Tag Archives: California Workers’ Compensation

Access to Medical Treatment for Injured Workers in California

Year 1 Annual Report

by Andrew W. MulcahyMadeline B. DoyleRosalie MalsbergerKandice A. Kapinos

worker in hard hat holding shoulder for article, Access to Medical Treatment for Injured Workers in CaliforniaAn estimated 16 million workers use workers’ compensation (WC) insurance annually in California. Many recent policy changes might have affected access to care for injured workers. For this report, the authors assess the various dimensions of access to care in the evolving policy environment to ensure that injured workers have adequate access to needed medical care and the opportunity to achieve better health outcomes. Access to care is an important domain to monitor, especially among vulnerable populations, as patients with better access to care systems are more likely to receive comprehensive, higher-quality care and are therefore more likely to experience better outcomes.

The key objective of this report is to describe access to medical care among injured workers in the state of California, as mandated by Labor Code Section 5307.2. The authors analyze administrative and medical service bill data to examine changes over time for measures related to access to care for injured workers. The authors aim to highlight potential access-to-care barriers in the WC system and to understand whether changes in the WC system may be increasing access for injured workers.

Overall, there were increases in claims, bill lines, and spending per provider. Although these increases were moderate to large in number, many of the differences were not statistically significant. These results suggest a concentration of treatment for injured workers, in which a relatively smaller number of providers furnished care to injured workers. Increasing concentration could offer opportunities for specialization in the treatment of work-related injuries. On the other hand, increasing concentration could lead to future access barriers related to scheduling.

Key Findings

Provider participation

  • Fewer providers provided care to California WC patients in 2014 than in 2010.
  • The specialties with the largest declines from 2010 to 2014 in WC-participating providers were family medicine/general practice, chiropractic medicine, and pharmacy providers. Most other specialties were relatively stable.
  • Over the same period, there was an increase in the number of WC injuries.

Utilization and payments per provider

  • The average number of claims per provider increased from 2010 to 2014.
  • Payments per provider increased by $8,813, on average, from 2010 to 2014.
  • The observed increases in average claims per provider, bill lines per provider, and payments per provider were likely driven by changes in very large practices or health systems treating many injured workers.


11 Ways Supervisors Can Enhance Your Workers’ Compensation Program

Supervisors are critically important to the effectiveness of your injury management program. They are often the first person on the scene of a workplace accident and may know the injured worker better than anyone else in the organization. They set the tone for how well the injured worker responds and engages in the recovery process.

Employees in charge of other workers who view their role in the workers’ compensation process as just an annoyance do a disservice to injured workers and the organization. Employers should take steps to ensure supervisors appreciate the value of the workers’ compensatioin case of workplace injury poster for article, 11 Ways Supervisors Can Enhance Your Workers’ Compensation Programn program and have a thorough understanding of how they can positively contribute to it.


Injury Response

While some organizations have detailed step-by-step plans in place for handling workplace injuries, many don’t; or even if they do, most employees are typically not well versed in the protocol. That’s why it is imperative to continually train supervisors on all the various aspects of the workers’ compensation system and how they fit into it.

For example, if one of your workers went to his supervisor after sustaining an injury, how would the supervisor respond? Would he know, or have a list of steps to follow, a medical provider to treat the worker, if needed? Would he know to address the worker’s medical needs first?

Here are some of the initial procedures supervisors should have down pat:

  • Get injured worker medical attention. First and foremost, make sure the worker gets medical attention if needed. If so,

Where to go

  • How to get the worker there; i.e., should he drive himself, and, if not, who should drive him
  • What, if anything to take with him
  1. Communicate appropriately. Extensive research has been done on the impact of a supervisor’s language and tone toward an injured worker. Questioning the truthfulness of the worker, for example, can have a dramatic impact on outcomes. Negativity threatens the worker and research has shown the odds are there will be twice as many days out of work than if there is a positive response from the supervisor.
  2. Whom to contact. Is there a department/person/number the organization has for reporting injuries? For example, is there a nurse triage system in place?


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.


Bob’s Top Ten Workers’ Compensation Predictions for 2016

By Robert Wilson

hands spread to reveal future predictionsIt has been a few years since I issued a “Top Ten” prediction for the new year. This is for a variety of reasons, none less relevant than the fact that I generally suck at it. Seriously, my past performance has been less than stellar when it comes to annual prognosticatory behavior. An annual prediction issued by me has the life expectancy of a Jack Bauer love interest, or the two minute reign of Ms. Colombia as Miss Universe. After the last time I tried this, in 2012, the results were so poor I vowed to only do predictions after the year was over. I thought that would improve my accuracy significantly. However, I am older, and therefore automatically wiser, so I thought I would once again weigh in with my biggest predictions for the year ahead.
So, with a brief introduction and related formalities aside, what can we expect in 2016?

