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WCIRB: Nearly 1 in 5 Indemnity Claims Allege Cumulative Trauma

  • State: California
  • Topic: Top
  • -  1393 views
  • - Average time spent on item: 32 minutes
  • - Popular with: Legal
  • -  9 shares
The proportion of cumulative trauma claims filed in California has steadily increased each year for …

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3 Comments (3 Replies)

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Christopher Brigham Apr 12, 2018 a 2:04 am PDT

The root cause of the "epidemic" of CT cases in California (particularly the LA area) is litigation, i.e. reflective of dysfunction in the workers' compensation system and driven primarily by applicant attorneys and applicant oriented physicians. Evidence-based medicine, i.e. science should always be used to determine the cause of medical conditions and/or patient complaints. (links to the AMA text on causation analysis is available at www.causation.com) Unfortunately, the data is very clear - if an injury or illness is dealt with in the workers' compensation arena (particularly if there is litigation) the outcomes are worst. Therefore, falsely identifying a problem as work-related is a disservice to the worker - although it does drive income for other participants. Using evidence-based medicine as the basis for diagnosis, causation analysis, and treatment reduces costs - both financial and most importantly personal.

Rod Coppedge Apr 12, 2018 a 10:04 am PDT

Absolutely true Dr. Brigham.

Apr 12, 2018 a 8:04 am PDT

[deleted]

Scott Rubel Apr 12, 2018 a 9:04 am PDT

Mr. Brigham’s comments and the entire premise of this article are without basis. The “problem” of continuous trauma claims is a fabrication designed to rob legitimately injured workers from compensation for real injuries.
The farm worker who bends over all day in the field picking strawberries and injures his back is not playing a game. The firefighter who runs into burning buildings and inhales toxic fumes causing cancer is not trying to get something for nothing. The office worker who develops PTSD due to relentless sexual harassment by her superiors is not a “fraudster”. Many of these claims are filed after the last date of employment because the symptoms or the diagnoses occur after the employment has ended. That does not mean they are not legitimate claims. It only means they were not identified or diagnosed until after the employment ended.
The real facts show that CT claims are not increasing. They are down. The real facts show that many CT claims are filed by the insurance company (not the supposedly fraudulent applicants’ attorneys) to try to divide the PD award and save money under the Benson case.
The real facts show that, according to the Auditor General, injured worker fraud represents only 2% of fraud in the California workers’ compensation system. The real facts show that the vast majority of fraud in workers’ compensation is committed by providers and employers.
Playing the “fraud card” is nothing more than a contrived attempt to remove legitimately injured workers from the system and save money for employers and insurance companies.

William Calderon Apr 12, 2018 a 9:04 am PDT

Well said Scott. And let's not forget the CT DOI added and requested by defense when a specific injury is settled via C&R an they want to resolve the entire period of employment...

J anon Apr 12, 2018 a 11:04 am PDT

Insurers probably top the fraud list but since they control investigations and prosecution they have nothing to worry about. Insurers for the most part don't care about costs. They will get paid regardless when premiums are adjusted. So CT claims are great for management that is siphoning money on the side using pain creams and homeopathics subscriptions style. The money is too easy not to take and the worker and employer get screwed again.

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