Author: WorkCompAcademy

Many Cal Fire firefighters told CalMatters they are fatigued and overwhelmed, describing an epidemic of post-traumatic stress in their fire stations. Veterans say they are contemplating leaving the service, which would deplete the agency of their decades of experience. Some opened up about their suicidal thoughts, while others – an unknown number since Cal Fire doesn’t track it – already have taken their own lives.

Interviews with Cal Fire firefighters, including many high-ranking battalion chiefs and captains, and mental health experts paint a picture of the state agency’s sluggish response to an urgent and growing crisis:

– – Cal Fire has an unyielding policy of 21-day shifts and forced overtime. Staffing is insufficient as firefighters battle thousands of fires year-round, sometimes for 40 days in a row, year after year. The nonstop work and increasing overtime are contributing to on-the-job injuries and post-traumatic stress disorder.
– – The workers’ comp system is difficult to navigate for firefighters suffering from post-traumatic stress, even suicidal thoughts, beginning with skepticism among managers about the legitimacy of their unseen wounds. Some say to get help or be reimbursed for mental health care, they have to hire lawyers, who told CalMatters that claims are routinely denied.
– – In California’s rural areas, where many Cal Fire employees are based, there are inadequate numbers of qualified mental health care providers. And many won’t accept workers’ compensation cases because of the extensive paperwork and low compensation. As a result, firefighters say they can’t find help when they desperately need it.
– – Work conditions and stress are driving an exodus from the department, which loses invaluable institutional knowledge and field experience. Last year 10% of Cal Fire’s permanent, non-seasonal workforce quit.
– – Firefighters say suicidal thoughts and PTSD are rampant. But Cal Fire collects no incidence data on suicides or PTSD. Experts say the agency can’t develop an effective program to combat them if they don’t understand and monitor their scope.
– – Cal Fire’s behavioral health unit ramped up slowly despite the growing problem. Although created in 1999, it had no permanent budget and no permanent employees for 20 years. It began with one staffer — and six years later there were two. Now it has 27 peer-support employees, who assist a permanent and seasonal workforce of more than 9,000.

An administrative claim notice from Cal Fire’s firefighters’ union had a Dickensian tone, like a logbook from a 19th century sweatshop: Forced overtime, punishing working conditions, little sleep, workplace injuries, an inhuman system of indenture.

“Employees have been known to work 30 days or more without any time off due to forced overtime, and the most egregious cases include employees on duty for 49 days or more straight without a day off. Overworked beyond the point of exhaustion,” says the claim, which union attorneys sent in February to the state’s Division of Occupational Safety and Health (Cal OSHA) and the Labor Workforce Development Agency.

Cal OSHA rejected the request, saying it has no jurisdiction because there are no workplace standards for overtime and it is not illegal for employers to make employees work long hours as long as they are compensated.

Medical help is the endgame. Workers’ compensation benefits, paid by the state, cover the costs, which average $60,000 for first responders’ cases, according to a Rand Corp. estimate. But the barriers to firefighters’ claims are myriad.

The long wait for workers’ comp insurance “is hugely frustrating,” said Gena Mabary, Cal Fire’s injury and accommodation manager. “When you are dealing with psychiatric stress, you are already stressed out. It adds another layer of stress. It means that sometimes people won’t go through the process.”

Cal Fire workers’ comp claims for mental health problems “are more frequent. I am expecting them to increase still more,” Mabary said. No data, however, was available.

In 2020 SB 542 changed Labor Code section 3212.25, and recognized that all first responders engage in stressful and dangerous occupations, and made PTSD “presumptive” for workers’ comp benefits – codifying that a mental injury is a legitimate medical claim, although it must still be proven. That law sunsets at the end of 2024.

Before the law was enacted two years ago, California firefighters’ PTSD cases were denied workers’ comp benefits 24% of the time – almost three times more often than their claims for other medical conditions, according to a RAND Corp. report. They were also denied more often than PTSD cases filed by people in other occupations.

