Loss of an eye: California ranks lowest in the nation!

Hearing loss in one ear: California ranks lowest in the nation!

Loss of a foot: California ranks second lowest in the nation!

Loss of a leg at hip: California ranks sixth lowest in the nation!

Loss of a thumb: California ranks seventh lowest in the nation!

(Source: "Analysis of Workers' Compensation Laws," U.S. Chamber of Commerce)

In a special hearing regarding the Reform, Senator Sheila Kuehl had admonished the then, Administrative Director Andrea Hoch by stating that there was no legislative intent to reduce "whole hog" the overall benefits, the then Chairman Richard Alarcon, stated it was his understanding "that [SB899] should not reduce benefits to injured workers." In fact, Governor Schwarzenegger was quoted as saying, "I never wanted to hurt any one of the workers or the people that get benefits," (Sacramento Bee, November 19, 2003). However, that is exactly what is being done by this reform.

SB 936 sponsored by Senator Don Perata, would help restore fair and adequate in small measure benefits for those who through no fault of their own become permanently disabled as a result of a work related injury and will not require any cost increase for employers. As permanent disability benefits represent only 13 percent of total benefits. This measure has been passed on a virtually unanimous vote of Senate and Assembly Democrats. This remedial bill partially corrects unintended 50 to 70 percent cuts in permanent disability compensation to injured workers. There are many problems with the workers' compensation reform dealing with limits on reasonable medical treatment, temporary disability benefits and vocational retraining. SB 936 would be a first step in trying to restore modest compensation to California's injured on the job.

Alan J. Wax, a Certified Specialist by the State of California in the area of Workers' Compensation Law, and a member of Board of Governors of the California Applicant's Attorney's Association is a partner with the law firm of Wax & Wax. He can be reached at (661) 255-9585. His column represents his own views, and not necessarily those of The Signal. "Business Law" appears Fridays and rotates between members of the Santa Clarita Valley Bar Association. www.SCVbar.org.

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.
....
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

Workers' Compensation: California Worker Coalition Objects to ...

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 ...

http://workers-compensation.blogspot.com/

Workers' Compensation: The Great California Trade Off 2012

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 ...

http://workers-compensation.blogspot.com/

Workers' Compensation: California Takes an Austerity Axe to ...

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 ...

http://workers-compensation.blogspot.com/

Corporate Workers Compensation Fraud: California Targets ...

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 ...

http://workers-compensation.blogspot.com/

Related articles

• US Supreme Court Hears Oral Argument on Workplace Harassment Case
• Corrupt Employers Just Keep Cooking the Books
• NY Worker's Compensation Board Proposes New Medical Treatment Guidelines
• Italy's Supreme Court Rules Cell Phone Brain Cancer Work Related

California Worker Coalition Objects to Recent Workers Compensation Legislation

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 concern about 3 major issues:

1. Stop Attacking Injured Workers
2. For Full Healthcare Rights and No More Insurance/Employer Control Of Workers Compensation
4. Stop Cost Shifting By The Insurance Industry and Employers

More about California and Workers' Compensation

Workers' Compensation: California Takes an Austerity Axe to ...

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 ...

http://workers-compensation.blogspot.com/

Workers' Compensation: The Great California Trade Off 2012

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...

http://workers-compensation.blogspot.com/

Workers' Compensation: California Settlement Protects Hair Salon ...

May 31, 2012

A groundbreaking settlement between California's Attorney General and manufacturers of Brazilian Blowout hair smoothing products that contain a cancer-causing chemical will help protect salon workers and consumers, ...

http://workers-compensation.blogspot.com/

Workers' Compensation: Law Firm Prosperity California Style-Post ...

May 29, 2012

Applicant firms (as they are called in California) have not seen much if any attrition since 2004,when the Terminator reforms were instigated, and several have actually expanded taking up the slack of the less dedicated firms.

http://workers-compensation.blogspot.com/

Related articles

• Cell Phones, Glioma and Cancer in the Workplace
• The High Price of Drugs: Upscale Pricing By Doctors
• Should Genetic Medical Information Be Given to Workers' Compensation Insurance Companies?
• The Great California Trade Off 2012

Chlorpyrifos (CPS) Banned in California

Today's post is shared from khn.org
State Bans Pesticide Linked To Developmental Problems by Ana B. Ibarra, Kaiser Health NewsCalifornia will ban the use of a widely used pesticide in the face of “mounting evidence” that it causes developmental problems in children, state officials announced Wednesday.

California Supreme Court to File its Decision in a Derivative Immunity Claim Tomorrow

The California Supreme Court will file its much-anticipated decision regarding KUCIEMBA v. VICTORY WOODWORKS, Case: S274191, on Thursday, July 6, 2023, at 10:00 am (PT). The Court had accepted the request of the US Court of Appeals for the Ninth Circuit to answer a question of state law regarding employers' liability in COVID claims. Briefs are now available online (See below).

