In a couple of days your doorbell will be ringing. Halloween will be here.

The Mummy will be at your doorstep along with R2D2, Jack the Ripper, Spock, Frankenstein and Zombies from Night of the Living Dead.

California has a new kind of trick or treater this year, though. The Mungers.
Molly and Charles, wealthy siblings.

Charles Jr. contributed $22 million this week to the Small Business Action Committee, a group that opposes Prop 30, Jerry Brown’s tax initiative, and supports Prop 32, which would kneecap labor’s political influence in Sacramento. Munger’s total contributions to that group are $36.5 million.

Sister Molly Munger has dumped $47.4 million into Prop 38, a competing tax increase measure that would dedicate revenues to California schools.
Prop 38 is headed for certain defeat but its big ad budget has created stiff headwinds for Prop 30.

California’s political consultants, ad agencies and TV outlets are feasting on this orgy of spending, of course.

But it spells trouble for Prop 30, Governor Brown’s tax plan. After taking a hit from both Mungers, Prop 30 is quite likely under water for good.

All year, Brown’s strategy has been to reach out to business in an effort to neutralize opposition to his revenue initiative. The SB 863 workers’ comp reform was part of this.

But what lies ahead for California workers’ comp if Prop 30 fails?

We’d likely see the DIR/DWC receiving significant budget cuts. We’ve been down this road before. Although the system is user funded, Schwarzenegger’s administration refused to exempt the WCAB from personnel furloughs. There’s little reason to think that the Brown administration would do things differently.

In theory, SB 863 may over time reduce the workload of the WCAB. Why?
Medical disputes would largely be handled by Independent Medical Review, not by expedited hearings over medical issues with WCAB judges. New rules concerning liens will likely reduce the amount of liens in the future. Independent Bill Review will siphon off billing disputes that would otherwise wind up in hearings over liens. Vocational experts will render reports rather than live testimony.

Eventually, there will be less issues coming to judges.

But most of that is down the pike, so any cuts imposed if Prop 30 fails will have an impact on current cases.

Brown has said that without more revenue, California faces a “war of all against all”, meaning that interest groups will struggle mightily to protect their state programs at the expense of other worthy state programs.

Spending on other DIR programs would likely take a hit, as would programs such as the California Department of Rehabilitation and the California Department of Fair Employment and Housing.

So don’t be surprised if next year you see some Munger masks at your door.

Trick or treat.

Stay tuned. In a coming post I’ll muse about the impacts of the presidential election on the California comp system.

Julius Young
www.workerscompzone.com
www.boxerlaw.com

In a couple of days your doorbell will be ringing. Halloween will be here. The Mummy will be at your doorstep along with R2D2, Jack the Ripper, Spock, Frankenstein and Zombies from Night of the Living Dead. California has a new kind of trick or treater this year, though. The Mungers.Molly and Charles, wealthy siblings.

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One aspect of doing the blog is that people send me letters and e mails.

Today I received this unsolicited but noteworthy inquiry from an injured worker (not a client of our firm), which I’ll quote in its entirety:

“I wanted to send you an e-mail about an issue that may or may not be a standard of practice. I had a nurse case manager (without my knowledge at the time) who also acted as my utilization review nurse. I found this out after I subpoenaed my records from (redacted) UR company. In my records were copies of correspondence from my claims adjuster to a nurse case manager from the same company who does my utilization reviews (redacted company name). I called (redacted company name) for telephonic responses to UR determinations, and talked to a nurse. This nurse told me she would send the UR response to another doctor. I wrote down the name of this nurse. When I later subpoenaed my records from the UR company, (redacted company name), I found the nurse I talked to was also my case manager.
How can it be legal that the same nurse who is involved with my UR issues can also be hired as my nurse case manager from my self-insured employer? Isn’t this a conflict or is this legal? The nurse case manager had written discussions with my claims adjuster about meeting my primary treating physician and closing my claim. How can she also be involved with my Utilization Review decisions?”

I can’t vouch for the accuracy of the allegations, but I have no reason to doubt them either.

So if true it appears that the firm, a leading provider of both UR services and nurse case manager services which goes my a moniker that plays upon generational changes, was engaging in dual purpose
nursing.

Like the privacy practices of interpreter companies recently detailed in my post “The Tattlers”, dual purpose nursing may not be illegal.

But dual purpose nursing seems so obviously unethical that regulators and legislators may have assumed that it was not a problem.

