One of my favorite features in the San Francisco Chronicle is Earthweek. It's a syndicated column that summarizes both great world natural disasters and strange small earth disturbances.

This week, there was news of an explosion of the gopher population in the Canadian prairie. One rancher was quoted as saying gophers were multiplying faster than he could load his gun.

Tornadoes in Chad. Earthquakes in Tibet. Heatwave causing death of a tiger in Bangladesh. Sicily's Mt. Etna spewing lava. And starving vulture attacks in southern Spain. The earth is a busy place.

In the workerscompzone things were busy, too. Here are some key events of the past week (Note: links to information on all of these are listed at the tail end of this post):

1. A workers' comp judge in San Francisco gave former Division of Workers' Compensation Director Andrea Hoch an "F" for the new workers' comp rating schedule that was adopted for disability ratings under the AMA impairment rating scheme. In an exhaustive 51-page decision, Judge Jacqueline Duncan found that the new permanent disability rating schedule does not comply with the intent of the legislature in enacting SB 899 in 2004. This decision will be appealed, but could have major ramifications in many cases. I'll be covering this further over the coming weeks.

2. The Los Angeles Times reported that there was a Sacramento meeting to discuss adjustments in permanent disability benefits held Friday. Marc Lifsher of the LA Times, who covers workers' comp issues, noted that participants included staffers from the offices of California Senate Pro Tem Don Perata and Assembly Speaker Fabian Nunez with representatives from labor unions, large employers, insurance companies and attorneys for injured workers. The meeting is under wraps of course, but workerscompzone will cover information as it surfaces. You can expect rumors in the rumor mill to be multiplying as fast as those Canadian prairie dogs pretty soon.

3. Senator Perata's bill to double PD benefits (over a period of several years), SB 936, passed from committee on a 3-2 party line vote. At this point, SB 936 is quite similar to SB 815, which was passed by the legislature in 2006, only to be shot down by a Schwarzenegger veto.
And -- like the Spanish vulture plague -- expect lobbyist attacks on whatever is passed this year.

4. The California Division of Workers' Compensation sent its final version of medical treatment guidelines off for approval to the California Office of Administrative Law (OAL) for approval. These new treating guidelines continue to use the ACOEM guidelines as the standard for medical treatment in California workers' comp. The guidelines now use acupuncture guidelines that have been borrowed from Colorado.

5. The National Council on Compensation Insurance (NCCI) unveiled its study of workers' comp nationally. Medical and pharmacy costs are now the major expense in comp claims, surpassing workers' comp indemnity payouts for temporary and permanent disabilities. Medication cost increases are noted to be rising especially.

You can actually download a copy of Judge Jacqueline Duncan's decision rejecting the "new schedule" by scrolling to my May 11 post
"Workers' Comp PD Schedule Ruled Invalid":
http://www.workerscompzone.com/

For the other stories, note that you can click the following:
-Re the meeting of legislative staffers:
http://www.latimes.com/business/la-fi-c ... s-business
-Re the medical treatment guidelines:
http://www.dir.ca.gov/dwc/DWCPropRegs/M ... ations.htm
-Re the national comp insurance study:
http://www.ncci.com/NCCI/article2.aspx? ... 07_SOL.htm

Stay tuned.

Julius Young
www.boxerlaw.com

Check out the new look of boxerlaw.com!

Workers’ Comp Judge Jacqueline Duncan has issued a 51-page decision (Scott Boughner vs Comp USA and Zurich North America) which rules that the Schwarzenegger administration’s revision of the permanent disability schedule is invalid. It’s a decision that will create great waves in California workers’ comp circles.

You can download a copy of the decision by clicking here.

I’ll be posting more on it over the weekend. It is potentially very significant to claimants who were injured after 1/1/05 (and to many workers hurt before 1/1/05 who may not fall within the “exceptions” that would place them under the “old” schedule). Meanwhile, if you are a claimant reading this, you should note that this decision will be appealed. It is not binding on other workers’ comp judges, but may well be followed by many of them until the statewide WCAB tells them otherwise. The statewide Workers' Compensation Appeals Board will be forced to deal with this issue.

Julius O. Young, Esq.

BREAKING NEWS:

A Workers Compensation Judge at the San Francisco District office of the California Workers' Compensation
Appeals Board has ruled that the new permanent disability rating schedule adopted by the Schwarzenegger administration is invalid.

In a few hours I will be doing another post after uploading a copy of the 51 page decision by Workers Compensation Judge Jacqueline C. Duncan. Check back later today for my next post to download a copy of the decision.

The decision involves some complicated legal issues regarding what the legislature required of the Administrative Director in implementing a new post-reform rating schedule.

Until I can get the document uploaded,note that these are Judge Duncan's key findings:
1. The Administrative Director failed to base the adjusted rating schedule on empirical data and findings from the RAND Institute for Civil Justice study as required by Labor Code Section 4660(b)(2).
2. The Administrative Director failed to base the adjusted rating schedule on data from additional empirical studies, as required by Labor Code 4660(b)(2)
3. The new schedule adopts translation factors (translating impariment percentages into disability percentages) that are inconsistent with Labor Code 4660(b)(2).

