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Final IMR and IBR Regulations Now In Effect

The Office of Administrative Law approved the new Independent Medical Review (IMR) and Independent Bill Review ( IBR) regulations . Both sets of regulations were filed with the Secretary of State on February 1 2 , 2014 and are effective immediately . Prior to March 1, 2014, any version of the IMR Application form adopted by the Administrative Director under section 9792. 10.2 may still be used.

The final IMR regulations include revisions to the IMR application form and improved instructions .Clarification that IMR determination cannot be based solely on information provided by a UR determination . And provisions for penalties to be assessed against a claims administrator for failure to timely produce medical records

The final IBR regulations include revisions to the forms used by providers to request a second bill review and IBR . Limitations on the consolidation of separate IBR requests to 20 requests . Required index of supporting documentation . And updated versions of the Electronic Medical Billing and Payment Companion Guide a s well as the California Division of Workers’ Compensation Medical Billing and Payment Guide ..

Stress From Claims Process Makes Injuries Worse

People injured in an accident or at work sometimes file for monetary compensation, and according to some studies those who file tend to have worse long-term health than those who do not. A new survey of Australian accident victims found that claims stress often comes from confusion about the process, delays and related medical assessments. Those who were most stressed by filing a claim tended to have higher levels of disability years later.

According to the article in Reuters Health, study author David M. Studdert of Stanford University in California said past studies have compared people who filed for compensation to people who did not, but those groups might have different types of injuries to begin with. Another aspect to consider is that people who file claims have an incentive to exaggerate their symptoms to receive more compensation for longer. “The novelty of this study was to look within a group of claimants to test whether those who reported experiencing the most stress also had the slowest recoveries,” Studdert said. “They did.”

He and his colleagues polled a random selection of more than 1,000 patients hospitalized in Australia for injuries between 2004 and 2006. Six years later, 332 of the patients who had filed for workers’ compensation or another accident claim told the researchers how stressful the process had been. Claims can take four to five years to conclude, Studdert noted. A third of the claimants reported high stress from understanding the claims process and another third were stressed by delays in that process. A slightly smaller proportion said repeated medical evaluations and concern for the amount of money they would receive were sources of stress.\Negative attitudes from doctors, friends, family or colleagues, on the other hand, did not seem to be common sources of stress.

People with the most stress tended to score higher on a disability scale and have higher levels of anxiety and depression and lower quality of life, the researchers reported in JAMA Psychiatry. “While it’s intuitive that the compensation process is going to be stressful for some claimants, what is less clear is whether that stress has a substantial impact on recovery many years after the injury,” Studdert said. “We were surprised by the size of the compensation effects on outcomes like level of disability and quality of life – they were fairly strong,” he told Reuters Health.

“There is much debate at the moment about the role of ‘systems,’ in this case ‘compensation systems’ on health outcomes,” said Michele Sterling, who studies injuries and rehabilitation at the University of Queensland in Herston, Australia. She was not involved with the current study. “If it can be established which parts of the process cause stress and/or poor outcomes or recovery then the system could look at targeting these specific areas and improve them,” Sterling told Reuters Health. “Some insurance regulators are already trying to do this in some areas.” This study deals with severe injuries that require hospitalization, and her own research focuses on more minor injuries, she noted, but the relationship between stress and health is likely the same, she said. She has found that posttraumatic stress symptoms predict poor recovery, and that could be worsened by stresses in the claims system, she said.

“Our study joins many others that show the rate of mental health problems among people who are injured is astonishingly high,” he said, adding that medical systems are excellent at treating physical injuries but not as good at treating mental conditions Studdert said. “I think the point that needs to be made is that those managing these systems, insurers or workers’ compensation boards, or no fault automobile compensation schemes, should realize that they are undermining their own mission of getting workers back on their feet if the process is unnecessarily stressful,” said Katherine Lippel, who studies occupational health and safety law at the University of Ottawa in Ontario, Canada and was not involved in the study. The authors suggest that compensation schemes could be redesigned to get the process over with quicker and make it easier for patients to understand, which could alleviate some sources of stress.

Studies such as this one may be a basis to seek apportionment of permanent disability based upon causation. New Labor Code sections 4663, subdivision (a) and 4664, subdivision (a) eliminate the bar against apportionment based on pathology and asymptomatic causes. Thus, under the post SB 899 workers’ compensation system, apportionment of permanent disability shall be based on causation (§ 4663, subd. (a)), and the employer shall only be liable for the percentage of permanent disability directly caused by the injury arising out of and occurring in the course of employment. Creative trial work coupled with a comprehensive forensic presentation may accomplish a persuasive argument to apportion away the effects of stress from the disability after a physical industrial injury.

