Category Archives: CA Workers Comp News

Lower Back Pain and Better Outcomes

09/08/17     Safety National

Millions of dollars are spent annually on treating low back pain (LBP). It accounts for one third of all occupational musculoskeletal injuries and illnesses resulting in work disability. At the 2017 CWC and Risk conference a panel of experts discuss lower back pain and the latest research.

Illustration representing lower back pain for article, Lower Back Pain and Better Outcomes

Conservative treatment options

There is no magic bullet. There is moderate evidence for multiple forms of conservative treatment. Acute lower back pain(LBP) treatment options include reassurance, remain active, heat, manipulation and acupuncture.

Meds can include NSAIDs or muscle relaxants (not opioids). Chronic LBP options are exercise, mindfulness based approaches, cognitive behavioral therapy, multidisciplinary rehab. Meds can include NSAIDs, tramadol. Bed rest is not advised. Physical agents and modalities are of unproven benefit to justify their costs in patients with acute LBP. There is evidence against traction for acute LBP but there is some support for chronic LBP. There is building evidence for stratified care based on risk profile that includes psychological and physical characteristics. Some patients may need a little more than reassurance and simple education. Others may need more advanced “psychologically informed” rehabilitation.

Central sensitization is becoming better understood and represents significant changes within the nervous system. This may require multidisciplinary care that includes specialized physical rehab and pharmacotherapy. People with uncomplicated LBP who are first sent for MRIs are more likely to receive a surgical or injection intervention, require specialty care or visit to an emergency system and LBP related medical charges were higher. MRIs can trigger catastrophic thinking and disability beliefs.

The Power of Words

Words can:

• Reassure or frighten

• Signal interest or not

• Build trust /confidence or distrust or insecurity

• Create expectations – positive or negative

• Grow relationships or not

Words are most powerful when you are seen as a credible authority (benevolent, trustworthy and expert in the matter at hand. When you are familiar with and respect the worker’s specific situation: What are they wondering or worrying about, and what they want to accomplish.

University of California – WorkStrong program

The WorkStrong program is a University of California system-wide program developed with the expertise and collaborative support of UC staff in wellness programs, occupational health and recreational services. It is designed to promote recovery and prevent future workplace injuries. Each UC campus has its own unique program to suit the needs of the employees on its campus. All campuses offer the core services of WorkStrong, which include a 6 month gym membership, exercise guidance and nutrition counseling, while each campus offers their own unique programming to suit the needs of its campus.

Some of the program benefits include:

• Post-rehab wellness program (pre- and post-body composition assessments included)

• Pre- and post-flexibility/mobility and strength assessment

• Flexible hours geared towards what works best for you

• Focused on functional strength for your workplace

[SEE FULL STORY HERE]

ADA vs. WCC – Return to Work & the Interactive Process

What does it mean to return to work for a work related injury versus a non-industrial injury? What is reasonable accommodation? What is are the consequences for failing to accommodate adequately?

Return To Work logo graphic to go with article, ADA vs. WCC - Return to Work & the Interactive ProcessAt the 2017 CWC and Risk conference a panel leads a discussion on return to work and the interactive process.

Outcome is the same regardless of the type of injury. Whether the injury is work replaced or non industrial injury you must follow the interactive process. Tips for return to work include require a medical status authorizing return, internally designate who receives the status, and find out if the work restrictions are temporary or permanent. Company should have the employee sign the job analysis or job description upon return.

What should you do with conflicting medical reports?

    • still need to engage in interactive process(this is required under ADA)
    • gap between workers’ compensation and employment law
    • engage employee
    • ultimately the employer has the final decision
    • stay consistent with each employee
    • fitness-for-duty exam is an option
    • no return to work should be considered where there is a safety concern for workers or others

What is acceptable medical documentation?

Require for all medical status or certifications must include statement that worker has a disability or medical condition that requires accommodation or restriction, sufficient detail of the restrictions or accommodations required, and length of expected restriction or accommodation.

What is a “disability?” FEHA definition of disability is:

Physical: physical condition or disorder that affects a major bodily system and that limits a major life activity

Mental: having any mental or psychological disorder or condition that limits a major life activity

“Limits” means simply that the condition makes achievement of the major life activity difficult.

Under workers’ compensation there is no requirement that the employer must accommodate temporary modified duties however, under FEHA, the employer must determine if they have a “disability” and is this employee disabled under ADA.

