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Posted on: Jan 7, 2019

The signs continue to point to insurers wanting to launch an attack on cumulative trauma (CT) claims resulting from long-term repetitive motion or toxic exposures, but of course they'll do it in the name of protecting jobs and the economy.

What they won't tell you is that profits for insurance carriers continue to rise.

The National Association of Insurance Commissioners reported in December that the average profits for Workers' Compensation premiums in California rose to 12% in 2017, up from 8.5% in 2016. Nationally, the average profit was 7.9%, up from 4.6% in 2016.

The WCIRB also reported in December that for the first 9 months of 2018, premiums employers paid were down 3% from the same period in 2017.

Insurers and employers are enjoying massive windfalls while workers continue to face an uphill battle in obtaining necessary medical treatment after being injured on the job.

Attacking CT claims will only continue to line the pockets of carriers while hurting hardworking men and women.

2019 is a new year. We can keep from repeating the same old story with competent administration of the workers' compensation system and sound policy to protect injured workers.

CAAA IN ACTION

 

 

In response to an invitation to provide feedback and ideas for improving the current regulations for the medical legal fee schedule, CAAA submitted comments on December 14th to the DWC before the formal rulemaking process begins.

In the response, CAAA took note of the DWC's assertion that they've received much feedback indicating "a desire on the part of the QME community for a flat rate fee system" and encouraged the DWC to ensure any such proposal addresses the unique statutory responsibility placed on evaluating physicians in California through Labor Code sections 4663, 4664 and the Benson line of cases requiring complex apportionment analyses. As a result, CAAA's position is that any final medical legal fee schedule proposal should clearly delineate that charges for medical record review is a per-page or a page range add-on to any agreed upon flat fee.

CAAA cautioned against the use of report incentives citing a disconnect between the MTUS and AMA Guides causing delays in reporting, the possibility of bonus incentives leading to physicians rushing reports just to get the bonus, and the notion that failure to produce an evaluation report within the specified 30-day requirement might not be the fault of the QME and could be the result of the carrier's failure to provide medical records on time. CAAA instead emphasized a focus on "nuts and bolts" training for QME's to write quality reports.

CAAA supported a number of stakeholders' proposals regarding the need for an annual cost-of-living adjustment. CAAA also supported a separate fee for completion of the required Return to Work and Voucher report and laid out recommendations for areas QMEs should address at a minimum in each report, including causation, apportionment, permanent impairment and work restrictions, among others.

Citing the recent CWCI study showing decreased access to QMEs, CAAA strongly urged the DWC to focus on improving QME access. Findings of the CWCI study include that the total number of QME providers dropped by 20 percent between January 2012 and September 2017. Of those, 82.8% voluntarily non-renewed their QME certifications.

To view CAAA's comments in their entirety, click here.