Part 6 in Series: What’s Wrong with this Picture? Workers' Compensation Insurance Companies Shift 80% of Costs to Taxpayers, Group Health & Injured Employees FOR IMMEDIATE RELEASE: Thursday, December 18, 2014 - Sacramento, CA - The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today continued its “What’s Wrong with this Picture?” series with an Infographic showing that workers’ compensation insurance companies pay just twenty percent of the costs of on-the-job injury claims, shifting eighty percent to taxpayer-funded public health programs like Medicare, Medicaid and Social Security, and other disability funds, private group health insurance and injured employees and their families.

DePaolo's Work Comp World:  Mandatory UR?, By David DePaolo - FOR IMMEDIATE RELEASE: Thursday, October 30, 2014 - “Perhaps one of the reasons that the California workers' compensation system spends so much on cost containment services is because there are no incentives not to spend so much.


DePaolo's Work Comp World:  The Hedging of Work Comp, By David DePaolo - FOR IMMEDIATE RELEASE: Thursday, October 30, 2014 - Workers' compensation, like most property and casualty lines of insurance, goes through a cycle. Work comp in particular for many states seems tied to a seven to ten year cycle of "hard" versus "soft" markets.  A "hard" market is where the insurance industry has more control and power over pricing. A "soft" market is where the consumer of insurance products has more power - i.e. there is more price competition in the market.
 

José Dubon: The Human Face Behind WCAB Decision: Consequences of Insurers Gaming UR System, Withholding Medical Records - FOR IMMEDIATE RELEASE: Tuesday, October 28, 2014 - Sacramento, CA - The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today released a UR DENIED story on José Dubon, the injured laborer whose case has resulted in three different Workers’ Compensation Appeals Board decisions, addressing what insurers are required to provide to Utilization Review (UR) to make the UR valid. Insurance carriers’ Utilization Review (UR) denies one in five physicians’ requests for medical treatment - up to 3,500,000 per year. The Dubon v. World Restoration case is an excellent example of the widespread failure of claims administrators to provide adequate medical records to the UR reviewer. “José Dubon’s case has produced a WCAB decision that addresses insurers’ withholding of key medical records. Today, we are releasing the human story behind the Dubon I and II decisions,” CAAA President Bernardo de la Torre. “José waited more than a decade for back surgery for his work injury. That is unacceptable and outrageous and shows what is wrong with the abuse of Utilization Review (UR). The law requires that injured workers receive medical care in a timely and just fashion.”
 

UR Denied Story. I needed spinal surgery, but UR denied it.  The insurance adjustor failed to send my medical records to the UR doctor, who therefore saw no need for my surgery.  IMR upheld the UR denial.  How can UR and IMR deny surgery without seeing my MRIs & medical records?  To see his story click here: UR Denied Story Jose Dubon

Part 4 in Series: What’s Wrong with this Picture? Workers’ Compensation Insurance vs. Group Health: 39 Times More Medical Care Denial Appeals in Comp - FOR IMMEDIATE RELEASE: Thursday, October 23, 2014 - Sacramento, CA - The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today continued its “What’s Wrong with this Picture?” series comparing quality health care measures in California workers’ compensation insurance to group health insurance. The fourth release compares the frequency of Independent Medical Review (IMR) decisions regarding denied medical treatment. The 800,000 workers’ compensation insurance patients appealed IMR treatment denials 60,776 times during a twelve-month period, while the vastly greater number of group health patients (16,000,000) filed just 1,558 appeals. This is one IMR decision for every 10,000 patients in group health vs. one for every 131 workers’ compensation patients. The IMR landslide of IMR appeals reflects a fundamental flaw in workers’ compensation: insurers send 3,500,000 doctors’ recommendations for care to their own Utilization Review (UR) companies each year...

 

CAAA Reacts to WCAB's "Dubon 2" Decision on Utilization Review (UR) and IMR Requirements -FOR IMMEDIATE RELEASE: Monday, October 6, 2014  - Sacramento, CA - The California Workers’ Compensation Appeals Board (WCAB) issued its reconsidered decision today in Dubon v. World Restoration, addressing the issue of what insurers are required to provide to Utilization Review (UR) to make the UR valid. The Dubon v. World Restoration case is an excellent example of the widespread failure of claims administrators to provide adequate medical records to the UR reviewer. Without medical records, a UR reviewer's decision is not substantial evidence, and should not be applied to deny an injured worker the right to necessary medical treatment. “The public policy objective of UR and IMR is to expedite medical care, not delay it, but it is used to delay and deny medical treatment millions of times each year,” CAAA President Bernardo de la Torre. “CAAA is disappointed in today’s decision. Our members will continue to fight to protect the rights of California’s injured workers and ensure that injured workers receive medical care in a timely and just fashion.”...
 

