Wednesday, March 3, 2010, 10:27 PM - QME processSome interesting statistics surfaced in the presentation on the QME process at this week's DWC conference.
While the Medical Unit is getting QME panel requests issued in less than a month for unrepresented workers, panels in represented worker cases are currently not issued until around 90 days from request.
Labor Code 139.2(h)(1) requires unrepresented panel requests be issued within 15 business days of receipt by the DWC Medical Unit. For represented worker panels there is no statutory timeframe but the Medical Unit has previously indicated a goal of processing those within 30 working days.
Suzanne Honor-Vangerov, manager of the DWC's Medical Unit, gave a presentation on the workload of the Medical Unit. Each month 6,600 panel requests are filled. The breakdown is as follows:
Unrepresented cases: 4,700
Represented cases: 4,100
Ordered by judges: 100
Replacement panels: 550
Honor painted a picture of a unit besieged by a huge volume of paper
(the Medical Unit is not on EAMS) that is also coping with the effects of furloughs. Apparently some Medical Unit personnel have been off on Friday furloughs but come in on Saturdays. Eventually they'll have leave time as a result.
The boxes of backlogged requests may multiply.
The situation is complicated by procedures and forms which result in many requests being kicked back. That occurs for a variety of reasons where forms are not filled out properly, supporting documentation is not attached, there is a conflict between the data in the form and the underlying documentation etc etc. Ms. Honor and DWC Legal Unit staff counsel Suzanne Marria did an admirable job of detailing the types of errors that can delay processing of requests in represented and unrepresented cases.
It's hard to fault the DWC staff, who are trying to keep the QME system flowing. One does wonder if there aren't steps that could be made to streamline the process.
What was most disturbing was word that requests for panels for workers represented by attorneys is taking 90 days. And if the request is kicked back for clarification from one or both of the parties, the wait could be much longer.
Having such a processing time differential between represented and unrepresented cases is troubling.
Yes, if there are long delays it may encourage adjusters, defense attorneys and applicant attorneys to agree on AMEs.
There are many cases where it's in the interest of the insurance carrier to get a speedy resolution. If there are disputes over TTD status or over treatment issues, employers and insurers may be prejudiced by having to wait many months for a panel to be issued. In some cases a panel is issued and there are problems with one or more of the panel docs, necessitating a replacement panel.
So if there are delays in the QME process it may give more incentive to parties to use AMEs. With AMEs in a represented case the parties have more control over scheduling. If an AME is scheduling too far out in time the parties can agree to someone else. I suspect there are many adjusters and claims managers who would be more willing to consider use of an AME if they understood the delays at the Medical Unit.
The problem is in represented cases where the parties cannot or will not agree to an AME. A wait of 90 days-or more-to even get the QME process rolling is prejudicial to many workers and to many employers.
A 90 day wait-or more-is hardly a hallmark of an expeditious, unencumbered system.
Under these circumstances I believe that many attorneys will start getting orders from a workers comp judge directing the Medical Unit to issue a panel promptly. If the unit is too swamped to comply expeditiously (some of these orders may require Medical Unit compliance in a designated timeframe) judges may allow the defense attorney and applicant attorney to bypass the process altogether. Ultimately the WCAB has jurisdiction on what medical evidence it will allow, particularly if the parties stipulate to the admissibility of evidence.
Either the DWC needs to devote more staff resources to the unit or the
QME request procedures need to be revamped.
With the Schwarzenegger-appointed DWC administration headed towards its final hurrah, it's not clear this is a priority. But this DWC administration or the next needs to address these problems, which may only grow worse.
Tuesday, March 2, 2010, 08:39 AM - Political developmentsWe're getting past the era of Cheech and Chong getting stoned in the back room.
Statewide Insurance Services, based in Rancho Cordova, has announced nationally based insurance coverage written specifically for the medical marijuana industry.
Apparently the coverage will cater to pot growers and dispensaries. An official of Statewide Insurance Services, Mike Aberle, is quoted in today's Sacramento Bee as saying it covers "all aspects of the industry", including workers' compensation.