No Jurisdiction in Federal Court Over Subrogation Money

A federal judge has ruled he is without authority to decide whether Sacramento County should continue workers’ compensation payments to a former sheriff’s deputy who survived a 2005 helicopter crash that killed two other deputies.

According to the report in the Sacramento Bee, U.S. District Judge Morrison C. England Jr. threw out Eric Henrikson’s lawsuit that claimed the county is not entitled to offset his $26 million recovery from the helicopter’s manufacturer against his workers’ compensation. England ruled that Henrikson “has identified no basis for this court’s jurisdiction over this matter.” Henrikson’s arguments against the county’s third party credit rights, including a contention that the county waived those rights because it paid the benefits for five years before stopping last year, “are issues that must be addressed” by the California Workers’ Compensation Appeals Board, the judge said. Contrary to an argument by Henrikson’s lawyers, the judge also ruled that there is nothing in the documents memorializing Henrikson’s settlement with Turbomeca S.A., the French company that manufactured the helicopter’s engine, obligating the county to continue workers’ compensation payments. Henrikson’s lawyers argued that the county waived its credit rights when it agreed to forgo a claim for part of the Turbomeca settlement money.Not so, said Judge England. “The waiver is utterly silent with regard to any impact on separate workers’ compensation proceedings,” he wrote in a 12-page order.

Turbomeca has never publicly admitted liability, but it settled two lawsuits accusing it of supplying a defective part that caused the helicopter to slam into a hillside near Lake Natoma on July 13, 2005. The company settled with the families of Joseph Kievernagel and Kevin Blount, the deputies who died in the crash, and with Henrikson. The settlement bars the parties and lawyers from publicly discussing its terms, and the amount of money received by the families of the deceased deputies has never been revealed. The amount Henrikson received was disclosed as a result of his suit against the county. Turbomeca also paid Sacramento County $1.5 million to resolve its suit over various damages alleged to have resulted from the crash.

The incident ended Henrikson’s career in law enforcement. He was 28 at the time and had been with the Sheriff’s Department eight years. He had collected $2 million in workers’ compensation before the county pulled the plug in May on the monthly payments and medical coverage. Kievernagel and Blount were 36 and 29, respectively, when they perished in the crash.

$1 Billion in Cuts to California Courts Leaves System on Life Support

The Bee reports that Sacramento County Superior Court has swallowed a 23 percent budget cut over the last five years. With 230 of 800 employees gone, the pain is acute in every aspect of court operations. Twenty-five court counter windows have closed. Courts remain open, but the wheels of justice grind so slowly that a lot of people have given up. Statewide, civil filings dropped 43 percent over three years ending in fiscal 2011-12. “Access to justice has been hurt badly, and it affects everybody in the community,” said Robert Hight, the court’s presiding judge. In Sacramento, the queue at family court can take seven hours. Small-claims courts are on life support, if they operate at all. And getting a trial date is not a guarantee there will be a courtroom available that day. Some local trials have been continued to a later date multiple times, for months at a time.

The cuts hurt companies large and small, say business advocates. A worker who needs a restraining order but fails to make it to the front of the line will have to go back another day. The attorney whose trial was bumped will have to prepare for trial all over again. “I think some people are giving up,” Hight said. Couples frustrated with family court split and don’t file, he said. And some business owners resolve disputes outside the court system. They pay for private alternative dispute-resolution services instead of using the tax-supported justice system.

As stated in a 2009 New York Times editorial, “[A]t some point, slashing state court financing jeopardizes something beyond basic fairness, public safety, and even the rule of law. It weakens democracy itself.” Since 2009 when this editorial was published, California trial courts have lost nearly three-quarters of a billion dollars in State General Fund support.

California has the largest judicial system of any state, but it has suffered the deepest financial reduction of any state, according to a new report on the state of the judiciary in Sacramento County. Statewide, the judicial branch has undergone $1 billion in cuts over the last six years. Fifty-one courthouses and 205 courtrooms have closed. After five years of court cuts, there is no fat left in the system. “People lose faith and feel it is no longer open to them,” said Tani Cantil-Sakauye, chief justice of the California Supreme Court. “It’s a nefarious way to deny people their rights.”