CAAA Teams with CHIRLA to Fight Anti-Immigration Bias; Protect Workplace Injury Rights - FOR IMMEDIATE RELEASE: Monday, October 6, 2014 - EL MONTE, CA - The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today joined with the Coalition for Humane Immigrant Rights of Los Angeles (CHIRLA) in protecting the rights of immigrant defense workers at Vinyl Technologies, Inc. (VT) of Monrovia, who were recently dismissed in the wake of an immigration inspection...
 

CAAA Bill to Curb Gender Bias in Workers' Compensation Insurance Vetoed: Nurses Deserve Protection from MRSA Infection - FOR IMMEDIATE RELEASE: Monday, September 30, 2014 - The California Applicants’ Attorneys Association (CAAA), whose members represent Californians hurt at work, and the California Nurses Association’s (C.N.A.) measure to eliminate gender bias against female first responders in California workers’ compensation insurance was vetoed by Governor Brown. AB 2616 (Skinner) was the first measure passed by the Legislature to extend any of the fifteen existing presumptions that male first responders enjoy to first responder occupations dominated by women...
 

Part 3 in Series: What’s Wrong with this Picture? Group Health Patients Win 61% of Medical Care Denial Appeals; Workers’ Compensation Patients Lose 84% of Appeals - Insurers have Stacked the Deck Against Californians Hurt at Work - FOR IMMEDIATE RELEASE: Tuesday, September 23, 2014 - Sacramento, CA - The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today continued its series comparing quality health care measures in workers’ compensation insurance to group health insurance. The third release compares the frequency of Independent Medical Review (IMR) upholding Utilization Review (UR) denials of doctors’ recommended medical care. Workers’ compensation IMR denied 84% of patients’ appeals of denied medical treatments in one year, while group health IMR reviewers approved 61% of patients’ appeals. Group health patients win appeals of denied medical care nearly four times as often as California’s injured workers...
 

California Applicants' Attorneys Association Announces 2014-15 Agenda & leadership team: Limit Interference with Medical Treatment; Eliminate Anti-Female and Anti-Immigrant Bias; Protect Cumulative Trauma Rights - FOR IMMEDIATE RELEASE: Monday, September 15, 2014 - Sacramento, CA - The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today announced its policy agenda and leadership team for the coming year. CAAA targeted three changes to make California’s workers’ compensation insurance system work more fairly and quickly: 1. Limit insurers’ interference with medical treatment; 2. Eliminate anti-female and anti-immigrant bias; and, 3. Protect “cumulative trauma” claims for injuries that develop over time...
 

UR Denied Story. I was Catholic chaplain at Chino Youth Authority prison, serving inmates. The prison hired a former San Quentin inmate, who harassed me for being Catholic. I developed stress injuries and won medical treatment. SCIF has cut off my medicine over my doctor’s protest. To see his story click here: UR Denied Story Fr. Vince Connor.
 

Part 2 in Series: What’s Wrong with this Picture? Workers’ Compensation Insurance vs. Group Health: Comp Insurers Deny 1,748 Times as many Medical Treatments - California Workers’ Compensation Insurers Deny so many Doctors’ Recommendations Because, without Meaningful Penalties, They Can - FOR IMMEDIATE RELEASE: Tuesday, August 26, 2014 - Sacramento, CA - The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today continued its series comparing quality health care measures in workers’ compensation insurance to group health insurance. The second release compares the frequency of Utilization Review (UR) denials of doctors’ recommended medical care. Workers’ compensation insurers denied 1,748 times as many treatments in one year as did group health insurers. For the 16,000,000 California group health patients, insurers denied 40,300 recommended treatments, while workers’ compensation insurers denied an estimated 3,500,000 doctors’ recommendations for just 800,000 patients...
 

CAAA and C.N.A. Bill to Curb Gender Bias in Workers’ Compensation Insurance Passes Legislature: Nurses Deserve Protection from MRSA Infections Groundbreaking Measure Gives Female First Responders Equal Protection  FOR IMMEDIATE RELEASE: Friday, August 22, 2014 - SACRAMENTO, CA - The California Applicants’ Attorneys Association (CAAA), whose members represent Californians hurt at work, and the California Nurses Association’s (C.N.A.) measure to eliminate gender bias against female first responders in California workers’ compensation insurance passed the Assembly today by a vote of 46 - 23. AB 2616 goes now to the governor for action...
 