I don't have any details yet, but it's interesting to note such industry-specific coverage.
If they are writing workers' comp, perhaps they'll also offer medical marijuana dispensaries as part of their MPN. Perhaps they'll have medical marijuana on their formulary to be prescribed by treating physicians.
Is this the vanguard that will eventually get marijuana accepted as a treatment modality under California's MTUS?
Inquiring minds want to know.
Meanwhile, there's growing focus on the involvement of the Mexican mafia in large scale pot growing operations on public lands such as areas near Yosemite and in Sequoia National Forest. Here's a piece from the Los Angeles Daily News, "Drug Gangs taking Over U.S. Public Lands" by Alicia A. Caldwell and Manuel Valdes:
Stay tuned, and don't inhale too much.
Monday, March 1, 2010, 10:37 PM - Political developments(workerscompzone has been traveling in Israel; this week he returns to cover the DWC Conference in Oakland; meanwhile, this is the last in a series of four postings on his Mideast wanderings)
This ancient fortress, built on a desert mesa near the Dead Sea, is surely one of the most desolate places on earth. Built around 43 B.C. by Herod, the Roman ruler of Israel, Masada sits atop steep cliffs.
The closest American analogy to the site would be the Hopi Reservation in northern Arizona.
Masada is etched into the Jewish psyche as a symbol of Jewish resistance. History (writtten by Flavius Josephus) tells us that rather than submit to defeat at the hands of the Romans, Jewish Zealots elected to extinguish their own community rather than fall into Roman hands. Lots were cast, and those selected by lot then killed their fellow Jews, including women and children.
To some of you it may sound like an ancient Jonestown.
But to many modern Israelis the story is inspirational. School kids and the army visit the site, absorbing the message of ultimate resistance.
The day I was there the place was swarming with Israeli Arab kids. Israeli Arabs, who now probably make up at least 20% of Israel's population, are probably vital to the future direction of the country. They are a group distinguishable from Palestinians.
Those Israeli Arabs are largely Muslim, with a small number being Christian.
I wondered to myself how those schoolkids felt about the Masada story.
Did it give them inspiration about living in a Jewish state?
Israeli Arabs do have the right to vote, but are not required to serve in the military. Their incomes are much lower, and most observers would concede that there is a large class distinction between the Israeli Arabs and Jews. Among Israeli Jews, Ashkenazi Jews (European) are better off economically than Sephardic Jews (from North Africa and the Middle East).
In my brief travels in Israel it was clear that there is tension not just among Palestinians (see my posts on Jerusalem and Bethlehem) but also among Israeli Arabs.
This is a great worry for many Israelis.
The 2006 war with Hisbollah in south Lebanon went very poorly. The vaunted Israeli army pounded parts of Beirut from the air, but it was difficult to triumph over a slippery guerilla force.
Many Israelis believe that things are back to pre-1967. There will likely be permanent struggle to preserve the existence of Israel. They believe the criticism of the separation wall and settlements to be a distraction from the major challenges they face strategically.
Iran is a great worry as it proceeds on a nuclear path. They know that sanctions on Iran are a joke and will not work.
The growing demographic size of the Israeli Arab community is a great
worry for Israel.
Some question whether it can remain a Jewish state and still be an American style democracy. How will increasing numbers of Arabs within Israel affect the very Jewishness of the state?
NYU professor Tony Judt has questioned whether Israel got on board the nationalism train too late. Judt (who is Jewish) claims that Israel has imported a late 19th century separatist project into a world that has moved on to concepts of individual rights, multiculturalism and open borders:
Neo-conservative Jewish theorists such as Daniel Gordis defend the necessity for a Jewish state (they are joined by some Christian theorists who see the Jewish state as the protector of Christian holy sites). For those wanting a detailed analysis of where things stand for present and future Israel (from an intellectual who is pro-Israeli) I'd recommend Gordis' book, "Saving Israel: How the Jewish People Can Win a War Which May Never End":
http://danielgordis.org/books/saving-is ... never-end/
It's beyond the scope of this blog to get involved in the Judt vs. Gordis debate. I have friends and colleagues who predictably will join one or the other camp.
