Tuesday, January 16, 2007, 08:37 AM - Medical treatment under WCIf you are a California worker who does not want to be forced to treat with a company-chosen doctor in the event of a work injury, you MAY be able to predesignate a doctor
of your choice. You do not have this right unless you are covered by group insurance sponsored by your employer or union.
What is now required? The doctor you designate before you are hurt at work must:
- be your "personal physician" (defined as your primary care physician, but under
2006 changes to the law, that can be Kaiser or other multi-specialty group)
- have previously directed your medical treatment and retained your medical records
- agree to be predesignated (nothing in the law requires your doctor to agree)
If you predesignated before the 2004 workers' comp reform, the old predesignation form you used is probably defective. Pre-2004 law did not require that the doctor agree to be predesignated and that the doctor be your primary care physician or already have your medical records. You should consider executing a new form rather than assume that the courts will accept old predesignation forms on a "grandfather" basis.
To download a predesignation form, click this url:
Why predesignate? California workers who don't predesignate a treating doctor for work injuries BEFORE they are hurt must see the company doctor for 30 days. At the 30 day mark, they can then choose a doctor, unless the employer/insurer has adopted an MPN (medical provider network). If the employer has adopted an MPN, the worker will have to keep treating with company doctors. Company doctors often are looking out for the company's interest, not the worker's. This can affect whether the worker receives adequate treatment and weekly benefits, whether the worker is allowed to return to work, etc. This can be a critical factor in a workers' comp claim.
Sunday, January 14, 2007, 10:11 PM - Political developmentsIn my January 13 post, I summarized the key elements of Schwarzenegger's proposal to extend health coverage to all Californians. Key interest groups in California -- doctors, hospitals, large employers, counties, unions, drug companies, among others -- will be doing heavy lobbying to influence the outcome of this year's health care debate.
Since many injured workers either don't have group health insurance to begin with, or lose their coverage if they are off work for an extended time due to injury, reform of California's health care system is critical to unions and injured workers. As State Senator Sheila Kuehl (Chair of the California State Senate Health committee) noted recently:
"Plenty of money is being spent on health care-one out of every six dollars
spent in America, it's just not enough to cover everyone. And, while spending generally has risen by 7.5%, insurance premiums have gone up by double-digits every year for the last five. Wages have increased only 1.7%. Costs are getting shifted to patients and physicians are not getting reimbursed for their work."
Kuehl has her own health care reform bill in the hopper, SB 840. SB 840 would set up a state insurance trust fund, collecting premiums paid by employers and individuals alike. It is a version of a "single-payer" system pushed by many reform advocates. A "single-payer" system would greatly reduce health care administration and bureaucracy costs.
State Senate leader Don Perata has his own plan, Senate Bill 48. Assembly Speaker Fabian Nunez also has his own plan, AB 13, which would cover employees through a purchasing pool funded by fees on employers who do not offer health coverage.
Thus, we have at least four major proposals: one by Gov. Schwarzenegger, and the others, by power players Kuehl, Perata and Nunez. It will be interesting to see what emerges.
For a more detailed description of how some of these proposals would work, see
Senator Kuehl's article in the California Progressive Report:
http://www.californiaprogressreport.com ... re_in.html
To follow the details of the health care debate this year, you may want to bookmark the site of Health Access California, a consumer advocacy coalition working for affordable health care for all Californians:
Saturday, January 13, 2007, 10:29 AM - Political developmentsWell, it's a beautiful Saturday... picking up the paper, I see that California has slipped from 6th to 8th in the world economy. .. the Siskiyou salamander won in court... and tortilla prices are up in Mexico City.... A poll just out from the well-respected San Jose State Survey shows the Governor basking in a 63% approval rating, including 61% of Bay Area voters and 53% of Democrats, as well as a majority of blacks and Hispanics. Good news for the Schwarzenegger folks, indeed. But it's time for Workerscompzone to comment on Governor Schwarzenegger's new health care proposal.
Sacramento has been abuzz the last few weeks with talk about the health care reform debate. A recent Field Poll showed that over 75% of California voters favor reforming the current health care system. I'll be dealing with this repeatedly as the legislative session moves along, since it is an issue that is in many ways intertwined with workers' comp and the California economy. You can check the "related link" section just below this blog entry to see some of the more interesting articles that have appeared in the press about the plan. In future posts, I will be exploring some of the interesting interplay issues between health care reform and workers' comp. But first, lets get a grip on what the proposals are.