  1. It Will Be Discovered That the Concept of “Exclusive Remedy” Was the Result of a Typo – 
Researchers at Gunterman Polytechnica will unearth long forgotten foundational documents that show the creators of the Grand Bargain intended to establish workers’ comp as an “Elusive Remedy”, rather than the previously believed Exclusive Remedy. Somewhat embarrassed, the industry will realize we’ve been getting it right all along. This stunning discovery will mean the Florida Supreme Court has no cases left to review, and has kept us waiting for nothing.
  2. Medical Travel Will Become a Reality For Workers’ Comp –
    Despite being labeled as a “non-starter” by self appointed experts such as myself, Medical Travel will gain a strong albeit brief foothold in the workers’ comp industry in 2016. Hundreds of our most demanding injured workers’ will be schlepped to Turkishmaninacanstan to receive somewhat competent and exceedingly cheap medical care. The short lived effort will ultimately fail, however, when injured workers’ attorneys insist their clients be given round trip tickets, instead of the one way fares they were originally provided.
  3. ProPublica Will Issue a Scathing Report Revealing Workers’ Comp Professionals Receive Salaries To Perform Their Jobs –
    The stunning revelation will send shockwaves across the country, as people demand that workers’ compensation employee salaries “should instead be used to treat injured workers”. To appease the angry masses, salaries in the industry are eliminated. This frees up many dollars that are then distributed to injured workers, which makes everyone’s job extremely easy. Lawyers voluntarily eliminate all fees. Doctors work for free. Pharmaceutical companies donate their drugs. Everyone continues working because it just feels so darn good. The year ends with everyone joining arms in the town square and singing Kumbaya while the Grinch and his dog return Christmas to the village.


Industry Bloggers Debate Top Workers’ Comp Issues

graphic for bloggers name top workers' comp issuesTop industry bloggers debated the hottest issues facing the workers’ compensation and risk management industry at the 2015 California Workers’ Compensation and Risk Conference.

Is the grand bargain of workers’ compensation eroding?
Robinson: Exclusivity is still relatively resilient. That portion of the grand bargain is still doing relatively well. The Oklahoma Option is threatening to bleed into neighboring states, but exclusivity from a legal standpoint still remains resilient.Wilson: I think Padgett was a wake-up call to a degree. When the grand bargain was struck, the people that created it are no longer here. Employers today don’t necessarily appreciate the protections they are afforded and this can threaten the system.DePaolo: The grand bargain was negotiated 100 years ago and has morphed into something different. When you get down to basics, though, it still works.States are looking at treatment guidelines and formularies. Do you think this is different from what they have been experiencing in group health?

Gavin: No, it’s not. Good providers tend to view formularies as things that keep misbehaving doctors in check. Formularies in group health are intended to signal items like preferential pricing. Those concepts don’t exist in work comp. Formularies are coming. We are going to see them soon. You can’t compare them – they all take different approaches – and California is developing its own.

What about treatment guidelines? Why is California different?

Gavin: This is an important questions because the work comp system is fragmented nationally. We have 50+ sets of rules and guidelines on how to manage our system. That level of complexity is incredibly. Now we are introducing a list of medical guidelines to this. How do you reconcile that? Injuries are the same in all states. They aren’t unique in California. These are the mini bargains in the grand bargain.

Wilson: I think we have a problem with a perception of increased disability from a societal standpoint. Often, injured workers perceive their injury differently from the reality. We have to gain a better understanding of the psych component to better help our workers.

DePaolo: Work comp in the U.S. is a states’ rights issue. Every state wants to control its own population. It’s a bargaining chip in state politics.

Continue reading Industry Bloggers Debate Top Workers’ Comp Issues

An Epidemic of Fake Science


snake oil labelSacramento, CA – Medical treatment in the California workers’ compensation now requires that the treatment pass the scrutiny of “evidence based medicine” which means that scientific studies support the safety and efficacy of the requested care. That might seem like a straight forward process.

But, an article in Scientific American claims that false positives and exaggerated results in peer-reviewed scientific studies have reached epidemic proportions in recent years. The problem is rampant in economics, the social sciences and even the natural sciences, but it is particularly egregious in biomedicine. Many studies that claim some drug or treatment is beneficial have turned out not to be true. We need only look to conflicting findings about beta-carotene, vitamin E, hormone treatments, Vioxx and Avandia. Even when effects are genuine, their true magnitude is often smaller than originally claimed.

The problem begins with the public’s rising expectations of science. Being human, scientists are tempted to show that they know more than they do. The number of investigators – and the number of experiments, observations and analyses they produce – has also increased exponentially in many fields, but adequate safeguards against bias are lacking. Research is fragmented, competition is fierce and emphasis is often given to single studies instead of the big picture.

Much research is conducted for reasons other than the pursuit of truth. Conflicts of interest abound, and they influence outcomes. In health care, research is often performed at the behest of companies that have a large financial stake in the results. Even for academics, success often hinges on publishing positive findings. The oligopoly of high-impact journals also has a distorting effect on funding, academic careers and market shares. Industry tailors research agendas to suit its needs, which also shapes academic priorities, journal revenue and even public funding.

The crisis should not shake confidence in the scientific method. The ability to prove something false continues to be a hallmark of science. But scientists need to improve the way they do their research and how they disseminate evidence.