But as I flew back towards the U.S. I wanted to bring this debate to your attention. How it is dealt with may affect whether there is any peace process and whether we all face a lifetime with the Israel/Palestine issue at the forefront.
Stay tuned, readers. I'll be resuming workers' comp commentary shortly.
Monday, March 1, 2010, 09:25 AM - Political developments(workerscompzone has been traveling in Israel...the blog will be returning to cover the California DWC annual conference in Oakland...so stay tuned...meanwhile, some insights on Middle East wanderings are offered)
It's about as far from Jerusalem as San Bruno is to San Francisco or Malibu to Santa Monica. From my hotel I can look towards Jerusalem. The border fence separating the Palestinian Territories from Israel lies in between, snaking over the parched-looking hills.
My wife made me promise I would not go. She's worried about security in the entire region. But the temptation to see for myself is too great.
Getting there is not so easy. The cab driver takes a somewhat complicated route, but there are no actual entry checkpoints. Soon we're on the other side of the wall.
We're talking more than a fence. It's a separation wall that appears to be around 25 feet high. This wall runs for hundreds of kilometers. This is the real deal-not like the U.S. Border fence with Mexico that seems scalable.
Proponents of the wall cite it as one reason that terrorist incidents and suicide bombings are down in Israel. They argue that to have peace you must have a peace partner and that the Palestianian leadership was never willing or able to accept the existence of Israel and strike a deal.
They argue that with Arafat's passing and the rise of Hamas in Gaza and Hisbullah (in Southern Lebanon), there is no reliable peace partner.
Some of the Palestinians I talk to feel like they are living in a cage. The anger is palpable.
We head toward Bethlehem's Manger Square and the Church of the Nativity.
Oops...this road is a bad idea. Marching towards us are a couple hundred protesters. They're protesting the Israeli government's decision to designate Israeli historic site status to the Tomb of the Patriarchs in Hebron (a Palestinian controlled town) and Rachel's Tomb in Bethlehem
(also Palestinian controlled, albeit notable that Bethlehem has a large number of Christian Arabs).
Intent on avoiding getting caught amid the protest, we do a u-ie and head down other streets.
Arriving at Manger Square, I note a large group of Polish Christian pilgrims entering the Church of the Nativity.
Before entering, my Palestinian guide wants to point out the "settlements". We look toward Gilo and Ma'ale Adumim, two settlements which appear to be large apartment blocks interspersed between Palestinian towns.
After visiting the historic church, supposedly cited on the birthplace of Jesus, we head out to Herodian, a palace built by Herod of Rome. Situated in the Judean Desert above a flat topped hill, Herodian affords a panoramic view of the area. From there one can see the Dead Sea far in the distance. And beyond the Dead Sea are the high mountains of Jordan.
In truth the area-still far in Palestinian territory behind the separation wall- is totally parched. It reminds me of the hills looking east from Palm Springs-the area around Desert Hot Springs.
From the top of Herodian, more views of settlements. At the southwestern edge of Herodian is what appears to be a relatively new Israeli settlement perched atop its own little hill. There are perhaps 10 or 15 trailers, a water tower, a few makeshift barns, and some plastic covered buildings shaped like Quonset huts.
It's obvious that these settlements are like a poke in the eye toward Palestinian nationalists. Tolerated-and even encouraged-by some in the Israeli leadership, the settlements create additional "facts on the ground" that will eventually have to be dealt with as part of any lasting peace process.
Getting to Herodian we passed an Israeli Defense Force humvee. Presumably they were on patrol near the settlement.
headed back to Jerusalem, we enter one of the settlements. Large apartment buildings are under construction. For sale signs abound. There appears to be an office where they show model units. A neighborhood and a lifestyle is being marketed.
Geting back to Jerusalem, we pass through a checkpoint. The IDF officer looks carefully at me, see's I'm a tourist, and waives us through.