The mileage rate that workers’ comp claims administrators pay injured workers for travel related to medical treatment or evaluation of their injuries will increase from 58.5¢ per mile to 62.5¢ per mile for travel on or after July 1, 2022, regardless of the date of injury. The old rate of 58.5¢ per mile still applies for travel from January 1 through June 30, 2022.

California Labor Code §4600(e)(2), in conjunction with Government Code §19820 and DPA regulations, requires claims administrators to reimburse injured workers for medical mileage at the rate adopted by the Department of Personnel Administration (DPA) for non-represented (excluded) state employees, which is tied to the IRS published mileage rate.

The IRS normally adjusts the standard mileage rate each fall for the next calendar year based on an annual study of the fixed and variable costs of operating an automobile, but IRS Commissioner Chuck Rettig just announced that in recognition of recent gasoline price increases, the IRS made this special adjustment for the final months of 2022.

Therefore, for miles driven from July 1 through December 31, 2022, the standard mileage rate will increase to 62.5¢ per business mile driven. The IRS announcement is available in the agency’s online newsroom https://www.irs.gov/newsroom.

CWCI has alerted the DWC of the increase, so as soon as the Division receives confirmation from the DPA it will likely post a Newsline regarding the new mileage rate for travel on or after July 1, 2022 on its website, http://www.dir.ca.gov/dwc/dwc_newsline.html. In the meantime, claims organizations may want to alert their claims staff and programmers of the pending change.

Mid-year mileage rate increases are rare (the last one was in 2011), but there have been multiple mileage rate changes with January effective dates over the past decade, so the DWC has downloadable mileage-expense forms that show the applicable rates based on the travel date posted under “Medical Forms” on the Forms page of its website www.dir.ca.gov/dwc/forms.html.

New data from the California Workers’ Compensation Institute (CWCI) shows the types of drugs used to treat injured workers in California, and the distribution of payments for those medications, has shifted dramatically over the past decade, with opioids becoming far less prevalent and anti-inflammatory drugs (NSAIDs) accounting for an increasing share of the prescriptions and the total drug spend within the workers’ comp system.

The results show that NSAIDs, often used as non-narcotic alternatives to treat pain, surpassed opioids to become the top workers’ comp drug group in 2016, and in 2021 they increased to a record 34.0% of the prescriptions dispensed to injured workers in California.

The distribution of prescriptions by drug ingredient revealed that most of the growth in NSAIDs over the past decade has been due to the increased use of inexpensive ibuprofen, which increased from 27.0% of all anti-inflammatories in 2012 to 41.2% of the NSAIDs dispensed in 2021.

As a result, ibuprofen is now the most heavily used drug in workers’ compensation, accounting for 14.1% of all prescriptions dispensed last year, ranking well ahead of another NSAID, naproxen, which ranked second, accounting for 8.3% of the prescriptions dispensed to injured workers.

Meanwhile opioids’ share of the workers’ comp prescriptions continued to decline, falling to 10.2% last year, though most of the decline in opioid use within the past decade occurred between 2012 and 2019, as opioid’s share of the prescriptions has been relatively stable over the past 3 years, only edging down slightly from 11.7% to 10.2%.

As in 2020, anticonvulsants, dermatologicals, and antidepressants rounded out the top five most prescribed drug groups in 2021. Like NSAIDs, anticonvulsants and dermatologicals are often used to treat pain, and their share of the workers’ comp prescriptions has risen over the past decade, while antidepressants’ share, which ranged between 5.2% and 6.6% from 2012 through 2019, climbed to a record 8.0% in 2021 – the second year of the pandemic.

On the other hand, musculoskeletal drugs have fallen from 10.6% of all workers’ comp prescriptions in 2016 to 6.0% of the prescriptions last year, a drop that followed the state’s implementation of a workers’ comp formulary in 2017. The formulary made most prescriptions for musculoskeletal drugs subject to utilization review, with limited exceptions where they are allowed as special fill or perioperative drugs.

Ranking the top therapeutic drug groups based on total payments the CWCI analysts found that the top 10 groups combined for 77.9% of the total drug spend in 2021, down from 80.2% in 2012, when opioids consumed 26.2% of the prescription dollars (vs. 5.8% last year) and ulcer drugs accounted for 10.3% (vs. 6.3% in 2021).

