Workers Compensation Review

1
Workers CompensationReview Update

• Presented to BAESG
• April 16, 2003
• Beth Thomas, MS, RN, NP, COHN-S
• Analog Devices Health Services

2
WC Reform Act 1993-1994
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• Effects of Reform
• Encouraged Self-insurance
• Managed Care option for employers
• Competitive Workers Compensation Insurance Rates
• Loss Control Services available
• Reduced Medical-Legal Expenses
• Greater impact and responsibilities for treating
  physician
• Decreased incentive to litigate

3
WC Reform Act 2002
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• AB 749 by Assemblyman Thomas Calderon
  (D-Montebello) was signed into law February 2002
• Governor Davis said Workers injured on the job
  deserve fair compensation. Employers who
  create jobs deserve to be free of unreasonable
  burdens. For too long, this has been an
  either/or proposition. I believed that we could
  reach agreement on workers comp that is both good
  for workers and for employers. Thats exactly
  what weve done.
• 2.4 billion benefits increases
• Promotes early and sustained RTW
• Enacts 1.5 billion in cost-savings reform

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4
WC Reform Act 2002
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• Benefit Changes effective Jan 1, 2003
• TTD PD increases over 3 years
• Indexing to CAWW after that
• Injuries over 2 years old entitled to new TTD
  rate
• 70-100 PD TTD rate
• Death Benefits increasing with money to estate if
  no dependents
• Support payments for minor children until age 18
• Lifetime support for disabled children
  disability determined in ANY court

5
Temporary Disability Increases
6
Partial Permanent Disability Increases
7
WC Reform Act 2002
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• Posting Requirements and Notifications
• Required info at hire or by 1st paycheck
• Emergency Treatment plans
• Types of Injuries/Events covered
• Pre-selection and changing of Physician
• Role and function of treating Physician
• Who to report to
• Protection from discrimination
• New official responsible for court admin
• Rebates for employer providing accommodation
  supposed boon to employers

8
CA Workers CompensationEstimated Loss Per
Indemnity Claim
Data from Workers Compensation Insurance Rating
Bureau of California
9
California Workers CompensationWritten Premium
Data from Workers Compensation Insurance Rating
Bureau of California
10
Fair Employment and Housing Act

• Recently Amended FEHA
• Impairment only sufficient
• Defined as making difficult
• Work is assumed to be major life activity
• WC cases may easily fall under this protection
• Return to Work (RTW) programs critical
• Greater potential legal exposure than WC

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11
Employers First Report (5020) Modification
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• DLSR proposed changes to bring 5020 in line with
  OSHA 301 form
• Reduces paperwork burden
• Form 5020 Revision 7
• Instructions and formatting provisions to protect
  confidentiality (Sec. 14300.29, App. F)
• Added two required questions (App. F)
• Was the employee treated in an emergency room?
• Was the employee hospitalized overnight as an
  inpatient?
• Revisions OSHA 301 equivalent

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12
Fate of Bills from 2001-2002 Legislative Session

• AB 1829 Vocational Rehab Settlement
• From Committee without action
• AB 2752 Injured Worker Discrimination
• Vetoed by governor
• SB 1705 Disability Eval Acupuncturist
• From Assembly without action
• SB 1609 Health Care Workers BBP
• Bill died at end of session
• SB 1395 WC Peace Officers
• Bill died at end of session
• AB 2796 Blood Lead Reporting
• From Committee without action

13
SBX 1 Suspension of Statutes

• Provides for various statutes taking effect
  1/1/03 be delayed until such date as the governor
  declares the economy fully recovered
• Status Read first time, to Committee on Labor
  Industrial Relations

14
AB 431 AOE/COE Changes

• Would provide that WC laws be liberally construed
  ONLY after it is determined that an injury in the
  course of employment has occurred and that injury
  is both a specific injury and results in
  serious physical or bodily harm
• Companion bill to SB 365
• Status Referred to Committee on Insurance
  hearing schedule April 30th

15
SB 365 AOE/COE Changes

• Revises WC liability to specify that the injury
  be predominantly caused by work compared to all
  other causes combined
• Status Set for hearing before Labor
  Industrial Relations Committee April 23rd

16
SB 414 Injury Definition

• Revises the definition of work-related injury by
  specifying that the injury or disease arising out
  of employment must be one that is certified by a
  physician using medical evidence based on
  objective medical findings
• Status Set for Labor Industrial Relations
  Committee hearing April 23rd

17
AB 643 OSH Standards Board

• Modifies existing Occupatioanl Health and Safety
  Standards Board composition such that the two
  labor representatives must be from organized
  labor
• Status Passed first policy committee

