Panel Hears from Injured Workers, Advocates: SB 899’s “Appalling” Impact on Injured Worker Medical Care and Disability Compensation

 

FOR IMMEDIATE RELEASE: Monday, April 30, 2012

 

Contact: Steve Hopcraft 916/457-5546, Steve@hopcraft.com; Twitter: @shopcraft

 

OAKLAND, CA - Injured workers and their advocates told Department of Industrial Relations (DIR) Director Christine Baker and Division of Workers' Compensation (DWC) Administrative Director Rosa Moran today the horrors they have faced since the enactment of SB 899. The system they described is one that is plagued with delays and denials of medical treatment, and where disability compensation is grossly inadequate.

Past efforts to control costs by adopting "reforms" have instead created horrendous delays and cut already inadequate compensation, and as a result have actually increased costs.

 

Utilization Review (UR) is a prime example. One of the key goals of the system is to provide prompt and professional medical treatment so that injured workers can return to work as soon as reasonably and medically possible. With the advent of UR, this is just not happening. Although the original concept of UR was to authorize treatment quickly, UR has now become a cottage industry where the norm is not authorization, but rather delay and denial of treatment.

 

"CAAA members asked their clients to testify at these forums because ultimately  the only measure of the success or failure of the workers' compensation system is whether injured workers are receiving appropriate medical treatment and adequate disability compensation. As small businesspersons, CAAA members certainly understand the importance of controlling employers' costs," said Brad Chalk CAAA President. "But past efforts to control costs by adopting "reforms" have instead created horrendous delays and cut already inadequate compensation, and as a result have actually increased costs."

 

"Utilization Review (UR) is a prime example. One of the key goals of the system is to provide prompt and professional medical treatment so that injured workers can return to work as soon as reasonably and medically possible. With the advent of UR, this is just not happening. Although the original concept of UR was to authorize treatment quickly, UR has now become a cottage industry where the norm is not authorization, but rather delay and denial of treatment," said Chalk.

 

"The first delay with the insurer was with the so-called 'approved doctor' list that I was sent. It mostly contained names of doctors who do not take workers' comp patients, doctors who were deceased and retired doctors," said Sam Jackson, injured worker from Scotts Valley. "There were no doctors in Santa Cruz County, where I reside. My back injury caused urological problems and my surgeon referred me to a urologist, but the closest one who would me see was 3 hours away."

 

"The insurer has denied all tests. Physical therapy has been denied. My medication has been denied. It is a game the insurer plays with all requests," said Millicent Melum, an injured from Berkeley. "The denials just delay the proper treatment I need to heal and get back to work. I had to go to court to have the judge order the insurer to authorize my workers' compensation payments."

 

"Overlapping provisions have created a quagmire that in far too many cases delays needed treatment for months or even years. Consider the case of Margaret Ramirez, a hospital technician who testified at the San Bernardino forum. Margaret has experienced month after month of delay," said Chalk. "Treatment requests from her physician have been routinely ignored for months and then denied, Margaret told you. UR denials have spanned the range of requests and have included examinations, medication, surgery, even mileage."

 

"In short, instead of providing the intended quick process for approving medical treatment requests, UR is far too often used simply to delay treatment, and has become a major cost driver in the system. The entire process needs to be reexamined to make certain that the provision of appropriate and necessary medical treatment is not delayed," said Chalk.

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