A nurse case manager should not be allowed to have a role in utilization reviews for the case of the worker they have managed or monitored, period.

And nurses who have been involved in utilization reviews of a worker’s treatment should not be allowed to serve as the worker’s nurse case manager unless the worker is advised of the fact and consents.

There should be a firewall between nurse case management and utilization review.

Labor Code 4610(e) requires that “No person other than a licensed physician who is competent to evaluate the specific clinical issues involved in the medical treatment services, and where these services are within the scope of the physician’s practice, requested by the physician may modify, delay, or deny requests for authorization of medical treatment for reasons of medical necessity to cure and relieve.” (see also CCR 9792.9)

Many utilization review companies are using nurses as part of the UR process. I often see UR denials that are signed by both a nurse reviewer and an M.D. Occasionally there will be a UR signed only by the nurse, which seems a clear violation of the Labor Code and the California Code of Regs.

And so it may be that some of these nurses involved in the UR process are functioning in dual roles.

Workers and attorneys will want to pay more attention to the role of the nurse case manager and any dual functions. Some of the companies providing these services may be running amok and need to be subject to scrutiny.

If examples can be confirmed, a regulatory fix is in order.

Stay tuned.

Julius Young
www.workerscompzone.com
www.boxerlaw.com

One aspect of doing the blog is that people send me letters and e mails. Today I received this unsolicited but noteworthy inquiry from an injured worker (not a client of our firm), which I’ll quote in its entirety: “I wanted to send you an e-mail about an issue that may or may not be

Read more…

If you’re a non-English speaking injured worker seeing your doctor, you’d probably assume that the translated communications with your doctor were
not being relayed to others by the interpreter.

In all too many instances you would be wrong.

A source provided me papers that document the practices of 4 translation companies that appear to require interpreters to pass along sensitive information to the insurance adjuster.

Let’s look at the examples.

Example #1 is a company called Optimal Care Transportation and Translation, a Division of MSC. Interpreters who submit invoices for services must include an “Interpretation Summary” in an online field as well as a report on “Work Status”. Translation invoicing instructions specify that the Interpretation Summary is required in order to process the invoice of the interpreter.

Example #2 is a company called 3iCorp. Their “Interpreter Completion Report” has online fields that require information on such topics as “is there anything pending?”, “What occurred at this appointment?, “Were any medications prescribed or refills?” , “Claimant work status” and “Work status specifics. Please specify if return to work dates were mentioned, what type of restrictions etc.” Further, the interpreter was required to report back “Are there any other appointments that are pending for this claimant? Was additional treatment recommended?”.

Example #3 is a company called STOPS. Their interpreter invoice has a “Mandatory description summary” that requires the interpreter to describe the following:
-Injured worker’s status
-Restrictions placed on his activities
-List medication changes since the last visit
-List any treatment recommendations
-Were there any significant happenings at this appointment that the adjuster/case manager should know?

Example #4 is a company known as ProCare Transportation and Language Services. Their interpreter invoice requires the interpreter to provide information on the following:
-patient’s complaint
-diagnosis/doctor’s comments
-medications
-work status
-next office visit

Clearly the these companies are abusing the privacy righst of injured workers .Claimants are not advised that their medical discussions with their physicians are being transmitted back to the adjuster. Nor would it appear that physicians are advised of the fact.

Where nurse case managers attend appointments there is no expectation of confidentiality. But there is an expectation of confidentiality when an interpreter is involved.

Another side to the practices is the question of the format in which this data is transmitted to the adjuster. I suspect that much information is being transmitted which is not ultimately produced in response to applicant demands for production of documents in the litigation process.

Perhaps SB 863 will clean up these sordid practices. Labor Code 5811 has been amended to include the following language:
“The duty of an interpreter is to accurately and impartially translate oral communications and transliterate written materials, and not to act as an agent or advocate. An interpreter shall not disclose to any person who is not an immediate participant in the communications the content of the conversations or documents that the interpreter has interpreted or transliterated unless the disclosure is compelled by court order. Any attempt by any party or attorney to obtain disclosure is a bad faith tactic that is subject to Section 5813.”

Presumably Section 5813 applies as of 1/1/13.

But here’s a question for management at Optimal Care,3iCorp, STOPS and ProCare? Will you agree publicly announce your are immediately dropping your “interpreter spy” policies immediately?

I invite your response to the blog.

Julius Young
www.workerscompzone.com
www.boxerlaw.com