NBC Bay Area has been highly critical of the California workers’ compensation medical delivery system in a string of articles dating back to mid 2016.
Its thesis has been that “Many injured workers and their doctors say the California workers’ compensation system is dragging out their medical care, making it difficult to recover and get back on the job.”
The Investigative Report essentially was based upon anecdotal accounts of perhaps a dozen cases that it says leads to its conclusion that “Injured workers across California say the workers’ compensation system is dragging out or denying the medical care needed to get them back to work. Those workers say they feel trapped in the sprawling labyrinth of a system, battling insurance companies and navigating through red tape instead of getting well.”
But now the director tasked with administering California’s workers’ compensation system respondes to the criticism.
Christine Baker, the director of the Department of Industrial Relations, defended the system, saying reforms made four years ago improved access to medical treatment and helped contain costs. She also credits a new law enacted in January for further strengthening the system.
The major changes launched in 2013 under SB 863 emphasized evidence-based medicine and shifted treatment decisions from the courts to medical reviewers using state-approved guidelines to authorize or deny treatment requests. According to Baker, the changes are paying off.
“Benefits are going to workers, treatment has been sped up and appropriate treatment is being approved,” she said. “It is overall an improvement to the workers’ comp system, which is very complex.”
According to recent estimates, the reforms also cut costs to the nation’s most expensive workers’ comp system by more than a billion dollars per year.
NBC Bay Area responded to her assertion with more anecdotal accounts saying “many doctors and attorneys who represent injured workers told NBC Bay Area the savings have come at a price. They say denials have reached all-time highs. They believe the guidelines touted by state administrators are too rigid and don’t always keep up with modern treatment techniques”.
Baker rejects those claims.
“Ninety-five percent of medical care decisions are approved,” Baker said. “There are a few that don’t get approved and it could be that it’s inappropriate care or the doctor didn’t document the requirements for care.”
NBC refutes Baker’s claim. “But the data cited by Baker is impossible to verify. Until this year as a result of new reforms, the state has not collected data on the number of medical treatment requests that are approved or denied by insurers.”
“Instead, state administrators point to studies published by the California Workers’ Compensation Institute. The research group relies on data voluntarily provided by its members – insurance companies – which is not made available for public inspection.”
Baker said she’d have to look at these individual cases to understand why they faced denials, but reiterated the majority of the 250,000 workers who go through the system each year get satisfactory results.
“Most people are not stuck,” Baker said. “Most get back to work. Most people are getting their treatment.”
Baker said the state is also coordinating an outreach effort to help doctors understand how to properly document a request for a specific course of treatment, which she expects to further reduce denials.
“It’s an education piece and the Division of Workers’ Compensation is working hard at getting information and educational information about treatment guidelines on our website and how to use them,” Baker said. “We’re hoping the holistic approach will overall really make improvements to workers’ comp in California.”