With opioid payments down, NSAID’s share of the prescription dollars jumped from 13.4% in 2012 to 25.0% in 2021, dermatological drugs jumped from 12.9% to 17.2%, and anticonvulsants’ share rose from 4.9% to 8.6%.

The 2021 data also show that several other drug groups (psychotherapeutic and neurological drugs, anticoagulants, and antidiabetic drugs) that a decade ago each represented only 0.3% of the prescription dollars are now among the 10 most expensive drug groups, each accounting for between 2.6% and 2.9% of the total payments. Thus, combined payments for these drugs, which a decade ago represented only 0.9% of the prescription drug costs, accounted for 8.1% of the total drug spend in 2021.

Although ibuprofen and naproxen accounted for almost two-thirds of all NSAIDs dispensed last year, average payments for these drugs were $12 and $47 respectively, so they were relatively inexpensive.

However, the Institute found that as in 2020, two low-volume, high-priced NSAIDs, fenoprofen calcium and ketoprofen, made NSAIDs the most expensive drug category. In a March 2021 study, CWCI noted that under the formulary, both these drugs are exempt from prospective utilization review and because they are not listed in the national Medicaid database, neither has a Federal Upper Limit, which would serve as a price control in California workers’ comp. Instead, they are reimbursed at 85% of the average wholesale price, which is based on manufacturer pricing.

The Improving Access to Workers’ Compensation for Injured Federal Workers Act (H.R. 6087), was passed in the House of Representatives on a strong bipartisan basis.

Reps. Courtney and Walberg introduced H.R. 6087 in December 2021 to amend the existing Federal Employees Compensation Act, or FECA – the workers’ compensation program for the vast majority of U.S. federal employees – to allow injured workers to receive treatment for work related injuries from state-licensed Physician Assistants (PAs) and Nurse Practitioners (NPs).

PAs and NPs are increasingly taking on the role of primary care providers for many patients, but current law prohibits federal workers from being treated by PAs and NPs for worker compensation cases, even in states that allow PAs and NPs to practice independently.

Courtney and Walberg’s bipartisan bill earned the support of organizations representing both health care providers and federal employees nationwide, like the American Association of Nurse Practitioners (AANP), the American Association of Physician Assistants (AAPA), the National Treasury Employees Union (NTEU), and the National Postal Mail Handlers Union (NPMHU).

The bill would make a simple but important correction to FECA, enabling PAs and NPs to be compensated for care through the program, expanding access to health care for federal workers and providing a boost to the health of America’s labor force. The Improving Access to Workers’ Compensation for Injured Federal Workers Act was passed by the House by a vote of 325-83.

The federal government is the largest employer in the nation, and FECA provides federal employees with work-related disability and medical benefits, as well as survivors benefits to the families of employees killed on the job.

In 2021, the American Rescue Plan Act (H.R. 1319) created a presumption of FECA eligibility for cases of COVID-19, an important piece of the puzzle in ensuring that a large swath of America’s workers would be covered, cared for, and able to return work in the event they contracted COVID-19.

However, although many federal employees rely on PAs and NPs as their primary care providers, current law prohibits them from being reimbursed for caring for FECA patients within their state scope of practice, and from providing medical evidence to support a FECA benefit claim.

However, in California the bill seems to have triggered a turf war with the California Medical Association.

On June 6 it published an “URGENT!” message on It’s website claiming “Congress is rushing to push through a bill that recklessly expands scope of practice at the federal level.

It went on to claim that “If passed, this bill would allow nurse practitioners and physician assistants to diagnose, prescribe, treat, and certify an injury and extent of disability for purposes of compensating federal workers under the Federal Employees’ Compensation Act. To take this function away from physicians who have the proper education, training, and expertise to make these evaluations is a threat to the practice of medicine and quite simply, unacceptable.”