Essential job functions

If the workers is disabled, must accommodate to effectively enable him or her to perform an “essential” job function.

    • Proving a job function is “essential”
    •  failure to perform the job function has legitimate business consequences

      {SEE FULL STORY HERE]

Top 10 California Workers’ Comp Topics: First Half of 2017

07/13/17   Julius Young

graphic for Top 10 California Workers' Comp Topics: First Half of 2017Months race by, so now it is time to take stock of California workers’ comp after the 2017 half-way mark. What stands out?

Below, in no particular order, are my picks for the most significant topics in California workers’ comp during the first half of 2017. Most of these were discussed in my blog as the year went along.

1. Adoption of a formulary was delayed

Proposed formulary regs were unveiled, with a 45-day comment period ending with a public hearing on May 1, 2017. AB 1124, passed in 2015, amended Labor Code section 5307.27 to require the Administrative Director to adopt and incorporate an evidence-based drug formulary into the MTUS by July 1, 2017.

Many stakeholders expressed concern over the July 1, 2017 deadline, urging the DWC to take more time to “get it right”. As of early 2017 the DWC has not issued revised regs with a 15 day comment period.

The DWC moved forward on regs required to implement the two anti-fraud measures enacted in 2016. Emergency provider suspension regs were adopted as required by AB 1244, as were WCAB lien claims filing rules, required by SB 1160.

WCIS (Workers’ Compensation Information System) regs were also adopted.

Still undone are home health care provider fee schedule regs and an interpreter fee schedule.

It should be noted that the DWC is not required to go through the Administrative Procedures Act for treatment guideline updates and OFMS (treatment fees) updates.

2. The issue of apportionment to genetic causation rose in prominence

A case decided by the California Court of Appeal Third District, City of Jackson v. WCAB (Christopher Rice) 11 Cal. App. 5th 109, addressed whether the courts would uphold a QME’s determination that a portion of the disability should be apportioned due to genetic causation. The Court of Appeal determined that this was allowable. However, the Court refused to consider arguments that this was prohibited by the California anti-discrimination statues (Government Code 11135(a) and 12940(a)) since that issue was not raised previously. Likewise, City of Jackson v. WCAB did not consider potential issues as to whether genetic apportionment was a violation of GINA, the federal Genetic Information Nondiscrimination Act of 2008.

[SEE FULL LIST HERE]

Your Workers Travel Where?

07/07/17 Julius Young

A recent California Court of Appeals decision deals with the issue of how and when an insurance carrier can rescind a workers’ compensation policy.

fraud alert road sign for Californai Workers' Compensation insurance fraud articleStudies prepared for CHSWC have shown that California is plagued with a large amount of employer premium fraud (see link at the end of this post). Sometimes it may be the hiding and misrepresentation of payroll data. Or it may be misrepresentations of the nature of work done by employees.

So clarity about how and when a policy may be rescinded is critical.

In Southern Insurance Co. v. WCAB (note that the case is designated as an unpublished opinion), the misrepresentation was about the distances trucking employees would be driving.

The employer, EJ Distribution (“EJ”), filed an online application with Southern Insurance Company in December 2008. Interestingly, the application was prepared by EJ’s insurance agent. The application listed the business as “local hauling” and also that EJ’s employees did not travel out of state or in excess of a radius of 200 miles.

However, the insurance policy itself did not have an exclusion based on location of injury.

Southern was not pleased when it received a claim that an EJ trucker had hurt his back while on a trip to Tennessee for EJ.

So Southern sent a letter to EJ rescinding the policy on the grounds of material misrepresentation or concealment of material facts in the application for insurance. Southern returned the policy premium paid by EJ.

A later investigation by EJ determined that EJ had been doing trucking operations beyond 200 miles for some time, but there was a lack of specific data uncovered as to when those out of state operations actually started. So Southern apparently did not have direct proof that out of state service was underway at the time of the January 1, 2009 policy inception.

[READ FULL STORY HERE]

7 Ways to Proactively Reduce Comorbidity Costs

photo of fat guy to illustrate comorbidityAs if managing workers’ compensation claims isn’t challenging enough, we’re increasingly seeing comorbid conditions among injured workers. We know that these health issues can increase the likelihood of workplace injuries and illnesses, and then add to the complexity and costs of managing a claim. The aging workforce means we’ll probably see more multiple comorbidities per claim in the years ahead.

