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Delays, denials plague medical treatment for injured workers

At a series of public forums held this month by Christine Baker, Director of the Department of Industrial Relations, and Rosa Moran, Administrative Director of the Division of Workers’ Compensation, injured workers have graphically described their experiences in California’s workers’ compensation system. The system they described is one that is plagued with delays and denials of medical treatment, and where disability compensation is grossly inadequate.

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. 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.

At the forums, injured workers told of months and years of delays and denials of requests for medical treatment. And these are delays and denials of treatment that, in almost all cases, was recommended by the company’s chosen doctor. Many injured workers go months without any treatment or medications due to the UR process. The constant denial of recommended treatment has delayed injured workers’ recovery and has kept them off work much, much longer than needed.

At the Los Angeles forum Michael McClendon, an injured worker from Bellflower, told the panel that he injured his back in 1999 but “ever since SB 899 was enacted, I have experienced unnecessary delays and denials. My medicine, therapy, and surgery have all been denied. I have to go to court to order the insurer to approve treatment, even though I have been rated 100% disabled with medical and home care.”

At the Fresno hearing Mary DeSoto, an injured worker from Exeter, told the panel of tearing muscles in her neck and shoulder moving a bookcase at work. Although her doctors recommended surgery for both her neck and shoulder, her insurer repeatedly denied these surgeries, and she “had to go to court twice to order the workers’ comp insurer to approve the recommended treatment. It has been a horrendous three years.”

Those are just two of the many stories that were related by workers up and down the state. And as horrible as these delays are for injured workers, they are not the only victims – employers also pay for these delays. The system costs that are increasing fastest are so-called “cost containment” expenses, primarily the cost of UR and bill review, and medical-legal costs. If we want to control employers’ costs, these are the areas on which we need to focus.

And delay is not the only problem facing injured workers. A number of workers told the panel of their struggle to keep their homes and provide for their families on their meager disability compensation. This should come as no surprise to anyone. Multiple independent studies, including studies conducted by the California Commission on Health, Safety and Workers Compensation (CHSWC), and the Administration itself, have documented that compensation for permanent disabilities was cut fifty to seventy percent by SB 899, a “reform” bill enacted in 2004.

Under SB 899, injured workers saw their disability compensation plummet to near the bottom of the 50 states. In addition, their medical care has been delayed and denied to the point that many physicians will no longer treat injured workers. This is not only contrary to our state Constitution, which mandates full medical treatment and adequate compensation, but it is just plain wrong. We can, and should, work together to remedy this horrible situation for Californians who are injured while working.

Ed’s Note: Brad Chalk practices in Santa Rosa and specializes in workers’ compensation and disability cases. He can be reached at sbc@chalklaw.com.


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