Amazon Settles with California Over Concealment of COVID Data From Warehouse Workers COVID-19

Historically workers have been denied adequate occupational exposure information, which has led to epidemics of disease/death and lawsuit, including workers' compensation claims. Exposure to the SARS-CoV-2 (Coronavirus) virus has been no exception.

CA Cities and Counties announce settlement agreement with NL Industries on lead paint

NL to provide $60.2 million in funding to address lead paint in homes across California.

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.

Related articles

• The Devil is in the Details California Style (workers-compensation.blogspot.com)
• California Worker Coalition Objects to Recent Workers Compensation Legislation (workers-compensation.blogspot.com)
• Universal Medical and Workers' Compensation: It's Not "If", It's "When" - California (workers-compensation.blogspot.com)
• A California Lesson: How to Kill Workers' Compensation Pill By Pill (workers-compensation.blogspot.com)
• The SMART Act and Workers' Compensation (workers-compensation.blogspot.com)
• Study: Calif. workers compensation overhaul too new to parse (workers-compensation.blogspot.com)

Drop in California Spending Lowers U.S. Workers' Compensation Benefits and Costs

August 22, 2007

WASHINGTON, DC—U.S. workers’ compensation payments for medical care and cash benefits for workers disabled by workplace injuries or diseases declined in 2005, according to a study released today by the National Academy of Social Insurance (NASI).

The drop in payments in 2005 (the most recent year with data) reflects large declines in California payments, as reforms enacted in 2003 and 2004 took effect. Nationally, workers’ compensation payments for injured workers fell by 1.4 percent to $55.3 billion in 2005. The payments include $26.2 billion to providers of medical care and $29.1 billion in cash wage replacement benefits for injured workers. California payments fell by 12.2 percent; a change made up of a 16.0 percent decline in medical payments and an 8.6 percent decline in cash payments. “The reduced spending for benefits and medical care reflects the initial stages of cost containment measures that were put in place in 2003 and 2004 reforms to the California system,” according to NASI member Christine Baker, who directs the California Commission on Health and Safety and Workers’ Compensation, a nonpartisan labor-management group that advises state policymakers.

Because it is a large state – accounting for nearly 20 percent of national benefit payments in 2005 –California altered national trends. Outside California, total workers’ compensation payments rose by 1.7 percent, an increase driven by a 4.1 percent increase in payments to medical providers. Cash payments to injured workers outside California showed a small decline (0.3 percent).

The costs to employers for workers’ compensation are what they pay each year. For employers who buy insurance, costs are premiums they pay to insurance companies plus benefits they pay under deductible arrangements in their insurance policies. For employers who insure their own workers, costs are the benefits they pay plus administrative costs. In 2005, employers paid a total of $88.8 billion nationwide for workers’ compensation. A sharp drop in California employers’ costs (of 9.8 percent) held down the national increase in employer costs to 2.3 percent. Outside California, employer costs for workers’ compensation rose by 6.5 percent.

The new report tracks trends since 1989 in workers’ compensation benefits and employer costs relative to total wages of workers covered by the program. Relative to wages, cash benefits in 2005 were the lowest in 17 years ($0.56 per $100 of wages). Nationally, total benefits (cash plus medical) and employer costs fell relative to wages in 2005. Cash and medical benefits combined were $1.06 per $100 of covered wages in 2005, a drop of $0.07 from 2004, while employer costs were $1.70 per $100 of wages in 2005, down $0.05 from 2004.

Outside California, benefits per $100 of wages fell by a smaller amount ($0.03) and employer costs per $100 of wages rose slightly (by $0.02). According to John F. Burton, Jr., chair of the panel that oversees the study, “The relative stability of benefits outside the Golden State reflects a rough balance between the declining frequency of workplace injuries and higher expenditures for medical benefits.”

The new report, Workers’ Compensation: Benefits, Coverage and Costs, 2005, is the tenth in a NASI series that provides the only comprehensive national data that covers all types of employers. The study provides estimates of workers’ compensation cash and medical payments for each state, the District of Colombia, and federal programs.

To download the full report, click here.
To download a PDF of this release, click here.

The State of Medical Care in California’s Workers’ Compensation System

Katherine Roe

Todays' guest post is authored by Katie Roe*  of the California Bar and was originally published at rivercityattorneys.com/blog (Fraulob & Brown).

When you’re injured at work, you expect that your employer’s insurance carrier will dutifully provide you with proper medical treatment for your injury. After all, future medical care is one of the “benefits” injured workers are entitled to in California. Denial of medical treatment is the number one frustration we hear from our clients on a daily basis.