Some jurisdiction, such as California, require employers to pay for treatment of a comorbidity if it hampers recovery. Even in states that don’t have that requirement, it still benefits payers to identify and address comorbid conditions that are present or, ideally, try to prevent them in the first place.

The Stats

The rate of claims with comorbid conditions per claim nearly tripled between 2000 and 2009.  These claims are more likely to include lost time and have about two times higher medical costs than comparable claims.

Obesity, addiction, mental health and hypertension are those with the greatest impacts on negative outcomes. Obese workers, for example, file two times as many claims as non-obese workers, have medical costs that are seven times higher, and incur an average 13 times more days away from work.

Diabetes has one of the lowest impacts on claims among comorbidities; and yet it is associated with increased recovery times, delayed healing, an increase in the likelihood of infections and other complications, and results in increased reserves.

When more than one comorbidity is present the increases are staggering.

  • 76 percent increase in claims duration.
  • 341 percent increase in total incurred costs.
  • 285 percent increase in temporary total disability days.
  • 147 percent increase in litigation rates
  • 123 percent increase in surgery rates

    [READ FULL STORY HERE]

Negotiating Drug Prices: Should CA State Agencies Band Together?

California Drug Price Relief Bill, logoCiting budget-busting drug costs, a California lawmaker wants state health programs to band together to negotiate better prices with drug companies.

Assembly member David Chiu (D-San Francisco) has introduced a bill that would strengthen intra-agency collaboration on drug cost-saving strategies. Lawmakers will consider the bill at an Assembly Health Committee hearing on Tuesday.

“Californians and Americans are frustrated with the lack of progress around drug prices,” Chiu said, citing the uproar over EpiPen and hepatitis C medications.

He said state agencies should pool their efforts “so that we can leverage that consumer power and get the best deal for our money.”

While the proposed California Drug Costs Reduction Act does not mandate that various California health programs such as Medi-Cal or Covered California purchase drugs together, it would require administrators of those programs and 17 other state agencies to convene twice a year to strategize about ways to keep costs down.Through the California Pharmaceutical Collaborative (CPC), state officials would consider a uniform state drug formulary and look at paying for drugs based on the value they bring to the health system.

A pharmaceutical collaborative by that name already exists within the California Department of General Services and purchases drugs for state prisons, hospitals and universities. This bill would expand on those efforts.

Chiu says it’s unclear what the current program is doing, and if it has been successful in bringing down drug costs. The 2002 legislation that created the collaborative required only a few agencies to participate, and only one report back to the legislature in 2005.

Continue reading Negotiating Drug Prices: Should CA State Agencies Band Together?

Workers’ Compensation in the Agriculture Industry

September 12, 2012 by

sign that reads, "I'm making agricultural safety and health part of my lifestyle."Workers’ compensation insurance for employers in the agriculture field is normally provided by insurance carriers who market to this field. The cost of coverage is about average (except for livestock farms and stables which runs about double other farming operations). The frequency and severity of claims is comparable with other industries.

Agriculture operations are found in every state with most businesses tending to be small in the number of permanent employees, but with some large operations with large payrolls. Among the large operations are agri-businesses. These are very different than family farm-type operations.

  • Physical hazards include machinery, exposure to insecticides and herbicides, various types of manual labor and heavy lifting.
  • Safety issues include those related to working with equipment and/or machinery with moving parts, using proper protective gear and knowing proper lifting techniques.
  • Occupational illnesses do occur when proper protective gear is not used with the application of insecticides and herbicides.

The workforce of permanent employees is normally stable with experienced long-term employees. The cost of work comp coverage is impacted by the number of seasonal employees who are employed for short periods of time for planting in the Spring and harvesting in the Fall. Most seasonal employees have low levels of education, little or no understanding of workers’ compensation, and no loyalty to the employer due to the short duration of employment. In approximately half of the states seasonal employees are excluded from work comp coverage unless the business purchases a rider or endorsement adding coverage for seasonal employees.

[READ FULL STORY HERE]

Smokers Have Help to Kick the Habit as Tobacco Tax Increases

Date: 3/28/2017

Contact: Ali Bay or Corey Egel | 916.440.7259SACRAMENTO 

Cigarette Tax Increases $2 on April 1

poster with the benefits of quiting smokingIn light of the new tobacco tax going into effect this week, the California Department of Public Health (CDPH) reminds Californians that resources are available to help them kick the habit.

