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Santa Monica-based public radio station KCRW has now broadcast a segment focusing on the California workers’ comp system.

The piece, done as part of KCRW’s KCRW Investigates, was produced by Karen Foshay and is titled ” A Denial of Care”.

Readers can use the following link to access the audio and/or text summary of the piece, which focuses on troubles a Southern California groundskeeper is having getting treatment:

http://curious.kcrw.com/2017/03/a-denial-of-care

Ms. Foshay interviews a worker, Clancy McCafferty, with  post surgical chronic back pain.

McCafferty  experiences the system as really complex and really frustrating. Visiting him at his home, Foshay notes piles and piles of medical records and a large stack of denial paperwork.

Although the segment is only about seven minutes, it manages to distill and highlight many of the current systemic problems.

The segment notes upfront that concerns about unnecessary treatment and problems with provider fraud had led legislators to tighten up the system in 2012.

Christine Baker, California Director of Industrial Relations,was interviewed for the show. Ms. Baker claimed that the reforms generated $1.3 Billion in savings and also claims a 30% increase in benefits.

But the focus of the show is on the difficulties some severely injured workers are having accessing treatment.

Interestingly, the piece notes that KCRW called names of Orange County neurologists on an MPN list  but when reached less than half said they were taking workers’ comp patients.

An attorney noted that it was very difficult to find doctors in some specialties to treat a workers’ comp patient.

As noted in this blog before, this is a widespread MPN problem that does not appear to be getting better.

Also, Ms. Foshay notes that there are potential conflicts of interest in the way some claims are administered:

“In Clancy McCafferty’s case, the company responsible for making decisions about his care is a division of the company in charge of his claim, including its costs. That company, York Risk Services, was sued in Arizona in 2013 by a group of firefighters who alleged York was intentionally denying care. The case was confidentially settled before trial. In 2014, a similar case was filed against York by members of the Rialto Police Department, but most of it was dismissed.

A spokesperson for York Risk Services declined to comment on Clancy McCafferty’s case citing privacy laws but in a statement wrote, “in all cases we are committed to handling every claim professionally, ethically and fairly.”

Acting administrative director of the Division of Workers Compensation, George Parisotto, has heard concerns that utilization reviewers may be motivated to deny care in order to keep their contracts with the insurers or administrators who hire them.

“If there was that kind of financial arrangement and we came upon it I’m sure we would penalize it. While we have heard of it, we have no real evidence it actually exists,” said Parisotto.

A new law takes effect next year to address some of these potential conflicts. SB1160 bans insurers or administrators from hiring utilization review companies they have a financial interest in unless that relationship is disclosed to both the employer and the state. However, the state is not allowed to make those disclosures publicly available.”

As Ms. Foshay further notes:

“The law prohibits medical review doctors from being compensated based on how they decide a workers’ comp treatment request. The contracts between all of these parties – the doctors, utilization review companies, the insurers and third party administrators – must be made available to the state, although the public is denied access to the contracts.” 

One would hope that the DWC would take an aggressive stance in looking at potential conflicts if financially links between UR companies and TPAs. After all those  do not have to be disclosed to the worker and applicant attorney.

From a public policy standpoint the carriers and TPAs are shielded by the law as written since only the DWC will have access to  the information about potential conflicts.

Whether Mr. Parisotto and Ms. Baker will prioritize the DWC looking at this issue (once they receive these disclosures) is not clear.

My understanding is that KCRW will be doing more on the California workers’ compensation system.

It’s great to see media focus on the system. There are many stories to tell and issues to be raised.

Stay tuned.

Julius Young

www.boxerlaw.com

 

 

Julius Young

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