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The DWC has recently posted its “2013 Study of Access to Medical Treatment for Injured Workers”, written by the Berkeley Research Group.

Labor Code 5307.2 requires the DWC to do annual access studies. Specifically, Labor Code 5307.2 includes the following language:
“The study shall analyze whether there is adequate access to
quality health care and products, including prescription drugs and
pharmacy services, for injured workers and make recommendations to
ensure continued access. If the administrative director determines,
based on this study, that there is insufficient access to quality
health care or products for injured workers, including access to
prescription drugs and pharmacy services, the administrative director
may make appropriate adjustments to medical, prescription drugs and
pharmacy services, and facilities’ fees.”

California DWC studies done in 2006 and 2008 are available online (see links at he end of this post). The studies for 2009, 2010, and 2011 are not posted on the DWC site if in fact there were studies done for those years in compliance with Labor Code 5307.2.

The 2013 Berkeley Research group report analyzes 2 data sets: questionnaire responses from 500 randomly selected workers and data from medical claims submitted to the WCIS (Workers’ Compensation Information System).

The 2013 medical treatment access study paints a generally rosy picture.
84% of a worker sample were said to be satisfied with their health care provider. Only 7% of the sample claimed they were denied care. Workers generally saw a doctor within a reasonable time frame after their injury and the doctor was usually within a reasonable commute distance.

In summarizing their findings the Berkeley Research Group noted that although the 2006 and 2008 studies had some different survey methods, the “findings for each survey were similar: a substantial portion of injured workers (approximately 85%) were satisfied or very satisfied with their care.”

The 2006 access report, prepared by the UCLA Center for Health Policy Research included 1,001 survey responses out of a random sample of 5,260 claims, twice the size of the 2012 sample.

The 2008 access report, done by the University of Washington School of Public Health appears to have been based largely on phone interviews with injured workers.

Putting aside methodology differences between these studies and questions about whether the size of the worker sample is adequate for measuring the issues in question, the 3 access studies do seem to agree that access to care is adequate.

But in a parallel universe, many medical providers, attorneys and judges hear a different story.

What’s that story? A physician commenting on a recent Workcompcentral.com article said “I wonder what planet these people are on? Access to care is worse than ever,to get UR to approve anything is a joke, FMC is laughable. I think they interviewed a group of first aid only patients.”

How to reconcile these parallel universes?

The truth of the matter is that the DWC commissioned studies and the commenter may both be right.

Most workers probably ARE happy with their doctors and their care.

But it’s quite possible that the workers who are NOT satisfied are workers with more severe injuries or workers whose treatment extends over a long time frame. It’s also possible that the dissatisfaction is not with the doctor per se, but rather with the process of getting treatments approved and denied.

Those are the cases that attorneys and judges see. Yet in the 2013 Berkeley Research Group study, only 11% of the sample group of 500 workers were represented by attorneys. That would be only 55 represented workers sampled.

I think a more interesting study would be to study a larger sample of workers represented by attorneys as well as a large sample of pro per applicants at the WCAB. I’m not sure what such a study would show, but it might well verify that there are indeed parallel universes in workers’ comp.

The Berkeley Research Group report is located here:
http://www.dir.ca.gov/dwc/AccessMedTrea … WC2013.pdf

Here is a link to the 2008 access study:
http://www.dir.ca.gov/dwc/MedicalTreatm … report.pdf

The 2006 access study can be found here:
http://www.dir.ca.gov/dwc/AccessMedTrea … C2006.html
Stay tuned.

Julius Young

Category: Medical treatment under WC

Julius Young

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