What injured workers quickly discover is that their medical treatment is strictly controlled by the insurance carrier and their medical fate is in the hands of a doctor who has never treated them and may not even have their complete medical records. This process is called Utilization Review (UR). Under UR an outside physician gets to decide whether or not the insurance company should authorize the medical treatment prescribed by your primary treating physician. This doctor doesn’t even have to be licensed in California.

If the medical treatment prescribed by your physician is denied, your only recourse is to appeal the decision to an Independent Medical Reviewed (IMR). In California, MAXIMUS is the company contracted to conduct IMR reviews. Like UR doctors, the IMR doctor deciding your fate, has never met you or treated you and does not need to be licensed in California. In fact, their identity is protected. If your medical treatment is denied by UR, your chances of IMR overturning the decision are not good. California Workers’ Compensation Institute, an insurance research group, found that 91% of IMR decisions uphold the UR denial. If the treatment is denied by IMR, absent a change in circumstances, the denial will be in effect for one year.

While an injured worker has the right to appeal an IMR determination to the Workers’ Compensation Appeals Board, the only legal bases on which to appeal are fraud, conflict of interest, or mistake of fact. However, even if your appeal is successful the WCAB still cannot overturn the IMR doctor’s decision. If an appeal is granted, the remedy is referral to a different IMR for another review. Yes, you read that right, your award is to go through the IMR process again!

Many injured workers end up seeking treatment for their work related injuries through private insurance, Medicare or Medi-Cal. A study by J. Paul Leigh, a health economist at the University of California, Davis, estimated that only 1/3 of necessary medical treatment and lost wages is being paid for by workers’ compensation insurers.

The lack of adequate medical care for injured workers today is the result of Senate Bill 863, which was passed on August 1, 2012 and signed into law by Governor Brown on September 18, 2012. This law was the result of lobbying by big businesses and insurance companies, who have influence over the State Legislature and the Governor of California. We remind our clients that you also have a political voice. We recommend you go to Voters Injured at Work (www.viaw.org) for information on how to become involved with fixing this broken system.

To read more about the dismal state of medical treatment for injured workers all over America I encourage you to read Insult to Injury by Michael Grabell athttps://www.propublica.org/article/the-demolition-of-workers-compensation.

*Katherine Roe is originally from the San Francisco Bay Area. She attended University of St. Thomas, Saint Paul Minnesota for her undergraduate degree in Sociology with a minor in Criminal Justice. She earned her Master in Public Administration from University of Notre Dame de Namur, Belmont, CA. Katie graduated from University of the Pacific McGeorge School of Law in Sacramento where she received the Witkin Award for Health Law and Elder Law Clinic. She is a practicing attorney in the areas of Workers’ Compensation Law, Social Security Disability and Elder Law, including estate planning with wills, trusts, deeds, powers of attorney and health care directives.
While in college, Katie tutored grade school and high school students in low-income neighborhoods in Saint Paul and Minneapolis, MN and interned with the Oakdale, MN Police Department.
During law school, Katie interned with Legal Aid Society of San Mateo County, Human Rights Fair Housing Commission and the California Department of Insurance. While at McGeorge, she worked in the Elder and Health Law Clinic where she handled Medicare appeals, elder abuse cases, restraining orders, wills, trusts, consumer protection, special needs trusts, and powers of attorney.
While the Clinical Fellow at McGeorge she received the Cohn Sisters’ Scholarship for Patient Advocacy.

Related articles

• Google to Make Security Guards Employees, Rather Than Contractors (workers-compensation.blogspot.com)
• If Things Go Very Wrong (workers-compensation.blogspot.com)
• Insurance Carrier Subject to Lawsuit for Failing to Reimburse CMS (workers-compensation.blogspot.com)
• The Economic Benefits of Paid Parental Leave (workers-compensation.blogspot.com)
• The Plot Thickens As Uber Turns to Leasing Vehicles (workers-compensation.blogspot.com)
• California: WCIRB Report Shows Continued Increase in Claim Frequency (workers-compensation.blogspot.com)
• Mechanic can sue Ford for further damages in asbestos case (workers-compensation.blogspot.com)

California Implements First-in-the-Nation Measures to Encourage State Employees and Health Care Workers to Get Vaccinated

The State of California is taking decisive action to combat the spread of COVID-19 and protect vulnerable communities – implementing a first-in-the-nation standard to require all state workers and workers in health care and high-risk congregate settings to either show proof of full vaccination or be tested at least once per week, and encourage all local government and other employers to adopt a similar protocol.

