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Friday, July 24, 2015

DWC: SB 863 Doing Everything Intended

  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  0 shares
The Division of Workers’ Compensation on Thursday published a report outlining how California&…

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Anonymous Nov 21, 2016 a 6:49 pm PST


"There’s also the Return-to-Work Supplemental Benefits Fund, which is designed to give a boost to the incomes of workers whose loss of income due to injury is disproportionately high compared with their permanent disability awards."

How is this statement accurate?Every injured worker with a PD rating and who is not offered a position to return to their employer can get this benefit and everyone receives the same amount. How is this helping the patients who loss of income is disproportionately high?

If this system is working then why are so many injured workers complaining about it? Go on any public forum for CA injured workers and you will see the pattern. Those who have chronic older injuries are getting unilaterally denied all of their medications. Many injured workers are being prevented from referrals to specialists and MRI's. Without this they will not have any medical evidence of the extent of their injury. Take away the PTP's ability to bill for record review and this shit soup has become a perfect way for the insurance industry to save a lot of money.

For the lucky injured workers who have other insurance or the VA the cost is being shifted to tax payers while the insurance industry makes out like greedy bandits.

Charles Cleveland Nov 3, 2016 a 2:58 pm PDT

I agree, it is doing everything intended. My injured workers who are most severely injured get their medical care denied 80 to 90% of the time all the way through independent medical review. Cases with awards of future medical care from years ago are all getting their medical care denied. Cases stay open twice as long now as injured workers wait in the MPN, RFA, UR, IMR line for treatment causing TD costs to go through the roof. This is good because it doubles the work of applicants attorneys who work for a set fee by doubling or tripling the time in every case, makes doctors want to leave the system because it is so burdensome, and is a boon to the defense industry since cases stay open so long now. Best part is it saves money for insurance companies by shifting the burden of care for these injured workers to taxpayers and generates new revenue streams through cost containment. We may win the race to the bottom yet.

Dr. Edwin Haronian Nov 3, 2016 a 2:58 pm PDT

What a nice collection of falsified info! How did the DWC has come to be one sided and lie. The entire article and every point is false. 80% of the requests get denied by some Joe Shmo that does not understand medicine. Then IMR stamps the approval and there is no recourse. Then WC central prints that doctors are making medical decisions and not judges!

Then there is a scheme placed not to pay for services even if its authorized somehow.

Ultimately, one can see why there is $6 billion reserve for SCIF and every insurance carrier is attempting to come in to California and get more business.

Anonymous Nov 21, 2016 a 6:49 pm PST

In my opinion the workcompcentral author was relaying the info that was stated by the DWC. I do not agree with the DWC information, however I find workcompcentral unbiased in this article.

John A. Don esq. Nov 3, 2016 a 2:58 pm PDT

Obviously - the only thing to do is buy MAXIMUS stock!

Gary Nelson Nov 3, 2016 a 2:58 pm PDT

So much I could say. "Do you remember when it took 9 months to get a QME.... and WE stepped in and now its 24 or 17 days..." Ms. Baker seems to forget that it was the State that caused the back up in the first place by their incompetence. The QME system never should have been put into their hands. Now we have QMEs that literally run the case according to how many reports they want to write and charge for... and we have low quality reports to boot. Oh yeah, you fixed it Ms. Baker.

DEBORAH HALVERSON Nov 3, 2016 a 2:58 pm PDT

Yes, I agree the 'system' is working as intended.

California Work Comp Healthcare is now rationed, denied, and reimbursed at levels BELOW actual cost. The highest tier hospitals receive the most acutely ill patient cases and are overwhelmed with the 'system', while they provide the free, top of the line life-saving care and have to expensive IBRs and/or liens, which can take years, just to receive minimum reimbursement.

Yes, I agree the DWC wants a single-payor system and these regulations only encourage providers to ultimately drop WC patient coverage.

Yes, I agree that SB863 was designed without ANY provider input, as 'intended.'

Yes, I agree that Insurance, employer, and government collusion will never equate to excellent medical treatment. Only providers can offer medical care solutions to rehabilitate WC employees. That is the basis of Workers' Compensation, and it should be the priority of the program.

Yes, I agree, fraud also contributes to a weaker 'system.' But investigating and advertising only employee and provider fraud is incomplete. Not investigating illicit insurance claims systems/processes, UR, Bill Review, primary and secondary Payor networks, illegal 'payor price shopping' and never-ending consulting firms who do not understand the acuity difference in treating Medicare and WC-related acute accident populations, also contributes to a weaker system. All sides must be held accountable for supporting SB863 'deforms' not win-win reforms.

Yes, I agree - providers are forced to treat patients well below the hard cost of care, yet insurers obtain premiums well above it.

Yes, I agree - this was never the intent of the California Workers' Compensation program.

Yes, I do agree, this WC system needs fact-based truth, not one-sided propaganda, as this article represents.

Anonymous Nov 21, 2016 a 6:49 pm PST

I took me more than 6 years to get the insurer to approve back surgery, all the test results were the same just before surgery as they were from the beginning of my claim, a second opinion for spine surgery AME deemed the surgery was medically necessary only to be ignored and or delayed until the law changed with SB863.
When surgery was finally done there was a serious complication of a CFS leak and infection, what my surgeon did was right, RFA after RFA was submitted only to be ignored by the insurer, Sedgwick, preventing my surgeon from stopping the spinal fluid leak or even treating me, if it wasn’t for me going to the emergency room and getting admitted, the infection would have killed me for sure. I still had the CFS leak that I had to live with for over a month before the head exploding headaches let up. But to this day a NCM got assigned and still no treatment request or testing has been approved and the pain just keep increasing, the bad part is nothing can be done for the pain because of complications the years of pain medication has caused.
If the doctors were allowed to treat me early like it was requested none of this would have happened, but I am sure money was saved for the insurer and employer so in that sense SB863 has worked as intended.

Jack Goodchild Nov 3, 2016 a 2:58 pm PDT

When you let clueless individuals who do not not know what it is like to be involved in a workers compensation case decide what the revisions to the law should be you will invariably get total garbage like this law.Governor Brown is the responsible party and should be impeached for his hatred of injured workers and this area of the law. He vetoed funding for the system when he was governor the first time.He is trying to destroy it entirely this time.He appointed Christine Baker who is largely responsible for this pile of garbage. She seems to be a "nice" person. Other than that she is totally clueless as to how many thousands of lives she has ruined if not ended by her ignorant actions.Until we educate the public at large to the effects of this mess on everyday citizens their families and friends we will not have a sufficient political base from which to reverse this heinous law.Because of term limits there is no longer an "institutional memory" of the numerous tradeoffs between labor and the employers /insurance coalition. Practically everyone will have an industrial injury or illness during their work career. When it happens people are truly shocked at how Nazi -like this system has become. My clients want their cases settled so that they can treat out side of the system and have even a chance of recovering from their injuries which is close to impossible now under this law which has "worked" so well . We should all be protesting this horror!

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