18
AB 606 HSWC Commission Composition

• Requires one employer member on the Commission on
  Health and Safety and Workers Compensation be a
  representative of small business
• Status Referred to Committee on Insurance, no
  hearing date

19
SB 867 Disability Eval Acupuncturist

• Authorizes the Industrial Medical Council to
  appoint an acupuncturist as a QME
• Requires acupuncturists to meet specific
  requirements to qualify
• Status Referred to Committee on Labor
  Industrial Relations

20
AB 1483 WC Physicians

• Requires every physician who treats and evaluates
  injured workers after 1/1/2006 to be certified by
  the IMC as a Qualified Workers Compensation
  Physician (QWCP)
• Status Referred to the Committee on Insurance,
  hearing scheduled April 30th

21
AB 1196 NP Prescribing Authority

• Extends currently Schedule III through V
  controlled substances prescription authority for
  Nurse Practitioners to include Schedule II
  controlled substances
• Status From committee chair , with authors
  amendments Amend and re-referred to Committee on
  Business Professions, Read second time and
  amended

22
AB 597 Outpatient Surgery Fee Schedule

• Requires administrative director to adopt an
  outpatient surgery facility fee schedule on or
  before July 1, 2004
• Status Re-referred to Committee on Insurance,
  hearing scheduled April 30th

23
AB 778 WC Claims Processing

• Declares intent of the Legislature to enact
  legislation that would affect Workers
  Compensation and the processing time of claims
• Status Was to be heard in Committee March 22nd
  but no update available

24
AB 1262 WC Insurance Study

• Requires the Insurance Commissioner to conduct a
  study on the competitiveness of the WC Insurance
  system and to submit a report to the Legislature
  and Governor
• Status Referred to Committee on Insurance,
  hearing scheduled April 30th

25
AB 1215 WC Fraud Detection

• Authorizes an insurer that provides WC insurance
  to have access to quarterly wage and withholding
  reports with the EDD for the purpose of detecting
  fraud on the part of employers
• Status Referred to Committee on Insurance,
  hearing scheduled April 30th

26
AB 1434 WC Agreements

• Extends option of the establishment through
  collective bargaining of dispute resolution
  process in lieu of WCAB jurisdiction and for
  alternative WC programs beyond current industry
  limitations (construction, construction
  maintenance, and related activities)
• Status Referred to Committee on Insurance,
  hearing scheduled April 30th

27
AB 1480 Physician Reports, Billing, Permanent
Disability

• Requires physicians to issue reports when injured
  employees condition, treatment plan or status
  changes, at claims admins request for additional
  information, and within 21 days of any previous
  reports
• Reduces timeframe for payment of physician bills
  from 60 to 45 days with 10 penalty if late (when
  properly done)
• Prohibits exceeding the maximum reasonable fees
• PD paid at TD rate when able to determine or
  estimate owed amount
• Increases penalties for unreasonably delayed or
  denied compensation to 25 or 500, whichever is
  greater
• Status Referred to Committee on Insurance,
  hearing scheduled April 30th

28
AB 1481 Apportionment,Determining PD

• Provides that in denying apportionment, the
  appeals board may not, in determining permanent
  disability, rely on any medial report that fails
  to fully address the issue of apportionment and
  fails to set forth the basis for the medical
  opinion, on any report that fails to apportion a
  previous injury that has been the subject of
  prior claim for damages or any report that fails
  to discuss medical processes by which previously
  asserted injury resolved without affecting bodily
  function
• If prior award or PD exists, presumed PD still
  exists and limits cumulative award beyond 100
• Prohibits PD if injury causes less than 10
  causation
• Burden of proof for apportionment on defendant
• Requires physicians to use established guidelines
  for the determining of PD
• Status Referred to Committee on Insurance,
  hearing scheduled for April 30th

29
SB 714 Apportionment

• Provides that in denying apportionment, the
  appeals board may not, in determining permanent
  disability, rely on any medial report that fails
  to fully address the issue of apportionment and
  fails to set forth the basis for the medical
  opinion, on any report that fails to apportion a
  previous injury that has been the subject of
  prior claim for damages or any report that fails
  to discuss medical processes by which previously
  asserted injury resolved without affecting bodily
  function
• Status Set for Labor Industrial Relations
  Committee hearing April 23rd

30
SB 893 Permanent Disability

• Provides that when applying the schedule for the
  determination of the percentage of PD, no injury
  rating shall be based on a medical report that is
  not in accordance with certain meciacl
  publications relating to injuries and impairments
• Status Set for Labor Industrial Relations
  Committee hearing April 23rd