Because the federal Constitution gives priority to criminal cases, state budget cuts have disproportionately affected civil courts where most business cases are filed. A 10 percent cut in court funding translates to a 40 to 50 percent cut in access to justice in civil cases because that’s the only place to cut, said Nancy Drabble, executive director of the California Consumer Attorneys Association. This of course has an adverse effect on Workers’ Compensation subrogation efforts. Delays affect both employees and employers, said Allen Zaremberg, president and CEO of the California Chamber of Commerce.

Gov. Jerry Brown’s proposed state budget includes $100 million for trial court operations and $5 million to support the state judiciary. Cantil-Sakauye, chief justice of the California Supreme Court

Analysts Predict Obamacare Caused Comp Treatment Delays

Though parts of the Affordable Care Act have been in place since 2010, key reforms began on January 1, 2014. According to industry experts quoted in a Claims Journal article,,the ACA won’t affect the medical bill payment process; however, insurers will likely see an increase in the cost of medical care for auto accident patients, more subrogation liens from health insurers and the potential for delayed treatment in workers’ compensation claims.

According to a Travelers white paper, The ACA and its Potential Impact on the P/C Industry, some key ACA components expected to affect the P/C industry include:a 15 percent increase in demand for a fixed supply of healthcare services. A potential increase in costs in pharmacy and durable medical equipment (DME) taxes and assessments by 1.5 percent and 2.3 percent respectively. Enhanced electronic record keeping and sharing of medical data among providers.

Michele Hibbert-Iacobacci, vice president of information management and support for San Diego-based Mitchell International, has been with the company since 1994, since they acquired the property/casualty bill review company that she worked for at that time. She described Mitchell’s general predictions for the ACA’s impact on property/casualty lines and workers’ compensation in 2014. “We don’t see any changes in the way bills are paid. However, because of the extensive amount of population predicted that would be joining the health care system that didn’t have it before, it could impede patients from getting care as quickly as they do today,” said Hibbert-Iacobacci, emphasizing that for auto injuries, in particular, patients will flock to emergency rooms because they won’t be able to get in to see their primary care physician.

Another prediction, according to the Mitchell exec, is that subrogation is going to become an even bigger deal as more patients become insured. “Today, if you and I get in an automobile accident, we may go to the emergency room, if we have insurance, and usually we get referred to our primary care to start directing our care. They’re being paid by the healthcare [carrier], but the healthcare [carrier] is not going to tolerate that for a very long period of time. They’re going to want their money from the property/casualty insurer,” said Hibbert-Iacobacci. Auto is particularly vulnerable because there are policy limits for available just for medical expenses. “We will see that in auto, because auto has the money. They’ve got it there in their pocket. They plan on spending it, up to the policy’s limit, if need be, for the patient. It’ll just be more frequent than it ever was before. The carriers need to really have an expectation that their process of subrogation is going to take more time than it ever did before,”said Hibbert-Ioabacci.
Impact on Workers’ Comp Slow

As far as workers’ compensation, Hibbert-Iacobacci doesn’t think the ACA will have an immediate effect. “In workers’ comp, we do not see an immediate change initially,”she said. During the Casualty Actuarial Society’s (CAS) Ratemaking and Product Management Seminar held last year, Anne M. Petrides, a director and consulting actuary with Towers Watson, noted that greater access to healthcare could lower costs in workers’ compensation if it created a healthier workplace.

Ruth Estrich, chief strategy officer for MedRisk, a company that specializes in return to work treatment programs, thinks the ACA will impact workers’ compensation in two ways. Like Petrides, she said there could be a benefit if injured people turn to their healthcare provider instead of potentially claiming a work injury. On the flip side, Petrides said that if there was a provider shortage or delayed treatment, it could increase costs. Estrich said that if there is a provider shortage, treatment could take longer for the majority of workers’ compensation claimants. “Reducing access to primary physicians could have a significant impact on workers’ comp,” said Estrich. Estrich said that given the choice, primary care physicians will treat regular patients before workers’ compensation claimants. That’s due to the necessary authorization for treatment, fee schedules, litigious nature of those types of claims and the extensive paperwork involved.

Drug Shortages Persist

Despite efforts by the Obama administration to ease shortages of critical drugs, shortfalls have persisted, forcing doctors to resort to rationing in some cases or to scramble for alternatives, a government watchdog agency said on Monday. At the end of the day, this will translate to increases in medical costs for payment systems including workers’ compensation. According to the article in the New York Times, drug shortages have become an all but permanent part of the American medical landscape. The most common shortages are for generic versions of sterile injectable drugs, partly because factories that make them are aging and prone to quality problems, causing temporary closings of production lines or even entire factories. The number of annual shortages – both new and continuing ones – nearly tripled from 2007 to 2012.