California bill limiting workers' comp claims by athletes advances

Today's post was shared by WCBlog and comes from www.latimes.com

An effort by the National Football League and owners of other professional sports teams to limit workers' compensation claims by out-of-state athletes is close to final passage in the California Legislature.

The measure cleared the state Senate on Friday on a 34-2 vote. In May, it passed the Assembly on a 61-4 tally.

The proposal is expected to win final passage next week in the Assembly and to be on the governor's desk shortly after the scheduled Sept. 13 legislative recess.

Because of its liberally interpreted workplace injury laws, California has become the de facto forum of last resort for so-called cumulative trauma claims, including head injuries, by retired players. Many of them may have participated in just a handful of games in California over the course of their careers.

The crackdown on athletes' workers' compensation claims has been the focus of a major lobbying campaign by the NFL and other pro-sports leagues. Former athletes have filed more than 4,400 claims involving head and brain injuries since 2006.

Such claims represent an estimated potential $1-billion liability for the NFL alone.

The bill, AB 1309 by Assemblyman Henry T. Perea (D-Fresno), does not affect players who spent their careers with California-based football, baseball, basketball, hockey and soccer teams.

However, it bans claims from athletes who played for California teams for less than two seasons, and those who played for California teams at least two seasons but spent seven...

[Click here to see the rest of this post]

Related articles

• The uneven playing field of workers' compensation (workers-compensation.blogspot.com)
• Brain injuries a big problem for NFL in California (workers-compensation.blogspot.com)
• Workers compensation hike on California employers proposed (workers-compensation.blogspot.com)
• OK's True Cost Control Feature (workers-compensation.blogspot.com)
• Move Over: Obesity as a medical condition is coming to workers' compensation (workers-compensation.blogspot.com)
• Cost Shifting vs. Cost Fixing (workers-compensation.blogspot.com)

Found on

IF THINGS GO VERY WRONG

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

Bay Area residents were awakened last night to a 6.0 earthquake in Napa. News reports indicated that Napa County’s old courthouse was among the downtown buildings sustaining major damage. For many years, California has been lucky in not having an earthquake that caused widespread loss of life. But what if a major earthquake struck during work hours, killing or severely injuring scores of workers in a facility operated by one of California’s public entities? Such a scenario is clearly not out of the question, as schools, courthouses, hospitals, municipal administration buildings and other large structures are located in at-risk fault zones up and down California. Such structures could also be at risk for a terrorist incident. Hospitals could be at risk for a severe infectious disease incident. Many California public entities are self-insured. How would they deal with a widespread catastrophic incident? Thinking about this made me turn to a recent study that is currently posted on the CHSWC site for public comment. The study, titled “California Public Sector Self-Insurance” (link to the study can be found at the end of this post)  was produced by Mark Priven, an actuary with Bickmore Consulting. Priven’s study examines many aspects of public sector workers’ comp insurance in California, including a section on solvency. Recent municipal bankruptcies of cities such as Vallejo and Stockton have not resulted in defaults on workers’ comp...

[Click here to see the rest of this post]

Found on

Related articles

• Top 10 Events in California Workers' Comp 1st Half 2014 (workers-compensation.blogspot.com)
• California Medical Fraud Investigation Continues (workers-compensation.blogspot.com)
• Restoring Faith (workers-compensation.blogspot.com)
• California: Medical Delay and Denial Protested (workers-compensation.blogspot.com)

State Senate passes bill limiting pro teams' workers' comp liability

Today's post was shared by WCBlog and comes from www.latimes.com

An effort by the National Football League and owners of other professional sports teams to limit workers' compensation claims by out-of-state athletes is close to final passage in the California Legislature.

The measure cleared the state Senate on Friday on a 34-2 vote. In May, it passed the Assembly, 61-4.

The latest version of the bill is expected to win final passage next week in the Assembly and be on the governor's desk shortly after the scheduled Sept. 13 legislative recess.
Because of its liberally interpreted workplace-injury laws, California has become the de facto forum of last resort for so-called cumulative trauma claims, including head injuries, by retired players. Many of them may have participated in just a handful of games in California over the course of their careers.

The crackdown on a workers' compensation claims by athletes has been the focus of a major lobbying campaign by the National Football League and other pro-sports franchises. Former athletes have filed more than 4,400 claims involving head and brain injuries since 2006.

Claims by athletes represent an estimated potential $1-billion liability for the NFL alone, though they represent only a tiny percentage of all California workers' compensation cases

The bill, AB 1309 by Assemblyman Henry T. Perea (D-Fresno), does not affect players who spent their careers with California-based football, baseball, basketball, hockey or soccer teams.

However, it bans claims from athletes who...

