Gino DiCaro

Senate hearing examines medical treatment in workers' compensation

By Gino DiCaro, VP, Communications

Capitol Update, May 5, 2006 Share this on FacebookTweet thisEmail this to a friend

This week the Senate Labor and Industrial Relation Committee held an informational hearing on medical treatment in workers' compensation.  SB 228 (Chapter 639, Statutes of 2003, Richard Alarcon, D-Sun Valley) and SB 899 (Chapter 34, Statutes of 2004, (Charles Poochigian, R-Fresno) established medical treatment guidelines and utilization review processes in California workers' compensation.  Prior to these important reforms, claims had an extremely high utilization of treatment, rapidly inflating medical expenses.  Despite this added cost, there was no medical benefit to injured workers in California.

This week's hearing began with representatives from the California Medical Association telling the committee about the problems that they are facing with the American College of Occupational and Environmental Medicine's (ACOEM's) guidelines.  They expressed concern that these guidelines did not address all injuries or situations.  They testified that it would be much better if other guidelines were available.  What the doctors did not mention is that regulations dictating how treatment is authorized already provide ways to authorize treatment not addressed by ACOEM or inconsistent with the ACOEM guidelines.  

The panel of doctors also mentioned their many problems with the way that insurance companies have implemented utilization review processes.  They testified that the utilization review statutes are being abused by insurers to improperly delay and deny medical care for injured workers.  The testimony described insurers acting in a fashion contrary to the rules, not problems with the rules themselves.

Acting Administrative Director for the Division of Workers' Compensation, Carrie Nevans, joined the newly appointed Medical Director, Dr. Ann Searcy, to take questions from Senator Alarcon.  Ms. Nevans did come down strongly on insurers and self-insured employers who are using utilization review for every request for treatment.  She thinks that doctors in Medical Provider Networks should be afforded a greater amount of trust by insurance companies.  

CMTA joined other employer organizations in supporting the statutory and regulatory framework that is currently in place, and offered to work with the committee and other stakeholders to work out any unintended consequences from the recent reforms. But opponents of reforms also want to roll back changes to permanent disability, treatment caps, penalties, and more.  They are waging a public relations campaign that creates an environment hostile to engaging in deliberate discussions on possible improvements to the system. As in the past, the complicated and expensive workers' compensation system in California is destined to be shaped by political pressures as much, if not more, than by sound policies.

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