UR Denied Story.  I’m an R.N. in an Intensive Care Unit. I got a MRSA infection at work and Sedgwick denied my claim. They claimed I got MRSA from my dog! Nurses care for patients, risking our own health. We deserve protections for work injuries, so we can worry about the patient and not fear our injuries will be denied.... To see her story click here: UR Denied Story Kathryn Donahue.
 

UR Denied Story. I supervised home supportive living services for the disabled. I fell down a flight of stairs at work and suffered a traumatic brain injury. The insurance company’s UR has denied home support services for me using the wrong guidelines. This is no luxury.  I’ll die if left alone. ... To see his story and to get a glimpse fo his daily life after his workplace injury click here: UR Denied Story Lee Griffith.
 

CAAA and California Nurses Association (C.N.A.) Fight Gender Bias in Workers’ Compensation Insurance: Nurses Deserve Protection from MRSA Infections - Why are Female First Responders the only Ones without Protection? - FOR IMMEDIATE RELEASE: Tuesday, August 12, 2014 - SACRAMENTO, CA - The California Applicants’ Attorneys Association (CAAA), whose members represent Californians hurt at work, today joined the California Nurses Association (C.N.A.) in calling for elimination of gender bias against female first responders in California workers compensation insurance through passage of AB 2616 (Skinner). “California recognizes that some jobs are so inherently dangerous that those workers should not have to prove that certain injuries were job related,” said CAAA Women’s Caucus Co-Chair Christel Schoenfelder. “First responders like...
 

UR Denied Story. The company-approved surgeon recommended surgery on both shoulders for the same injuries. Before IMR, one was approved. When IMR took effect, the insurer’s UR denied surgery, and IMR upheld it. I’ve lost a year fighting to overturn denials..... UR Denied Story Art Conrad - Insurance companies use Utilization Review (UR) to deny and delay needed medical care. The care is usually recommended by the company’s own chosen doctor. Without consequences or effective penalties, insurers’ UR is out of control. It has real impacts on injured workers.  Here is one of their stories.
 

What’s Wrong with this Picture? WORKERS’ COMPENSATION INSURANCE VS. GROUP HEALTH: CALIFORNIANS INJURED AT WORK GET SECOND-CLASS TREATMENT - Why does the State of California require Group Health Insurers to Meet High Standards and not Workers’ Compensation Insurers? FOR IMMEDIATE RELEASE: Thursday, July 24, 2014 - SACRAMENTO, CA - The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today launched a new series comparing quality health care measures in workers’ compensation insurance to group health insurance. The first release compares the percentage of the insurance premium dollar that goes to health care and disability compensation to insurance carriers’ administrative overhead. Workers’ compensation insurance carriers spend more than twice as much (36% vs. 15%) on their own operations...
 

UR Denied Story. I want to die. This is no life. The insurance company has spent four years fighting to keep me from getting treatment for my stroke and the psychological trauma from the injury. They’ve ignored court orders without penalty... UR Denied Story Juan Mora - Insurance companies use Utilization Review (UR) to deny and delay needed medical care. Workers’ compensation insurers deny 1 in 5 doctors’ treatment requests, up to 3,500,000 denials per year. The care is usually recommended by the company’s own chosen network doctor. Without consequences or effective penalties, insurers’ UR is out of control.  Here is one of their stories.
 

UR Denied Story. I had carpal tunnel surgery. The insurance company’s UR denied post-surgical hot/cold therapy. IMR said the therapy was appropriate, but denied it as no longer useful since IMR took 3 months to rule and the time when the therapy would be effective had run out.  UR Denied Story Katrina Quach Insurance companies use Utilization Review (UR) to deny and delay needed medical care. The care is usually recommended by the company’s own chosen doctor. Without consequences or effective penalties, insurers’ UR is out of control. It has real impacts on injured workers.  Here is one of their stories.


UR Denied Story. I was denied Physical Therapy, a contrast MRI, pain medication, surgery for my hip, and chiropractic  care for my back... UR Denied Story Gregory Vlastelica - Insurance companies use Utilization Review (UR) to deny and delay needed medical care. The care is usually recommended by the company’s own chosen doctor. Without consequences or effective penalties, insurers’ UR is out of control. It has real impacts on injured workers.  Here is one of their stories.