And the American Medical Association also voiced opposition. “H.R. 6087 effectively removes physicians from the care team and sets up our federal workers for suboptimal health outcomes and increased costs,” AMA CEO James Madara wrote in a letter to House Speaker Nancy Pelosi and Minority Leader Kevin McCarthy, urging them to oppose the bill.

The proposed law will now move to the Senate, and if passed will need the approval of President Biden.

Kicking off National Safety Month, and one year after announcing a historic partnership with Amazon, the National Safety Council unveiled the first-of-its-kind MSD Pledge to reduce the most common workplace injury, musculoskeletal disorders (MSDs). During the inaugural Workplace Safety Summit: Business Action to Prevent Musculoskeletal Injuries, more than 15 of the nation’s leading organizations joined this effort and signed the pledge to improve workplace safety, reduce MSD risk, and enhance all workers’ well-being.

MSDs – such as tendinitis, back strains and sprains, and carpal tunnel syndrome – impact nearly a quarter of the world’s population and are the leading cause of worker disability, early retirement, and limitations to gainful employment. The MSD Pledge seeks to create safer outcomes for millions of workers worldwide by reducing these injuries by 25% by 2025. By making critical changes, employers will also build more equitable workplaces for frontline workers and communities of color, which are two groups disproportionately impacted by MSDs.

Along with Amazon and NSC, founding pledge members include Alcon Research, LLC; Ansell Inteliforz; Amentum; American Industrial Hygiene Association; AMP; Benchmark ESG; Cummins Inc.; Human Balance and Stability Systems, LLC; John Deere; MEGA InTech; Meteorite; Tenneco; United Airlines; and VelocityEHS.

Organizations signing the MSD Pledge promise to:

– – Reduce risks by analyzing the causes of MSD injuries across operations and investing in solutions and practices that reduce risks to workers.
– – Innovate and collaborate by leveraging best practices and sharing learnings and countermeasures to expand upon innovations to improve safety practices.
– – Build an organizational culture that values safety by promoting a workplace where safety excellence, transparency, and accurate reporting are equally valued, and where everyone, at every level of the organization, is accountable for the safety and health of workers.
– – Commit to a significant reduction of MSD injuries by creating safer outcomes for millions of workers worldwide and reducing MSD risk and subsequent injuries by 25% by 2025.

In addition to accessing free resources and sharing safety innovations to help reduce MSD risks, MSD Pledge members will participate in the MSD Solutions Index, an annual company index that analyzes the benefits of the pledge over time.

The index will aggregate data on risk reduction strategies, workplace safety culture, and innovation and collaboration, while also identifying areas for targeted action and uncovering trends to inform future approaches. MSD Pledge members benefit from free events, training and coaching opportunities from the Council’s team of ergonomics experts, as well as opportunities to share best practices and lessons learned with one another. Participation in the MSD Pledge is free and open to any employer that is committed to identifying and reducing risks of MSD injuries and creating a culture of safety at work.

The MSD Pledge was developed at the MSD Solutions Lab, a ground breaking initiative established as part of the NSC and Amazon partnership to solve this omnipresent safety challenge. Led by NSC, the pledge is one of several initiatives launching in 2022 to achieve the program goal of preventing MSDs before they start, including:

– – Advisory Council: NSC has named the founding members of the advisory council for this ground breaking program. Composed of volunteers, these experts in safety, health, ergonomics and innovation support and inform the program’s work by engaging in, researching, solving, and amplifying MSD prevention efforts.
– – MSD 2025 Pioneering Research: Support comprehensive research efforts, including utilizing natural language processing, case studies, reports, and expansive systematic reviews and meta-analyses to explore current and future MSD prevention-related strategies. The research findings will be available to all industries to explore and glean insights.
– – Innovation Challenges: Individuals and organizations alike will have the opportunity to develop and share cutting-edge solutions to prevent and eliminate workplace-related MSDs. During this competition, prizes and grants will be awarded to honor innovation and help fund these solutions.
– – Small Business and University Grants: Provide grants to small businesses, universities, and students to fund research and innovation that help companies of all sizes achieve impact.

To learn more about the MSD Pledge, the MSD Solutions Lab, and the risks associated with MSDs, visit nsc.org/msd.