Check back soon. This is a story that will not be covered by most of the workers' comp press until next week.

Julius Young
www.boxerlaw.com

Lucky you.

Undoubtedly thouands of Californians are online right now....reading the latest news about Paris Hilton's upcoming jail time, Lindsay Lohan's latest attempt at rehab, Katie Couric's poor ratings, where Britney Spears had lunch and whether she was wearing underwear under her outfit, and all the other burning questions in our celebrity-obsessed culture.

But you're here, on workerscompzone. And while the days get longer and longer, I'm covering the 2007 California legislative healthcare debate. It's a debate of great interest to many disabled workers, many of whom eventually lose their group medical coverage.

It's also a debate that makes Blue Cross unhappy. Blue Cross has the blues. Like all of the major California group health insurers, Blue Cross opposes SB 840, the "single payer" health plan bill sponsored by Senator Sheila Kuehl .

But Blue Cross is alone among the major California health providers in opposing Governor Schwarzenegger's healthcare reform package. Blue Cross is no small insurer. It insures roughly one fourth of the individuals who have coverage in California. Blue Cross PPOs and HMOs have been significantly more profitable than its nearest competitors, HealthNet and Pacificare. And according to California Department of Insurance figures, Blue Cross profits have been as high as 27% on many of its plans.

Blue Cross (and its parent company Wellpoint) have the blues over Schwarzenegger's proposal which would require that 85% of premium dollar go to patient care. According to an analysis of state regulatory data done by the San Jose Mercury, Blue Cross spends between 51 % to 79% of premium dollars on patient care, depending on the particular plan. Remind you of California workers' comp, where insurers may be spending only slightly more than a third of premium dollar on worker benefits?

Blue Cross also demands that it retain the right to cherry pick who it insures. Pretty good business model. Insure only the healthy.

And Blue Cross is getting aggressive with its insureds. They won't hesitate to sue you to recoup payouts if they provide care for conditions they claim weren't properly disclosed, even if the error was inadvertent.
Better make sure your spouse doesn't estimate your weight if they help you fill out your application!

Take a look at the amazing story of how they yanked coverage from Steven Hailey, a California accident victim, causing him to depend on a permanent bladder catheter. Deeply in debt and permanently disabled after Blue Cross refused to cover his treatment, Hailey sued. Hailey's case against Blue Cross is pending at the California Court of Appeal.
Blue Cross takes the position that they can yank coverage if there were any errors in the application, whether intentional or inadvertent.

But back to Sacramento. Blue Cross is now pitted aginst Aetna, Kaiser, Blue Shield, Safeway, other major corporations and the Governor. The trade off that may emerge is that cherry picking will not be allowed, but universal coverage will be required. And employers and workers will be required to pony up. Restaurant owners, small business owners and some in labor unions aren't pleased.

See the Sacramento Bee piece by Dan Weintraub by clicking here:
http://www.sacbee.com/110/v-print/story/170883.html

To read the San Jose Merc piece on Blue Cross, click here:
http://www.mercurynews.com/portlet/arti ... siteId=568

The LA Times story on the bladder catheter coverage issue can be found here:
http://www.latimes.com/business/la-fi-i ... 3950.story

For more information on some of these issues, check these links to earlier posts on workerscompzone:
"The $12,000 Broken Rib"
http://www.workerscompzone.com/index.ph ... 4e069ef8f9
"Who Shall Pay?"
http://www.workerscompzone.com/index.ph ... 4e069ef8f9

Stay tuned.

Julius Young
www.boxerlaw.com

Should California's workers' compensation system be abolished?

Yes, according to a provocative article by political analyst Frank Russo, editor of the influential blog California Progress Report. You can read Russo's article by clicking here:

http://www.californiaprogressreport.com ... s_com.html

California's workers' comp system has few fans. Employers call it a poison on the economy. Legislators have found it to be a political tar pit. Looking back over the past 25 years, there have been few times when major system stakeholders were not seriously chafing at the system. Historically, there were a handful of dominant parties in any legislative negotiations: insurers, manufacturers and the lawyers for injured workers. Change occurred when two of the three stakeholders struck a deal, freezing the other side out. Liberal Democrats (think Jesse Unruh, Leo McCarthy, David Roberti, Howard Berman, Willie Brown) running the California Senate and Assembly who were sympathetic to labor interests managed to "keep the wolf at the door".

In 2003 and 2003, with Arnold Schwarzenegger leading the way and Senate Pro Tem John Burton at the legislative helm, the wolf got inside the door.

Despite Governor Schwarzenegger's press releases that he has fixed the system, it is becoming more and more apparent that the current system is seriously troubled. Income replacement benefits paid to disabled workers have been drastically cut. Benefits paid to workers are only approximately a third of total premium dollars collected. (for links to prior posts on this, click on this:

http://www.workerscompzone.com/index.ph ... 4e069ef8f9

and this:

http://www.workerscompzone.com/index.ph ... 4e069ef8f9

Is Russo's call for the system to be abolished a vision of future political struggles? Will the health care reform debate have implications for the future of California workers' comp?

Stay tuned.

Julius Young
www.boxerlaw.com