In an otherwise sleepy legislative session for workers' comp issues, there's an end of session drama unfolding.

The issue was scooped last Friday by Workcompcentral.com, in an article by Workcompcentral reporter Jim Sams. Workcompcentrtal has obtained a copy of a document (written on the letterhead of CHSWC, the Commission on Health, Safety and Workers' Compensation) which apparently details a "grand bargain" type compromise that would make system cuts to achieve savings. The goal would be to create savings in order to restore some of the PD benefits cut after the 2004 reform and 2005 PDRS.

I say apparently because I personally have yet to see the document. But I do have reason to believe that the document is or will be making its way into the possession of major comp system stakeholders.

What's unknown at this point is how many of the key stakeholders are willing to line up behind this proposal, and what the legislative leadership's position is on a last minute deal. Major legislation sometimes emerges under cloak (for you Star Trek fans), and can sometimes be well down the track before the word gets out.

Would the Democratic legislative leadership prefer to wait in hopes that there will be a Democratic governor in another year?

According to the workcompcentral piece, the key players have been Sean McNally (formerly an attorney with Hanna and Brophy and currently an officer of Grimmway Farms and currently chair of CHSWC) and Angie Wei of the California Labor Federation, also an appointee to CHSWC.

Interestingly, according to the workcompcentral piece, CHSWC executive director Christine Baker was said to have denied knowledge of the document on CHSWC letterhead.

According to workcompcentral, the compromise would place limits on lien filings. In Southern California in particular, lien claimants are a major factor in the system. There would be a paper independent medical review system to review UR denials, apparently similar to the process used in managed care for group medical care systems. I have to assume that this would create a system bypassing the QME determination on UR denials that was endorsed by the California Supreme court in the Sandhagen case.

Ambulatory surgery fee schedules would take a hit. The supplemental job displacement voucher would be eliminated. The 15% PD bump up/down would be eliminated.

Workcompentral noted that the proposal seemed to call for indexing PD to a target earnings loss formula. Apparently the PD schedule would be
conclusive.

Exactly what other procedural and substantive changes are under consideration isn't known (it's worth noting again that I have not seen the document, which may be a work in process).

It's quite possible labor would want the governor to sign a bill extending predesignation.

And since the Almaraz, Guzman and Ogilvie cases could be re-decided by the WCAB any day now, it's possible that the proposal under discussion could contain language which would change or moot those
cases.

We'll probably be learning more in the coming days.

Stay tuned.

Julius Young
www.boxerlaw.com

Whether you are a worker, a lien claimant, an attorney or an adjuster, you rely on that part of the workers' comp community that works at the WCAB district offices.

These are the people who find the files, process the mail (or interface with
EAMS), take the phone calls, transcribe the letters and rate the cases. And yes, these are the people who also decide the cases (the workers' comp judges).

If you're detecting a little more signs of stress at the WCAB or an occasional snarl at your requests, consider the financial and morale effect of the furloughs. With an effective 15% pay cut, some of these workers find their financial lives out of whack.

Here's a piece by Shane Goldmacher in the Los Angeles Times examining the situation some state workers find themselves in:
http://www.latimes.com/news/local/la-me ... ?track=rss

Stay tuned.

Julius Young
www.boxerlaw.com

Insurance Commissioner Steve Poizner has announced that tomorrow he'll be filing a lawsuit to block the sale of State Compensation Insurance Fund assets.

Here's Poizner's press release:
http://www.insurance.ca.gov/0400-news/0 ... 129-09.cfm

Politically, this is an interesting play. It puts gubernatorial hopeful Poizner at odds with Schwarzenegger, whose administration cooked up the questionable SCIF sale idea.

Poizner gets to play the grownup to Schwarzenegger and a hapless legislature who went along with the SCIF sale idea in a desperate attempt to appear responsible in addressing the budget crisis. The high profile nature of the issue is good news for Poizner, who is lagging in early polls behind GOP hopeful Meg Whitman.

Here are links to some earlier posts I've done on the SCIF sale issue:
"Sacramento Bee: SCIF Asset Sale Likely to Fail""
http://workerscompzone.com/index.php?en ... 821-080037
"Sold Out"
http://workerscompzone.com/index.php?en ... 623-211148

One great thing about the lawsuit is that we'll probably start to learn more soon about the behind the scenes maneuvering for a SCIF asset sale.

I've been to several recent events recently that were attended by legislators who voted for the budget ( which included $1 billion budgeted for a SCIF asset sale). When I asked the legislators for some details on the plan and due diligence type information, their eyes glazed over.

I won't name any names, but it was apparent that legislators who voted for the budget with SCIF sale included weren't very well informed on the issue. Further, it was clear that they didn't have much confidence in this provision surviving.

Thanks to Commissioner Poizner for taking on this issue.

Stay tuned. I'll be blogging soon about a RAND presentation on return to work statistics that was presented at today's CHSWC meeting in Oakland. And I'll be reflecting about the 2nd DCA case which further confirms that voc rehab is gone.

Julius Young
www.boxerlaw.com

Suppose your doctor decided to bill for procedures you never had?
Therapy you were never given?

Suppose your doctor used billing codes for items that were never provided to you? How would you know? Would you know if in billing the doctor upgraded different procedure codes to generate higher bills?

Most injured workers either don't receive or don't pay attention to the medical reports generated by their treating physicians and therapists.
And they surely don't see (or audit) bills sent by their medical providers.

This has been a major concern for fraud investigators. An employer task force (whose members include some of California's large employers) believes that provider billing fraud is rampant. There have been occasional busts of medical providers, but the task force believes that many fraudsters slip through,

This was the impulse behind a bill that would have mandated that insurers send injured workers notices outlining what medical charges had been billed. The hope was that this would discourage provider fraud, making it more likely that a worker might notice that the doctor was up to something fishy.

The bill, SB 156 (sponsored by Inglewood Democrat Rod Wright), eventually was amended to remove the notice requirement. Insurers felt that the notice requirement would be expensive and would confuse injured workers.

Is this another instance of a California workers' comp insurance industry that is lackadaisical about cost control? After all, the industry is taking fire from Insurance Commissioner Poizner about its performance in controlling medical and loss adjustment expense costs.

Why not send out an advisory to workers so they will know what has been billed? A standard format could be worked out, just as a standard template could be devised to give an accounting of TD and PD benefits paid, instead of the confusing benefit printouts that vary from carrier to carrier.

Sending notices of billings wouldn't end provider fraud, but it would make it more risky. The provider might think twice, knowing that the worker might notice.

And there'd be another benefit as well. Sending the worker a copy of the bills might serve an educational purpose. Whether it's for non-industrial treatment or for treatment under the comp system, far too few of us have any concept about what our treatment costs. The attitude becomes "someone else is paying, so I don't care what is billed or what it costs".

Some would say this tends to skew the cost/benefit analysis for treatment, as the individual and the doctor become oblivious to the balance between reasonable treatments and unreasonable treatment costs. That may or may not be fair, but allowing the worker to be aware of what's been billed (and what's been paid) would be an interesting exercise.

It's worth noting that increasing medical costs in California workers' comp threaten to suck all the oxygen out of the system.

A bill notice procedure would also tend to educate some workers who are considering settling their future medical rights.

But the concept of making this mandatory will not be successful.

Still, some employers (such as the Walt Disney Co.) intend to adopt such a policy on a voluntary basis.

Here's a link to a recent piece on the issue by Los Angeles Times writer Marc Lifsher:
http://www.latimes.com/business/la-fi-m ... 7860.story

Stay tuned.

Julius Young
www.boxerlaw.com

Thank God someone's standing up for California.

Those Winnemuccans and the folks from The Strip have been attacking us:
http://workerscompzone.com/index.php?en ... 809-231029

But we don't have to take it.

Assemblyman Jose Solorio (a Santa Ana Democrat) is fighting back for us. Check this out on youtube:
http://www.youtube.com/watch?v=Cxe4ZVc7BeI

Solorio is determined to fight the myth that businesses should pack their bags and leave California. Here's the website "California is Golden":
http://www.californiaisgolden.com/

Stay tuned.

Julius Young
www.boxerlaw.com