In case you missed it, what are the essentials of Schwarzenegger's health care proposals? Note that these are ONLY proposals now. As summarized in the San Francisco Chronicle, the key elements are as follows:
-a pilot plan would be set up to try "24 hour care" coordinating workers' comp and group health care coverage (CALPERS employees would be in the pilot plan)
-employers with 10 or more employees that do not provide medical coverage would be required to pay a 4% payroll tax that would be pooled into a state fund to purchase coverage
-everyone would have to have insurance through an employer or purchase it individually. Minimum benefits would be a plan with a cap of $10,000 out-of-pocket expenses per family and a $5,000 deductible
-over a million low-income persons would get payment assistance to help them get coverage
-the state would provide health insurance to all children (including illegal immigrants) who are living below 300% of the federal poverty level ($60k for a family of 4)
-Medi-Cal would be expanded to cover about 630,000 indigent adults not now eligible for benefits
-Medi-Cal rates would be increased to pay doctors and hospitals more, but doctors and hospitals would be charged a 2% and 4% tax (or is it a fee?) respectively
-insurers would no longer be allowed to deny coverage to individuals based on their medical history
-insurers would have to spend 85% of their revenue on services
The headlines in reaction to the proposal have been interesting. Dan Walters of the Sacramento Bee: "Bold health plan faces rough road"; also see Walters' piece http://www.sacbee.com/111/v-print/story/106704.html; Peter Nicholas of the LA Times:
"When are 'fees' not new taxes?"; Harrison Sheppard of the LA Daily News: "Ready to
rumble in the capital." Also, see Steve Wiegand's piece: http://www.sacbee.com/111/v-print/story/107259.html
Stay tuned. In future posts, I will be exploring health care reform and workers' comp.
Tuesday, January 9, 2007, 05:34 PM - Political developmentsI just finished listening to Governor Schwarzenegger's 1/9/07 State of the State address.
It was a short speech that pushed big goals but broke little new ground politically. What were the themes? Among the principal themes were the following:
- Promoting green technology and clean fuels technology
- prison system reforms
- developing a water transit system for the San Francisco Bay
- jumpstarting spending the bond money that was approved by voters in 2006
- promoting career technical education
- lowering the budget deficit with no new taxes
- enacting a major health care reform package
He added little to the health care proposal which was unveiled yesterday. He will push major dam and water storage projects. More bonds will be proposed to deal with some of these things.
Workers' compensation was not mentioned.
The Governor's stated theme: the need for bipartisan action to address complicated issues that have been deferred for years. Schwarzenegger continued to position himself as seeking action from the political center, appealing to both parties for support.
Several Democratic legislators interviewed afterwards expressed optimism that there will be bipartisan cooperation on these issues.
Most of the California political blogs will be commenting on the speech. For example, www.newwestnotes.com (Bill Bradley's New West Notes) covers developing California political stories. But not much new in this speech tonight.
In my next post, I'll look at the Governor's health care plan and how that will impact California's working men and women.
Friday, January 5, 2007, 08:26 PM - Political developmentsPull your retrospectoscope out of your closet. Scroll back to 2005. Arnold Schwarzenegger's popularity tanked. In the special election he called, The Governator was dealt a humiliating defeat by a coalition of unions. He lost all of his reform initiatives. Re-election prospects looked dim. Polls showed a high disapproval rate. He reached within the ranks of former Gray Davis staffers to hire Susan Kennedy, a Democrat and former abortion rights lobbyist, as chief of staff. Giving a mea culpa and admitting his arrogant ways, The Governator began to re-invent himself.
Arnold pitched himself as someone who could get things done. Bonds passed. Infrastructure built. A global warming emissions bill passed. To the chagrin of some of his business supporters, a minimum wage bill even passed... he was the man with an optimistic view of California's future.
After a bruising 2006 primary campaign, challenger Phil Angelides never managed to connect with donors or voters, or even voters in his own party. Workers' comp never became a big issue in the campaign. Injured workers never mobilized en masse. The occasional ad mentioned Schwarzenegger's claim that he was the man who reformed California workers' comp, helping the economy stay strong. Schwarzenegger won in a landslide.
And so today, broken leg and all, Arnold basked in the glow of his second swearing-in ceremony in Sacramento. A featured speaker was none other than Willie Brown, former San Francisco mayor and long-term California Assembly Speaker, the Democratic party wheeler-dealer of wheeler-dealers.
Things have come a long way. The Governator's speech today claims that he is a centrist. But will he be able to corral the right wing within his own party? Can he work with the legislature to solve the myriad problems of California's deteriorating transportation networks, schools and health care systems? Will he be willing to take on the California Chamber of Commerce, the California Manufacturers Association, big health care and pharmaceutical interests?
And will he be open to compromise with the legislature to fix the harsh consequences of his 2004 workers' comp reforms, which have harmed many truly injured workers? Or will he continue to take as his script the inflexible position on comp reforms of his insurance and manufacturer allies?
Take a look at www.arnoldwatch.org to see a list of the corporate sponsors for today's inaugural festivities. One can't help but notice that many insurers and California's corporate heavyweights are listed as inaugural sponsors. These are the folks behind the 2004 comp reforms. $50,000 from the California Chamber of Commerce. $50,000 from the California Retailers Asociation. $15,000 from AIG insurance. $15,000 from Allstate Insurance. And that is just a small sampling.
Will the real Arnold please stand up? 2007 should be interesting.
In my next post, I'll be covering his State of The State address. Stay tuned.