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Wednesday, February 11, 2015

Labor Secretary Says Administration Satisfied with Reforms

  • By Greg Jones
  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  0 shares
LOS ANGELES – California Labor Secretary David Lanier said Tuesday that the administration i…

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Anonymous Nov 3, 2016 a 7:58 am PDT

According to the DWC everything is great. The only problem is that injured workers are receiving minimal treatment thanks to UR/IMR. Many of us are about to abandon treatment. When compared to private patients, WC treatment is so difficult to obtain, that it is laughable, but not really funny. OK, we know there was "fraud". But we can control this in treatment schedules. We have limited PT/OT/Chiro. It is not worth dispensing meds in house. MRIs/ EMGs/ PT are corralled into privately contracted deals, by the carriers. Docs are getting prosecuted for dispensing compounds. We wait months for UR/IMR to ok any of the above. Yes, there were a few bad guys, but why do the rest of us and our patients have to suffer? You can bet the next attack is on CTs. They are being abused by the applicant attorneys, so it will be no surprise when the ax falls. Then there will be crying "woe is me" by these attorneys who have brought this on. No, things are not getting better for anyone except the carriers. But the DWC is blind to reality. Or is their perception the real reality. Eliminate the applicant side, minimize treatment costs, maximize profits.

Feb 12, 2015 a 12:02 pm PST

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John A. Don esq. Nov 3, 2016 a 7:58 am PDT

The main fraud driver in workers' compensation today are the call centers who solicit workers throughout the State and then send cappers to close the deal at the workers' home. The call center then allocates the worker to a southern California attorney and medical provider who all work in cahoots to bilk the insurance industry. Until the call centers & cappers are shut down - the problem will contine unabated.

Charles Cleveland Nov 3, 2016 a 7:58 am PDT

I agree, the administration should form a task force as there are complex issues with this since most of these call centers are in Mexico and there may be jurisdictional problems. The cappers operating in California and the attorneys who buy these cases should be investigated. If this practice was stopped it would be healthy for the industry and injured workers.

Bill Cobb Nov 3, 2016 a 7:58 am PDT

Jackdon, Your idea of what the cost drivers are in the system isn’t right – it isn’t even wrong. We can skip over the fact that 40%+ of the money spent on work comp comes from the carrier – LA&E and other expenses. Then, let’s skip on down to employer fraud – under reporting and mis-classification. Then, move on down to provider fraud – up-billing and providing treatment that isn’t needed. Now comes the ‘Applicant’ side of the equation. I’ve been doing work comp consulting for 13 years – representing employers exclusively. In over 95% of the cases, the injured worker gets an attorney only after the carriers have denied and delayed treatment that the ‘in network’ doctors have prescribed. First the carriers (thanks to SB 899) set up a network of approved medical providers. Then, they ignore their medical advice and send everything to UR and IMR. Frankly, they (the carriers) had it coming. But it doesn’t cost them anything – they pass the costs on to the employers with a significant markup. Every year, the WCIRB increases the Pure Premium Rates on the majority of class codes by double digit figure. The carriers use this as a cover to raise their rates as well. Here’s the solution: give the injured worker the benefits they are entitled to – medical and indemnity. It would be ten times cheaper – even if the claim isn’t valid. Invalid claims that could have been bought out for $40,000 wind up costing $250,000+. Climb down from your cross, build a bridge with it, and get over it. Sorry - it's past 5 pm here and I'm on my second glass of wine.

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