On April 1, the tax on a pack of cigarettes will increase $2, from $0.87 to $2.87. This increase is a result of Proposition 56, the California Healthcare, Research and Prevention Tobacco Tax Act, which was approved by voters last November.

Californians who want help to quit smoking can call the California Smokers’ Helpline at 1-800-NO BUTTS. The helpline provides smokers free telephone counseling and plans to help them quit. The Helpline is staffed with trained counselors who are fluent in English, Spanish, Mandarin, Cantonese, Korean and Vietnamese. Additional resources and materials are available at www.nobutts.org.

“We know most smokers want to quit, and paying more for their habit could be the extra motivation they need to make an important life-saving step,” said CDPH Director and State Public Health Officer Dr. Karen Smith. “Quitting smoking helps protect your physical and financial health. A smoker who quits today could save nearly $1,500 in just one year.”

Continue reading Smokers Have Help to Kick the Habit as Tobacco Tax Increases

New CA Criminal Background Regulations Coming July 1

  | 

photo of fingerprint scannerThe California Office of Administrative Law (OAL) approved new regulations this week relating to the use of criminal background information in employment decisions.

These regulations will be filed with the Secretary of State’s office and take effect on July 1. Employers will have additional burdens under the new regulations.

As previously reported, the California Fair Employment and Housing Council (FEHC) proposed these criminal history regulations last year.

In addition to reiterating existing prohibitions on the use of criminal history information in California, the regulations require employers to demonstrate that any criminal history information sought is job-related and consistent with a business necessity.

Job-Tailored Consideration

Employers can demonstrate that the consideration of criminal history information is appropriately tailored to the job in one of two ways:

  • Employers may conduct an individualized assessment of the circumstances and qualifications of applicants/employees excluded by the conviction screen. Before taking an adverse employment action, such as refusal to hire, the employer must give the individual notice of the disqualifying conviction and a reasonable opportunity for the individual to respond and demonstrate that the criminal history exclusion should not apply to his/her particular circumstances. The employer must consider this information and determine whether an exception is warranted.
  • An employer may demonstrate that its “bright-line” conviction disqualification policy (one that doesn’t contain an individualized assessment of the facts) properly distinguishes between applicants and employees that do and do not pose an unacceptable level of risk and that the conviction being used has a direct and specific negative bearing on the applicant/employee’s ability to perform the duties or responsibilities necessarily related to the position.

Any bright-line rule that includes conviction-related information that is seven or more years old will be presumed to not be sufficiently tailored to meet a job-related/consistent with business necessity defense. The burden will be on the employer to rebut this presumption.

[READ FULL STORY HERE]

Help for Drivers Impaired by Edible Marijuana

photo of medical marijuana candy bar
Candy bars laced with medical marijuana are seen on display at the Alternative Herbal Health Services cannabis dispensary April 24, 2006 in San Francisco, California. (Photo by Justin Sullivan/Getty Images

Though marijuana edibles are becoming increasingly common, scant information exists on how to test drivers for impairment following their consumption.

For the first time, research published today in AACC’s Clinical Chemistry journal evaluates the performance of roadside saliva tests for tetrahydrocannabinol (THC) following consumption of edibles, showing that lower THC cutoff points are needed for these tests to effectively detect marijuana ingestion.

Consumption of marijuana edibles has expanded along with legalized medical and recreational use of this drug, and almost one-third of all marijuana is now either eaten or ingested in drink form. Marijuana-associated traffic accidents and fatalities have also increased rapidly in states where this drug has been legalized, with THC prevalence among U.S. weekend nighttime drivers increasing from 8.6% in 2007 to 12.6% in 2013 and 2014.

THC is the main psychoactive constituent in marijuana, and unlike with alcohol, no breath test exists that can accurately detect it. As an alternative, saliva tests show potential as quick roadside sobriety tests for cannabis. However, the efficacy of roadside saliva tests following edible cannabis consumption has never been studied before.

In this study, a team of researchers from the National Institute on Drug Abuse led by Marilyn A. Huestis, PhD, set out to fill this critical gap in roadside marijuana testing knowledge. The researchers gave occasional and frequent marijuana smokers brownies laced with 50.6 mg of THC. Over the course of 48 hours, the researchers then collected saliva and blood samples from the participants at several time-points Continue reading Help for Drivers Impaired by Edible Marijuana