 

New Study: CA Disability Compensation Among Lowest in US Only Alabama & Rhode Island pay Lower Weekly Compensation - FOR IMMEDIATE RELEASE: Wednesday, April 30, 2014 -  SACRAMENTO, CA - The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today responded to a new national study showing that Californians injured at work are compensated at one of the lowest weekly rates in the nation. The report by the Workers Compensation Research Institute and the International Association of Industrial Accident Boards and Commissions found that California’s $290 per week maximum...
 

UR Denied Story.  The Care I've Been Denied: I requested epidural injections to avoid risky back disc fusion surgery. UR and IMR said I must have surgery that’s as likely to fail as to succeed. UR Denied Story Jacinto Fonseca - Insurance companies use Utilization Review (UR) to deny and delay needed medical care. The care is usually recommended by the company’s own chosen doctor. Without consequences or effective penalties, insurers’ UR is out of control. It has real impacts on injured workers.  Here is one of their stories.
 

UR Denied Story.  The Care I've Been Denied: A Florida ANESTHESIOLOGIST overruled a California Audiologist!  I need hearing aids that work. - UR Denied Story Arthur "Bud" Nowell - Insurance companies use Utilization Review (UR) to deny and delay needed medical care. The care is usually recommended by the company’s own chosen doctor. Without consequences or effective penalties, insurers’ UR is out of control. It has real impacts on injured workers.  Here is one of their stories.
 

California Applicants' Attorneys Association - Workers’ Comp Fraud Harms Injured Workers - FOR IMMEDIATE RELEASE: Monday, February 24, 2014 - SACRAMENTO, CA - The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today responded to the indictment of Sen. Ron Calderon and the guilty plea by Dr. Michael Drobot for workers’ compensation fraud. CAAA President Jim Butler said, “When workers’ compensation insurers, physicians, or attorneys act without high ethical standards, injured workers ultimately suffer. Over and over we have seen the use of unacceptable practices by a few as a platform to assault the basic rights of injured workers.”...
 

CAAA Women’s Caucus & Women’s Legislative Caucus Spotlight California Working Women’s Injuries: Call for More Research, Attention to Safety Gear, Eliminate Bias from AMA Guides & Other Standards Women Injured More Frequently as they Age, while Men are Injured Less Often -FOR IMMEDIATE RELEASE: Wednesday, February 12, 2014 - SACRAMENTO, CA - The California Applicants’ Attorneys Association’s (CAAA) Women’s Caucus today hosted a “Working Women’s Injuries Symposium: Causes, Consequences and Prevention,” co-hosted by the California Legislative Women’s Caucus. Over 100 legislators, regulators, labor leaders, workplace safety advocates, and injured workers’ attorneys examined the causes of working women’s on-the- job injuries, and...
 

Round 5: Sedgwick v. Juan Jose Gonzalez SEDGWICK VS. THE PEOPLE “DENY & DELAY CARE TO DRIVE INJURED WORKERS AWAY” - X-Ray Technician’s Injury Tests Insurer, Sedgwick Fails: Defies Judge’s Order, Refuses to Provide Medical Care FOR IMMEDIATE RELEASE: Friday, February 7, 2014 Sacramento, CA – The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today released the fifth in their “Sedgwick vs. the People” series detailing Utilization Review (UR) abuses by insurance companies. The largest workers’ compensation insurer in North America, Sedgwick Claims Services, has failed to provide needed medical treatment and disability compensation to an injured X-Ray technician, despite a judge’s order finding his injury was work-related...
 

California Applicants' Attorneys Association Report: Insurers Deny 1 in 5 Doctors’ Treatment Requests; Up to 3,500,000 Denied Per Year
Significant UR Problems Undermine SB 863  FOR IMMEDIATE RELEASE: Wednesday, February 5, 2014
SACRAMENTO, CA - The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today released a report estimating that insurance carriers’ Utilization Review (UR) denies one in five physicians’ requests for medical treatment - up to 3,500,000 per year. CAAA based its report on information from the Division of Workers’ Compensation (DWC), and rejected insurers’ estimates of UR denials as “incorrect and misleading.”...


Injured Workers’ Advocates Convene: CAAA Releases eBook on AMA Guides -
FOR IMMEDIATE RELEASE: Thursday, January 23, 2014 
Rancho Mirage, CA - The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today convened more than 1,000 workers’ compensation professionals, the overwhelming majority advocates for Californians injured on the job, in Rancho Mirage for a four-day convention. As the Convention opened, CAAA announced the release of its first eBook, “The Pearls of the AMA Guides,” containing an unprecedented wealth of information, including practice tips, videos and analysis on how to navigate each chapter of the AMA Guides...


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