31
AB 1482 Medical Services Fee Schedule

• Requires the Administrative Director of the DWC
  to adopt and revise, at least biennially, an
  official medical fee schedule that establishes
  reasonable maximum fees
• All services provided to a worker to be subject
  to the fee schedule
• Status Referred to the Committee on Insurance,
  no hearing date

32
SB 228 Official Fee Schedule

• Earmarks moneys from employer assessments for
  fraud reporting and requires development of
  procedure to receive and review medical billing
  fraud
• Prohibits charges exceeding 125 of fee schedule
  for Medicare/ Medi-Cal
• Eliminates current requirement for pharmacy and
  outpatient fee schedule to be set
• Status From Committee, do pass, re-referred to
  Committee on Apportionment

33
AB 1581 Merit Credits

• Requires than experience rating plans include
  merit credits that decrease a policyholders
  rates based upon its record of job safety
• Status Referred to the Committee on Insurance,
  no hearing date

34
SB 457 Benefit Delays

• Provides for increase from 10 to 25 (with 500
  limit) the penalty for unreasonably delayed or
  refused benefits
• Status Set for Labor Industrial Relations
  Committee hearing April 23rd

35
AB 595 Durable Medical Equipment

• Gives the administrative director sole authority
  to develop a fee schedule for durable medical
  equipment
• Schedule to meet specified criteria
• Status From committee chair , with authors
  amendments Amend and re-referred to Committee on
  Insurance, Hearing scheduled April 30th

36
AB 596 Pharmaceuticals

• Provides for the pharmaceutical fee schedule to
  apply to all medicines and supplies dispensed or
  prescribed regardless of source
• Status From committee chair , with authors
  amendments Amend and re-referred to Committee on
  Insurance, Hearing scheduled April 30th

37
SB 223 Generic Drugs

• Extends current requirement for pharmacies to
  provide generic drug equivalents, if available,
  unless the prescribing physician provides
  otherwise in writing, to hospitals, clinics and
  physicians
• Status Set for Labor Industrial Relations
  Committee hearing April 23rd

38
AB 371 Blood Tests

• Allows certified phlebotomy technician to draw
  blood at the direction of a peace office
• Language of bill would allow the same to occur at
  direction of employer this is in conflict with
  provisions of the lead standard
• Status Hearing postponed amendments in process

39
SB 629 Bloodborne Disease Health Care
Professionals

• Adds county licensed health care professionals to
  existing presumption of work-relatedness of
  blood-borne infectious diseases when documented
  exposure incident exists
• Status Set for Labor Industrial Relations
  Committee hearing April 23rd

40
AB 1324 Infectious Diseases - Dependents

• Provides for compensation to dependents of
  firefighting, law enforcement, patrol members
  that contract bloodborne infectious diseases if
  the dependent subsequently develops the
  infectious disease
• Status Amended, Re-referred to Committee on
  Insurance, Hearing scheduled April 30th

41
AB 968 WC for Bioterrorism

• Provides that any adverse reaction, injury,
  disability, or death resulting from vaccination
  or medication administered to prevent
  transmission, infection, or exposure to a
  biochemical substance or bloodborne infectious
  disease shall be deemed to be AOE/COE for
  purposes of WC benefits
• Status In committee, hearing cancelled at
  request of author

42
AB 87 Disaster Service Workers

• Establishes the Workers Compensation for
  Disaster Service Workers Fund
• Moneys to be continuously appropriated in the
  annual Budget
• State Comp Insurance Funds tasked with claims
  handling and provision of benefits
• Status From Committee, Amended, do pass,
  re-referred to Appropriations Committee

43
AB 136 Public Employee LOA

• Lengthens the period that peace officers,
  firefighters, and fire prevention service public
  employees are entitled to leave of absence
  without loss of salary for work-related
  disability from one year to two years
• Status From Committee, do pass, re-referred
  to Appropriations

44
AB 149 Firefighter Asbestosis Claims

• Applies existing one year claim initiation
  statute from date of death due to asbestosis to
  firefighters
• Status To Assembly for third reading

45
Is the System Ripe for Reform?

• Sources seem to think that new Insurance
  Commissioner, John Garamendi, will push for
  substantial WC reform
• Quoted The states workers comp system is in
  crisis and only a complete restructuring of
  this complicated, litigious, fraud infested,
  grossly inefficient and ineffective system can
  achieve this goal

46
Bill Watching

• Currently, there are 48 bills directly or
  indirectly related to Workers Compensation under
  consideration
• How can you remain informed?
• www.leginfo.ca.gov
• Voice your opinions regarding critical bills to
  your representatives
• www.assembly.ca.gov
• www.senate.ca.gov