Sunday, August 29, 2010, 10:17 PM - Political developmentsWhen California needs all the income tax revenues it can get, you'd think that the Governor would fight to keep every job here in California.
But that may not be the case.
Last year Governor Schwarzenegger vetoed legislation to require that UR reviews be done by California-licensed physicians.
This seems like a no-brainer bill. After all, why should California export good-paying jobs to other states?
What's the benefit to California in having Texas or Florida doctors doing
utilization reviews? Whatta they got that we don't got?
Does the Governor really think that California doctors will be too generous with approvals of treatments requested by their brethren? If that's the argument. where's the evidence for that?
The Governor will get a second chance on this issue. A bill to require in-state reviews is headed to the Governor's desk. It's AB 933, carried by Assemblyman Paul Fong of Cupertino.
If my iPad and iPhone can be designed in Fong's district, right here in Cali, then surely we can give the business to UR reviewers right down the road.
Let's hope the Guv gets a change of heart on this one.
Here's the link to the text of AB 933:
http://www.leginfo.ca.gov/pub/09-10/bil ... en_v96.pdf
Here's the tally of the Assembly vote on the bill:
http://www.leginfo.ca.gov/pub/09-10/bil ... floor.html
And here's the California Senate vote tally:
http://www.leginfo.ca.gov/pub/09-10/bil ... floor.html
Friday, August 27, 2010, 08:54 PM - Understanding the CA WC systemI've just returned from Ingmarland.
Years ago when I was in theological school (getting a master's as a Rockefeller Brothers fellow), I did a thesis on the philosophical underpinnings of Ingmar Bergman's films. For those of you who have never seen The Seventh Seal, Persona, Hour of the Wolf, Shame, Scenes from a Marriage or any of the other Bergman masterpieces, let's just say they are not your basic Adam Sandler fare.
Bergman has now passed away. We live in a world that is less Chekov, Pirandello, Ibsen or Strindberg and more Homer and Marge and Bart.
Ugly Betty would have passed on playing chess with Death.
This was my first journey to Bergman's home, Sweden. And my first time in Denmark.
Listening to wannabes covering Dr. Dre and Snoop Dogg in a central Stockholm festival, I could have sworn I was in L.A.
But the semblance ended there.
Clean and safe streets...polite, stylish, well groomed, well educated people....efficient public transit.....a mixture of beautifully preserved old buildings and recent innovative architectural designs...
Stockholm and Sweden are both visually stunning. And the countryside in both countries is lush and appealing.
Aside from long, cold dark winters there's little to not like.
Heck, they even have the Icebars where George the Bartender could be serving cocktails in an ice glass sculpted out of a glacier.
But what's happening with workers' comp in Scandinavia and the Baltic states? Unfortunately there was not time to visit any hearing boards to see matters firsthand.
But for those of us in the workers' comp field I did find an interesting.
comparative analysis of Scandinavian and Baltic workers' compensation systems.
It's titled "Current Challenges for Nordic Workers Compensation Systems" by Janne Pekka. The presentation was done for an insurer, Munich Re:
http://www.munichre.com/app_pages/event ... _reini.pdf
What's so interesting is Pekka's comparative chart showing what is covered and what is not, whether there are private insurers or not, and how benefits are integrated with other available benefit systems.
Sweden and the Baltic states (Latvia, Lithuania & Estonia) currently do not have private insurers involved in workers' comp.
Pekka lists hot issues in the 3 Scandinavian countries that do have private insurers in the comp market:
-Denmark's change of the definition of "accident"
-the impact of lower premium volume on Finnish insurers and debates
over changes in Finnish comp law
-profitability challenges for Norwegian insurers and issues surrounding
transition to centralized claims handling
In California we sometimes get obsessed with our own system, forgetting that other places have figured out other ways to compensate their workers.
Everyone is trying to get it right, not just us.
Tuesday, August 24, 2010, 03:01 PM - Political developmentsToday's blog post by Joel Fox on "Fox and Hounds" is worth noting.
Fox is publisher of "Fox and Hounds" and is the President of the Small Business Action Committee.
Fox wistfully notes that pro-business forces had enough signatures to pursue a ballot initiative in 2004 and had been advised by some legislators to file "because they believed our initiative reform was stronger than what was coming out of the legislature".
Whether intended as a threat or not, Fox closes his blog post with this:
"With the threat of troubling workers' comp increases facing business again; we will see if that was the right move."
Here's a link to Fox's piece:
http://www.foxandhoundsdaily.com/blog/j ... comp-redux
Tuesday, August 24, 2010, 12:34 AM - Political developmentsIn an astute article, savvy Sacramento Bee columnist Dan Walters notes
the cycle that seems to prevail in California workers' comp.
After reforms, some system stakeholders nurse their wounds. Pressure builds until there's another set of players demanding reform.
It's a cycle I noted in my recent post, "Hurricane Season":
http://www.workerscompzone.com/index.ph ... 815-091042
You can find Dan Walter's piece, "Workers' Compensation War Poised for Blowup" here:
http://www.sacbee.com/2010/08/23/297575 ... %20Walters
Friday, August 20, 2010, 12:14 PM - Understanding the CA WC systemIn a victory for disabled workers, the California Court of Appeals 6th District has upheld the decision in the Guzman case (actually known as Milpitas Unified School District v. WCAB and Joyce Guzman).
While not final/final, its starting to look like the Almaraz/Guzman II decision of the WCAB will survive.
Workerscompzone is on vacation. But when I return to my office I'll be analyzing Guzman in a video point-counterpoint format I'll be launching soon with a leading defense attorney. More about that another time.
The Court of Appeals has yet to decide to hear the Almaraz II case, and in fact may never grant a writ to hear the case.
Unless a conflict develops between different California Court of Appeal districts, it's hard to imagine the California Supreme Court wading into this controversy. After all, the California courts have extended great deference to the WCAB.
So, it would appear that Guzman is here to stay.
This pretty much undercuts some of the self-serving experts who packaged themselves as keepers of the pure AMA Guides flame.
The decision by the 6th District makes it clear that doctors and judges are not bound to administer cookie cutter justice based on shibboleths of a narrow AMA Guides approach.
As the 6th District notes, "we take a broader view of both its text and the statutory mandate". The 6th District noted:
"We cannot expand the statutory mandate by changing the word "incorporate" to "apply exclusively." Nor can we read into the statute a conclusive presumption that the descriptions, measurements and percentages set forth in each chapter are invariably accurate when applied to a particular case. By using the word "incorporation," the Legislature recognized that not every injury can be accurately described by the classifications designated for the particular body part involved. Had the Legislature wished to require every complex situation be forced into preset management criteria, it would have used different terminology to compel strict adherence to those criteria for every condition."
Also worth noting in the opinion:
-the 6th district notes that "The Guides ratings do provide a standardized basis for reporting the degree of impairment, but those are "consensus-derived estimates," and some of the given percentages are supported by only limited research data. (Guides. pp.4,5.)"
-the Court also notes that "The Guides also cannot rate syndromes that are "poorly understood and are manifested only by subjective symptoms."
This leads the 6th District to note the importance of clinical judgement and the concepts of Chapters 1 and 2 of the Guides.
At the end of the day under Guzman, the "how and why" expressed by the physician will be critical. The 6th District notes that the physician's medical opinion must constitute substantial evidence.
Defendants will argue that Guzman applies only to extraordinary and complex cases. The decision notes that "Given the comprehensiveness and precision attendant in the chapters pertaining to each system, in most cases a WCJ will credit ratings based strictly on the chapter devoted to the body part, region, or system affected."
So we can expect defendants to focus on challenging doctors as to the how any why they are using other descriptors under the Guides. For example, the Court noted "if Guzman's carpal tunnel syndrome is adequately addressed by the pertinent sections of Chapter 16, an impairment rating that deviates from those provisions will properly be rejected by the WCJ".
On the other hand, noting in this decision prevents a physician from using other portions of the Guides where the Guides would otherwise not describe the condition qdequately. That's where we'll see doctors using their clinical judgement.
In the coming year or two we'll see the WCAB setting forth parameters in some cases as to how far doctors can go in using other charts, tables or methods. And we'll see in some cases how much how and why analysis the examining physician must provide before successfully departing from the "straight AMA" analysis.
But for the moment, chalk this up as a big win for disabled workers.
Here's a link to a pdf of the Guzman II decision:
http://www.dir.ca.gov/wcab/EnBancdecisi ... ep2009.pdf
And here's a link to the decision of the 6th District:
http://www.courtinfo.ca.gov/opinions/do ... 034853.PDF