[Click here to see the rest of this post]

Related articles

• California bill limiting workers' comp claims by athletes advances (workers-compensation.blogspot.com)
• California Senate Oks Limits On Workers' Comp For Pro Athletes (insurancejournal.com)
• Calif. State Senate OKs Limits On Worker Comp For Pro Athletes (sanfrancisco.cbslocal.com)
• Senate fails to revive workers' comp bill for first responders (workers-compensation.blogspot.com)
• Brain injuries a big problem for NFL in California (workers-compensation.blogspot.com)
• Workers compensation hike on California employers proposed (workers-compensation.blogspot.com)
• Workers' Compensation Task Force meets (workers-compensation.blogspot.com)
• The uneven playing field of workers' compensation (workers-compensation.blogspot.com)

Report Finds 8 Million California Residents Lived in Poverty in 2011

Today's post was shared by votersinjuredatwork and comes from www.californiahealthline.org

There were about 8 million California residents living in poverty in 2011, according to a new report that factored in health care and other costs, the Riverside Press-Enterprise reports. The figure is significantly higher than federal estimates of nearly 6 million state residents living in poverty that year. Federal poverty estimates for California and other states use a formula from 1964 that defines poverty as income less than three times the cost of a "minimum diet," which would have been $22,811 for a family of four in 2011. However, some observers have called this method outdated because food is a smaller part of most families' budgets than it was 50 years ago. The study was conducted by researchers at the Public Policy Institute of California and the Stanford Center on Poverty and Inequality. Unlike federal figures, the study's poverty estimates include: Government benefits; Housing prices; Health care costs; and Other expenditures (Olson, Riverside Press-Enterprise, 9/30). According to the report, the poverty rate in California was about 22% in 2011, the highest in the U.S. and significantly higher than the official rate of 16% (Holland, Los Angeles Times, 9/30). When the study factored in cost of living: Poverty rates increased in places with high housing costs and other expenses, such as Orange County and the San Francisco Bay Area; and Poverty rates decreased in areas where housing is less expensive, such as some Northern California and...

[Click here to see the rest of this post]

Found on

Related articles

• California has highest poverty rate in country (isteve.blogspot.com)
• Walters: 8 million in California living in poverty (fresnobee.com)
• 2mil more poor CAs: Stanford/PubPolicyInst does the math (californiaschildren.typepad.com)
• Tips and Poverty (workers-compensation.blogspot.com)
• Thousands of California injury claims made by professional athletes (workers-compensation.blogspot.com)
• Jobs are coming back, but they don't pay enough (workers-compensation.blogspot.com)
• Report Recommends Raising Workers' Compensation Premiums (workers-compensation.blogspot.com)

Workers Compensation: A Cash Cow For Medical Providers

Guest Blog

by Julius Young of the California Bar

Are medical treatment recommendations sometimes driven by profit motive?

In my whole career I've met very few injured workers who expressed concern that the treatment recommendations of their doctor were influenced by physician income considerations.

Americans tend to trust their doctors. Some of us grew up watching Dr. Kildare, Ben Casey, or the MASH doctors. Others cut their teeth on ER or General Hospital.

Nothing pisses off an injured worker as much as having an outside, non-examining utilization reviewer doctor challenge the recommendations of their doctor.

But the reality is that sometimes medicine and economics are intertwined. Just as insurers want to limit costs, there are some doctors who are happy to push procedures and tests for profit.

In a prior post, "Upcoding", I noted recent investigative reporting by California Watch that documented unusually high rates of billings for "cardiac failure" in some California hospitals:
http://workerscompzone.com/index.php?m=11&y=11

So it was no surprise to see today's article in the Wall Street Journal which documents high rates of spinal surgery procedures in some California hospitals. The article, "In Small California Hospitals, the Marketing of Back Surgery", was written by John Carreyrou, Tom McGinty and Joel Millman.

The article focuses on spinal surgery at Tri-City Regional Medical Center in the city of Hawaiian Gardens which is in southeast Los Angeles County near Long Beach.

According to the Wall Street Journal investigative reporters:

"For an operation known as spinal fusion, which joins two or more vertebrae, the small hospital billed workers' compensation insurers $65 million in 2010, up from less than $3 million three years earlier, state hospital discharge data show.Helping spur the business was Paul Richard Randall, a consultant to whom Tri-City has paid millions of dollars in marketing fees. According to people familiar with his role, it was twofold: bringing surgery cases to the hospital by recruiting surgeons to operate there, and supplying metal implants for the surgeries through distributorships he owned."

The article notes that Randall has been the subject of a federal investigation although charges have apparently not been filed nor have illegal acts been proven.

According to the Journal, many small hospitals are doing lots of workers' comp spinal surgeries, noting that "California employers paid $7.1 billion in insurance premiums to cover their workers' compensation liability in 2010. Spinal-fusion surgery is a growing part of the care these premiums pay for. It accounted for 40% of inpatient hospital charges to the state workers' compensation system in 2010, up from 30% in 2001, a Journal analysis of hospital discharge data shows."