The analysis by the United States Government Accountability Office, released Monday, was required by a 2012 law that gave the Food and Drug Administration more power to manage shortages. The watchdog agency was charged with evaluating whether the F.D.A. had improved its response to the problem, among other things. The accountability office concluded that the F.D.A. was preventing many more shortages now than in the past – 154 potential shortages in 2012 compared with just 35 in 2010 – but that the number of shortages has continued to grow.

“We are at a public health crisis when we don’t have the medicines to treat acutely ill patients and we don’t have the basics like intravenous fluids,” said Erin Fox, a drug expert at the University of Utah whose data was used in report. The most acute shortage now is that of basic I.V. fluids, she said.

The drug industry rarely spells out the precise reason for a shortage, citing its need to protect competitive trade information. Dr. Douglas C. Throckmorton, a senior F.D.A. official who deals with shortages, said in written testimony released on Monday that 66 percent of production disruptions that led to shortages were caused by quality problems and efforts to fix them.

The 2012 law required that drug companies provide the F.D.A. with a general reason, but Ms. Fox said that it was often not specific enough to understand what was driving the shortage.

Economic factors are also contributing to the shortages. Narrow profit margins are making some drug companies reluctant to invest in fixing old production facilities. Dr. Throckmorton compared aging drug facilities to an old car, which requires significantly more upkeep than a new one. Changes in Medicare reimbursement and the role of group purchasing organizations, which buy drugs on behalf of hospitals, could also be contributing, by further reducing prices.

The F.D.A. said in a statement that it is “committed to the prevention of new drug shortages and the resolution of ongoing drug shortages, which remain a significant public health issue in the United States.”

Comp Premium Rates Show Steep Increase in 2014

Workers’ compensation and commercial auto risks saw the steepest rate increases in January at +4% compared to the same month in 2013, but the commercial-lines market overall continued its moderating trend, according to MarketScout research summarized in PropertyCasualty 360. MarketScout officially listed January’s composite rate at +3%, the same as December, but CEO Richard Kerr notes, “If we were to post rate changes by fractional increments, you would see the actual increase at 2.55 percent, so the moderation trend continues.”

Recapping the previous year, MarketScout notes that 2013 began with a composite rate increase of +5 percent, moderated slightly in July,;ended up at +3 percent at year-end. For January, Kerr says, “Rates for five coverage classes declined 1% as compared to one year ago. No coverage classifications had a rate increase. By account size, half the accounts measured enjoyed premium reductions of 1%. By industry class, four out of seven were down 1%.” He explains, “Additional capacity, insurance-linked securities and a more stable economic environment (despite recent stock-market adjustments) are partly responsible for the moderating rate environment.”

Both workers’ comp and commercial auto saw 4% rate increases. BOP, general liability and umbrella/excess rates were up 3%. Commercial property, business interruption, professional liability and D&O rates were up 2%. Inland marine, EPLI, fiduciary, crime and surety risks all increased by 1%. Small accounts saw the steepest rate increases at 4%, medium accounts were up 3%, large accounts up 2% and jumbo accounts up 1%. By industry, risks in manufacturing, contracting, service and transportation all saw 4% rate increases. Habitational risks were up 3%, public entity and energy risks were up 2%.

Personal lines rates also moderated in January, up by 2% year-over-year compared to 3% in December. Kerr says, “2013 was a good year for personal lines insurers. We expect continued aggressive pricing, but that will be geographically modified as appropriate. Coastal homeowners continue to enjoy competitive rates because of the lack of windstorm activity in 2013, despite Superstorm Sandy.” For January, he adds, “Homes under $1 million in value were assessed a 2% increase, while high-value homes paid an additional 4%. Both metrics were down 1 percentage point from December 2013.” Automobile and personal articles were both increased by 2%, a slight reduction for personal articles and the same rate for automobile.

WCAB Says SB 863 Entitles Employer to Expedited Hearing on MPN Issues

On September 9, 2013, applicant, Eun Jae Kim, filed an Application for Adjudication of Claim alleging that she sustained cumulative industrial injury to her back and other body parts while working for B.C.D. Tofu House, Inc. (BCD) as a waitress manager. The employer asserted that upon receipt of the claim a “complete MPN package” was sent to applicant on September 18, 2013. However, on September 19, 2013, the next day, a letter was sent to the employee denying liability “as there is no policy in effect at the time of alleged injuries” and also because there was no “medical proof to substantiate whether your alleged injuries were due to your employment with BCD Tofu House.” Notwithstanding the denial letter, a delay notice was sent to applicant on September 30, 2013. The delay letter identified “Dr. David Heskiaoff” as primary treating physician, but did not schedule an initial medical evaluation. The next day on October 1, 2013 she was “informed that defendant” had selected Richard Feldman, M.D., as her new primary treating physician and had scheduled an initial evaluation for October 23, 2013.

