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Profitability Since SB 863 Unprecedented; Friction Remains a Top Concern

  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  3 shares
SAN FRANCISCO — As the Workers’ Compensation Insurance Rating Bureau looked toward …

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James Witkop Jun 14, 2019 a 1:50 pm PDT

If I am reading this correctly, the attorneys who practice before the WCAB are "frictional costs" and their representation of parties needs to be reduced or outright eliminated. And the alternative I suppose would be an autonomous, bureaucratic system whereby a single administrative judge determines the parties rights and responsibilities? And there are people who would support such a system???...terrifying!

Sue Borg Jun 14, 2019 a 2:06 pm PDT

It’s interesting to me that applicant attorney fees are calculated as part of the frictional costs when these fees are paid by the applicants out of their awards. While it may be true that there would be little to no need for defense attorneys if there were no applicant attorneys, one would think that there would be a more honest way of calculating that cost.

Jesse Marino Jun 14, 2019 a 4:06 pm PDT

Plenty of profits for insurance carriers and lower medical costs. Surprise!
Whats is the take away, CT claims cost too much. How absurd.
We pay for this data collecting for what purpose? So we can ignore the results.

INSURANCE COMPANIES ARE GETTING RICHER AND APPLICANTS GET LESS MEDICAL TREATMENT! MADNESS!
OUR COURTS HAVE FAILED US IN NOT CHECKING THE LEGISLATURES AFFECT ON CONSTITUTIONALLY MANDATED RIGHTS FOR INJURED WORKERS.
MADNESS!

Dr Jun 14, 2019 a 10:06 pm PDT

No surprise. Compare my workcompcentral column from 2016-07-26 ("Weinmann: SB 863 Benefits Employers, Harms Injured Workers"). Utilization Review remains an impediment to indicated treatment. Reforms that would have reduced the harmful impact of some UR decisions were timidly suggested in AB 1107 earlier this year but have recently been rescinded. -- Robert L. Weinmann, MD, Editor


Robert L. Weinmann, MD, Editor

Charles Cleveland Jun 15, 2019 a 3:06 pm PDT

Claims in California are open longer than in other states by design through SB 899 and SB 863. My clients wait for months for approvals for even the most basic treatment. The adjusters used to be able to approve many types of treatment but now adding RFA, UR, UR rebuttal and IMR into the mix it adds an enormous amount of time for every aspect of every case requiring medical treatment. Most doctors now because of abysmal reimbursement rates require preauthorization from the carrier who manages the MPN in writing before they will see an injured worker which oftentimes adds up to a month just to get an appointment with a specialty. MPN doctors are handpicked by the insurance carrier and when MPN’s were introduced it was supposed to smooth out these problems instead of create new ones. MPN doctors are the insurance carrier’s choice, therefore should not be subject to utilization review and IMR which would speed delivery of treatment thus reducing frictional costs. This is a problem that carriers created and of course place blame on applicants filing continuous trauma claims in highly populated areas, most of whom are women and older workers returning to service related occupations like because of economic conditions. Cost containment is a profitable business, time to stuff that back into Pandora’s box.

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