Hospitals that did a large amount of spinal surgeries included university-based hospitals such as UCSF, well known treatment centers such as Cedars Sinai and Scripps La Jolla but also a number of small hospitals around the state.

While it would be unfair to assume that some of the hospitals mentioned in the article are encouraging spinal surgery cases as a "cash cow", the article raises a number of questions worthy of further looks by policymakers.

Spinal hardware costs have already been addressed in a RAND study prepared for CHSWC, "Payment for Hardware Used in Complex Spinal Procedures Under California's Official Medical Fee Schedule", by Barbara O. Wynn and Giacomo Bergamo:
http://www.dir.ca.gov/chswc/Hardware_comp9.pdf

.....

Julius Young is a partner at Boxer & Gerson LLC and has practiced workers' compensation and social security disability law since 1979 advocating for injured workers and their families.. He is the founder, writer, and editor of an award winning blog on workers’ compensation and wider more far ranging and always engaging political issues, http://www.workerscompzone.com/. The blog has twice been selected as winner or co-winner of the top workers’ comp blog in the US by Lexis/Nexis. He was a Board member of the California State Bar Executive Committee in Workers' Compensation from 2007 to 2010. Julius has acted as a training consultant for the US Hastings Employment Law Center Workers’ Compensation Clinic, has acted as an advisor to Worksafe on workers’ compensation and safety issues, and is currently serving on an Advisory Committee re Rand Institute studies at the request of the California Commission on Health, Safety, and Workers’ Compensation.

Alternative Security Program Changes Collateral Rules

Christine Baker, director of the Department of Industrial Relations (DIR), today approved the implementation of the 2012/13 Alternative Security Program (ASP), freeing $6.17 billion in capital, giving self-insured California businesses greater financial flexibility.

The ASP is a first-in-the-nation, innovative program operated by the non-profit California Self Insurers’ Security Fund with the California Department of Industrial Relations. The program provides guarantees to replace security deposits required to collateralize self-insured workers’ compensation liabilities.

“Self-insurance and the ASP are innovative ways that California can support businesses and help them reinvest capital back into growing their business,” said DIR Director Christine Baker. “With workers’ compensation representing a major expense to businesses, this program benefits both the businesses and the larger California economy in a meaningful and positive way.”

All employers in California are required to have workers’ compensation insurance to protect themselves and workers and minimize the impact of work-related injuries and illnesses.  Meeting this requirement can be accomplished either by buying an insurance policy, or through obtaining authority from the DIR Office of Self Insurance Plans (OSIP) to self-insure the businesses’ workers’ compensation liabilities.

“I’m surprised that there are not more employers taking advantage of self-insurance,” said OSIP Chief Jon Wroten. “While there are standards and requirements that must be met, for employers with sound risk management practices the benefits can be substantial to the firm’s bottom line.”

Traditionally, self-insured employers are required to maintain a deposit to collateralize their risk in the amount equal to 135 percent of estimated future Liability. This deposit, which is cash, irrevocable letters of credit, securities or surety bonds, limits the employer’s ability to use the cash or credit line to expand their business. In contrast, ASP members can apply that cash or line of credit back into their businesses while the ASP assumes responsibility of the security deposits.

California currently has 7,952 employers protecting more than 4 million workers representing a total payroll of $173 billion through self-insurance workers’ compensation plans. One of every four California workers is protected by a self-insurance plan.

Self-insured employers in California represent large and midsized private companies, industry groups, and public entities such as city, county, state and school districts.

Related articles

• The Stockton Senario: When the Municipality Goes Into Bankruptcy

  ---

• National Experts Call Workers Compensation System Irrational and Unjust

  ---

Fatal Meningococcal Disease in a Laboratory Worker — California, 2012

Today's post is shared from Centers for Disease Control and Prevention

Occupationally acquired meningococcal disease is rare (1). Adherence to recommendations for safe handling of Neisseria meningitidis in the laboratory greatly reduces the risk for transmission to laboratory workers (2). A California microbiologist developed fatal serogroup B meningococcal disease after working with N. meningitidis patient isolates in a research laboratory (laboratory A). The California Department of Public Health (CDPH), the local health department, the California Division of Occupational Safety and Health (CalOSHA), and the federal Occupational Safety and Health Administration (OSHA) collaborated on an investigation of laboratory A, which revealed several breaches in recommended laboratory practice for safe handling of N. meningitidis, including manipulating cultures on the bench top. Additionally, laboratory workers had not been offered meningococcal vaccine in accordance with Advisory Committee on Immunization Practices (ACIP) recommendations and CalOSHA Aerosol Transmissible Diseases Standard requirements (3,4). In accordance with OSHA and CalOSHA regulations, laboratory staff members must receive laboratory biosafety training and use appropriate personal protective equipment, and those who routinely work with N. meningitidis isolates should receive meningococcal vaccine.