This was a couple of days before more serious events erupted in Jerusalem, with rock throwing protesters and countermeasures by Israeli police on the Temple of the Mount.
The flashpoint continues.
Sunday, February 28, 2010, 09:37 PM - Political developments(Workerscompzone has been traveling in Israel...the last post was from Tel Aviv....in a few days the blog will return to regular commentary on important events in California workers' comp....)
Jerusalem....surely the most contested place on earth. Pretty much every inch of the old city is contested by some religious group. The old city is divided into four zones: the Arab quarter, the Jewish quarter, the Christian quarter, and the Armenian quarter.
I come down from my hotel located on Mt. Zion. Entering the Jaffa Gate, I run the gauntlet of hundreds of vendors in the labyrinthine old streets.
Why is it that so many of the places seem to be selling the same trinkets? Are those antiquities really old? Shall I break down and buy one of those "Don't Worry America, Israel Will Defend You" t-shirts?
Some of the vendors really do "got game". One guy ropes me into his stand to show me a picture of his dad, who is supposedly an Orange County police officer. He quickly changes the subject to the carpets and jewelry for sale in his shop.
Another vendor claimed he lived for a few years in Venice Beach. I ask him whether he ever smoked cigars at Arnold Schwarzenegger's place there, Schatzi on Main. Blank stare.
I stop for lunch. It's hard to beat a plate of hummus topped with minced lamb, washed down with a glass of fresh squeezed pomegranate juice.
The restaurant owner seems intent to be hitting on middle aged Northern European females. I eat my lunch slowly and must hear him ask various women whether they are from Austria or Sweden.
I dead down the Via Dolorosa, where Jesus is said to have carried the cross. It's slow going, as a crowd of Koreans trail an old, frail looking Korean pilgrim dragging a huge wooden cross on her spindly shoulders.
From there I turn into the Arab quarter. It looks less prosperous. Lots of kids play soccer in narrow, ancient streets. Signs are in Arabic, unlike other parts of Israel where signs are mostly only in Hebrew. It's not scary, but there's not a welcoming feeling on these streets either.
I wind my way toward the Temple Mount, the holiest site in Judaism and the 3rd holiest site in Islam.
It's a no go in the afternoon, so I'm stopped by the tourist police. Even in the morning the Mosque is off limits. Try the Wailing Wall, I'm told.
Actually it's the Western Wall, a sheer stone face just below the Temple Mount. Several dozen IDF forces stand guard along the way, automatic weapons at their side, before I even get to the entrance with metal detectors.
Passing through, I'm at the wall. Actually it's a mammoth plaza. Perhaps a hundred Orthodox Jews are lined up praying at the wall, some sticking small pieces of paper in the crevices. Others seem to be standing or sitting, rocking and swaying as they recite the Torah.
Women seem to get the short end of the stick. The Western Wall female prayer area l takes up about a third of the space, with the guys getting the other two-thirds.
I missed the protests, but there were Temple Mount and old city clashes between rock throwing masked Palestinians and the police after stones were thrown at tourists.Tension has been very high this week after Israel announced plans to add several West Bank shrines to Israel's national preservation list.
Tension has been high in the Jewish quarter as some ultra -Orthodox Jews set up poles to demarcate areas where nothing can be carried on Shabbat (the Saturday religious holiday).
Everything looks dry as a bone, but menacing clouds roll in. There's thunder in the distance. Then lightning cracks appear to be closing in.
The scene is beautiful. It oozes history. But it's also somewhat menacing. One can see that an insult here or a stone thrown there can set off an international incident.
Time to get back to the hotel before the downpour.
A good time to read something on Israel's labor law. Here's an interesting piece, albeit several years old (so changes may have occurred):
http://www.ilo.org/public/english/dialo ... nal/is.htm
And this article by Steven J. Adler, President of the National Labour Court:
Stay tuned. In coming days' I'll complete this series with a view from Bethlehem (in the Palestinian Territories) and Masada (on the Dead Sea).
For a report on the current strife, see this: