The new California Workers’ Comp laws have an immense impact on the workers. It is a disappointment for many. As the total amount spent out per claim has raised significantly across the nation, the California law has dramatically reduced the amount of medical benefits paid for the claims. This is a piece of frustrating news for many workers.
Dr. Peter M. Schaeffer narrates, “When I began doing Workers Comp about 20 years ago it was a fair system for injured workers but was being ruined by a few scammers & unethical doctors & chiropractors who operated mill type clinics overcharging the insurance companies at every step as they know well how to play with the system.
In 2004, when Gov. Arnold S came to power, the system was in desperate need of overhaul as the charges of Workers compensation insurance was causing prices to employers to increase to the highest in the country, urging businesses to relocate their companies elsewhere to decrease insurance costs & found they could recover the expenses of relocation in short time & affordable terms. He approved the first nail in the coffin of Workers Comp SB-899 which was the 1st step in taking medical control away from doctors & lawyers. It started what became known as MPN (Medical provider network) list. Prior to a lawyer or injured worker for that matter could choose the treating doc from the universe of medical providers. Under new rules, they had to be on the particular employer’s workers compensation insurance carrier’s MPN list.
At the beginning of 2005 the list was rather large but as time went by the list of choices became somewhat restricted to those doctors who willing to play ball with the insurance carriers & only provide traditional treatment and reduce expenses to the insurance carrier. There were countermeasures in place that would still protect the injured worker, i.e. the AME/QME process.
If medical treatment was refused, the injured worker or his lawyer could request a neutral doctor to conduct an exam & write a report describing the case for the court. It’s called a medical-legal evaluation or report. The judge at the WCAB ( Workers’ Comp appeals board ) could then order the prescribed treatment, & it was provided.
Now, SB-863 – the IMR process and end of the due process (in my opinion) -the system is broken. Receiving proper medical treatment has become a virtual nightmare and hit & miss what is getting approved and what is not.
The system now is much one-sided for the insurance carriers.
1. They hand pick doctors allowed in their medical provider network weeding out the most liberal applicant-friendly docs.
2. All the treatment demanded by their own doctors has to be approved by the Utilization review, & if not approved you do not get it.
3. Refused treatment requests are appealed to an IMR (independent medical review) which is virtually a secret org like a star chamber with no appeal rights after they deny treatment.
Docs in their utter disappointment in not being able to get proper medical treatment for their patients are making the injured workers permanent & stationary so they may settle their claims & with the settlement money obtain some of the medication that had been denied to them under the system. Thus, the injured workers have left with a broken body and not enough money to fix it on their own.”
Dr. Peter M. Schaeffer added, “I’m perhaps more frustrated than you. I enjoyed for many years what I was doing for injured workers. I felt I’ve changed people’s lives for the better & gave them hope and a new start. In the process many became more than clients- they became friends. I do not feel I’m helping the majority of clients I am representing in a system that is absolutely stonewalling receiving sufficient medical treatment. I’m at the end of my work compensation career if nothing changes to help injured workers get treated fairly.
I was going to continue for a few more years but the frustration of fighting a hopeless battle most of the time with the system has taken its toll on myself, doctors, my co-workers, my hundreds of clients, and I am rather highly regarded as a work comp attorney. The system seems wrong. Fair play & due process weakened in California with the passage of SB 863.
Thanks to Governor Brown, for the insurance companies, had a larger lobby in Sacramento than injured workers and the company that allegedly protects them.”
The law is changing now and then. So, the claimants and their attorneys return to the courts for rulings on how various terms are to be interpreted.
The California law is complex, complicated, particularly for the claimant who is seeking to navigate the process without any legal counsel. The best advice is that you keep experienced attorneys like that from The Law Offices of Dr. Peter M. Schaeffer, involved at each step of the process, to make sure that you are receiving everything the law allows.