Case Report

On the evening of Friday, April 27, 2012, a microbiologist aged 25 years had onset of headache, fever, neck pain, and stiffness. The following morning, April 28, he was transported by automobile to the emergency department at hospital A, where he was employed in laboratory A as a researcher. While on the way to the hospital he lost consciousness. Upon arrival, the patient was noted to have a petechial rash, was suspected of having meningococcal disease, and was treated with ceftriaxone. He later had a respiratory arrest. Attempted resuscitation was unsuccessful, and he was declared dead approximately 3 hours after his arrival.

On the day of the patient's death, hospital A notified the local health department and CDPH of the case of suspected meningococcal disease. On April 29, hospital A notified OSHA, which notified CalOSHA that the deceased had worked in a laboratory conducting N. meningitidis vaccine research. Hospital A evaluated potentially exposed emergency department staff members and research laboratory employees; all persons found to have been exposed were immediately assessed for symptoms of meningococcal disease and offered postexposure chemoprophylaxis. Laboratory A voluntarily closed on April 30. No additional cases of meningococcal disease were identified among emergency department or laboratory staff members. The local health department identified other close contacts of the patient and ensured that they received postexposure chemoprophylaxis.

Blood and tissue specimens from the patient were sent to the CDPH Microbial Diseases Laboratory for isolation and serogroup identification. N. meningitidisserogroup B was identified in the clinical specimens by polymerase chain reaction. The patient had worked with N. meningitidis serogroup B isolates in the weeks and days before his death.

Investigation Findings

CalOSHA, OSHA, and CDPH initiated an investigation. Laboratory A was inspected, and employees were interviewed about their training as well as laboratory practices and protocols and were asked to demonstrate how procedures were performed. Multiple breaches in recommended laboratory safety practices were identified (Tables 1 and 2), including manipulation of N. meningitidis isolates on an open laboratory bench (2,5). The inspection team made recommendations for safe handling of N. meningitidis isolates and use of appropriate personal protective equipment. Laboratory A microbiologists working with N. meningitidisisolates had not been offered quadrivalent meningococcal vaccine, as recommended by ACIP (4). At the conclusion of the investigation, OSHA issued three citations classified as serious for failure to protect laboratory workers.

Discussion

Although occupationally acquired meningococcal disease is rare, it is a known risk among microbiologists who work with N. meningitidis isolates (6–8). Investigations of laboratory-acquired cases of meningococcal disease in the United States have demonstrated a many-fold higher attack rate for microbiologists compared with the U.S. general population aged 30–59 years and a case fatality rate of 50%, more than triple the 12%–15% case fatality rate associated with disease in the general population (9). In almost all cases, infected microbiologists had manipulated sterile-site isolates on an open laboratory bench outside of a biosafety cabinet (2,6). Manipulating N. meningitidis isolates outside a biosafety cabinet is known to be associated with a high risk for contracting meningococcal disease (7).

To decrease the risk of transmission to laboratory workers handling invasive N. meningitidis strains (serogroups A, B, C, Y, and W), CDC recommends the use of enhanced biosafety level two (BSL-2) containment practices, where BSL-2 requirements are met and some BSL-3 practices also are adopted (2). Updated recommendations for microbiologists manipulating N. meningitidis strains were published in January 2012 as a supplement to the Biosafety in Microbiological and Biomedical Laboratories guide and include the use of a nonrecirculating biosafety cabinet and the following personal protective equipment: disposable closed front laboratory coat, double gloves, fit-tested N95 filtering facepiece or higher level respiratory protection, and eye protection (2,5). In California, personnel using respirators also must be enrolled in a respiratory protection program (10).

Although this fatal case of serogroup B meningococcal disease was not vaccine-preventable by meningococcal vaccines currently licensed in the United States, licensed vaccines to protect against serogroup A, C, Y, and W-135 disease are available. ACIP recommends meningococcal vaccination for microbiologists who are routinely exposed to isolates of N. meningitidis (3,4). The CalOSHA Aerosol Transmissible Diseases Standard also requires that California employers offer all vaccinations as recommended by applicable public health guidelines for specific laboratory operations (1,4). A serogroup B vaccine (Bexsero, Novartis) was licensed in Europe, Australia, and Canada in 2013 and has received a "breakthrough therapy" designation from the Food and Drug Administration.

Employers should be familiar with laboratory biosafety recommendations and ensure that a laboratory biosafety program is in place. Employers also should ensure that laboratory staff are trained, adhere to recommended biosafety practices and procedures, and are offered recommended vaccines.

Acknowledgments

Linda Guthertz, MA, Heike Quinn, MS, Gillian Edwards, MS, Robin Hogue, Nancy Caton, Margot Graves, Barbara Materna, PhD, Sharon Messenger, PhD, Rita Brenden, PhD, Herschel Kirk, California Department of Public Health. Diane Portnoy, MPH, San Francisco Department of Public Health. Sandra Huang, MD, Alameda County Public Health Department. Occupational Safety and Health Administration.

1California Department of Public Health, 2California Division of Occupational Safety and Health, 3Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC (Corresponding author: Channing Sheets, channing.sheets@cdph.ca.gov, 415-254-2582)

References

1. CDC. Laboratory-acquired meningococcal disease—United States, 2000. MMWR 2002;51:141–4.
2. CDC, National Institutes of Health. Biosafety in microbiological and biomedical laboratories. 5th edition. Washington, DC: US Department of Health and Human Services, CDC, National Institutes of Health; 2009. Available at http://www.cdc.gov/biosafety/publications/bmbl5.
3. California Division of Occupational Safety and Health. Aerosol transmissible diseases. Title 8 C.C.R. Section 5199 (2009). Available athttp://www.dir.ca.gov/title8/5199.html.
4. CDC. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices. MMWR 2013;62(No. RR-2).
5. CDC. Epidemiologic notes and reports: laboratory-acquired meningococcemia—California and Massachusetts. MMWR 1991;40:46–7,55.
6. Boutet R, Stuart JM, Kaczmarski ER, Gray SJ, Jones DM, Andrews N. Risk of laboratory-acquired meningococcal disease. J Hosp Infect 2001;49:282–4.
7. Sejvar JJ, Johnson D, Popovic T, et al. Assessing the risk of laboratory-acquired meningococcal disease. J Clin Microbiol 2005;43:4811–14.
8. CDC. Guidelines for safe work practices in human and animal medical diagnostic laboratories. MMWR 2012;61(Suppl).
9. Kimman TG, Smit E, Klein MR. Evidence-based biosafety: a review of the principles and effectiveness of microbiological containment measures. Clin Microbiol Rev 2008;21:403–25.
10. California Division of Occupational Safety and Health. Respiratory protection. Title 8 C.C.R. Section 5144 (1974). Available athttps://www.dir.ca.gov/title8/5144.html.

What is already known on this topic?

Working with Neisseria meningitidis isolates without adequate protection on the open laboratory bench can result in aerosol transmission of the bacteria. Meningococcal disease is severe and can be fatal. Among laboratory-acquired meningococcal disease cases, the case fatality rate was 50% in one study, significantly higher than the case fatality rate in the general population. The Advisory Committee on Immunization Practices (ACIP) has published immunization guidelines for laboratory workers who are routinely exposed to isolates of N. meningitidis.

What is added by this report?

A laboratory researcher who worked with N. meningitidis died from serogroup B meningococcal disease. An investigation identified deficiencies in training and practices in laboratory A, including manipulating cultures outside of a biosafety cabinet. Additionally, laboratory workers who routinely worked with N. meningitidis had not been vaccinated in accordance with current ACIP recommendations.

What are the implications for public health practice?

Adequate safety training for laboratory personnel, adherence to recommendations for safe handling of N. meningitidis isolates, and vaccination (where indicated) are necessary to reduce the risk for disease among laboratory workers.

September 5, 2014 / 63(35);770-772
Channing D. Sheets, MSEd1, Kathleen Harriman, PhD1, Jennifer Zipprich, PhD1, Janice K. Louie, MD1, William S. Probert, PhD1, Michael Horowitz, MS2, Janice C. Prudhomme, DO2, Deborah Gold, MPH2, Leonard Mayer, PhD3 (Author affiliations at end of text)

Click here to rread complete article (including table 1.

Related articles

• Princeton University reports fourth case of bacterial meningitis since March (Video) (examiner.com)
• Disappointing summer for progress by OSHA on new worker safety regulations (workers-compensation.blogspot.com)
• Truckers Fired Over Workers' Comp Claim: What to Do Next (workers-compensation.blogspot.com)
• Healthcare Workers: Protect Yourselves! (workers-compensation.blogspot.com)
• OSHA fines Englewood, NJ, surgical center $68,000 for failing to protect workers exposed to bloodborne pathogen hazards (workers-compensation.blogspot.com)
• California Becomes First State to Set Safety Guidelines for Flavoring Chemical (workers-compensation.blogspot.com)
• OSHA Proposes Fines for NJ Uniform & Laundry Company (workers-compensation.blogspot.com)