Applicant at some point thereafter identified non-MPN physician Gabriel Rubanenko, M.D., as her primary treating physician. A WCJ found that that an expedited hearing was “not appropriate” to address defendant’s provision of medical treatment through its MPN because the case was not admitted. As a result, the defendant filed a Declaration of Readiness to Proceed on October 11, 2013, with the following statement: “Claim is in delay mode. Applicant has been advised of treatment within the MPN. Defendant is attempting to provide medical tretment [sic] within the delay period, within the MPN. Applicant’s attorney has selected a non-MPN physician as primary treactmng [sic] physician. Defendant seeks an order for treatment and transfer of care into the MPN, and an order regarding no liability for non-MPN treatment with Dr. Rubanenko.”

An expedited hearing was calendered for November 13, 2013, and the attorneys for applicant and defendant appeared at that time. However, the expedited hearing did not go forward. Instead, the case was ordered off calendar by the WCJ, who wrote on the Minutes of Hearing: “As of 11/13/13 defendant confirms that case is not admitted. Not appropriate for [Expedited Hearing].” The employer filed a Petition for Removal. In his Report, the WCJ confirms that the case was taken off calendar “because the [d]efendant confirmed on the day of hearing that it had not admitted or denied liability for the alleged injury, and the 90-day time frame permitted [by section 5402(b)] to make such a decision had not yet elapsed.” The logic was that Rule 10252 of the Rules of the Court Administrator, which provides that a party is entitled to an expedited hearing and decision on the issue of “the employee’s entitlement to medical treatment pursuant to Labor Code section 4600” when “injury to any part or parts of the body is accepted as compensable by the employer.” (Cal. Code Regs., tit. 8, § 10252.) In sum, the WCJ reasoned that Court Administrator Rule 10252 precluded an expedited hearing on the issue of applicant’s medical treatment in the MPN because defendant had not accepted any part of the claimed injury as compensable even though the 90-day period allowed by section 5402(b) to make such a decision had not yet elapsed.

The WCAB granted the Petition for Removal in the case of Eun Jae Kim v B.C.D. Tofu House and Cypress Insurance Company and concluded that the WCJ erred by ordering the case off calendar instead of proceeding with the expedited hearing. The reasoning given by the WCJ in his Report for not conducting an expedited hearing on November 19, 2013 is incomplete because it does not take into account the amendment of section 5502(b)(2) by Senate Bill 863 to provide for an expedited hearing to address the question of, “Whether the injured employee is required to obtain treatment within a medical provider network…” The amendment to section 5502(b)(2) does not take into account the pre-existing Rule 10252, which requires that at least one part of the body be accepted as industrially injured in order to obtain an expedited hearing. However, to the extent the amendment to section 5502(b) is inconsistent with Rule 10252, the statutory provision prevails. The WCJ also did not address Rule 9767.6(c) of the Rules of the Administrative Director, which requires an employer to provide up to $10,000 of medical treatment within its MPN “until the date that liability for the claim is rejected.”

Section 4616.3(a), provides: “If the injured employee notifies the employer of the injury or files a claim for workers’ compensation with the employer, the employer shall arrange an initial medical evaluation and begin treatment as required by Section 4600.” Thus, section 4616.3(a), which is one of the MPN statues, requires a defendant to commence treatment within its MPN when the employer receives notice of the injury from the employee, even if the claim has not been accepted or denied and is within the 90-day delay period allowed by section 5402(b).

Accordingly, the WCAB found that the WCJ erred when he decided not to proceed with the expedited hearing on November 13, 2013 as requested by defendant. Instead, the WCJ should have conducted an expedited hearing to determine whether defendant had met its obligation to provide reasonable medical treatment through its MPN pursuant section 5402(c) and as described in Administrative Director Rule 9767.6(c), or whether defendant was liable for the reasonable cost of medical treatment self-procured by applicant.

Santa Barbara Bus Driver Convicted of Comp Fraud

District Attorney Joyce E. Dudley announced that Daniel John Sifuentez, age 31, pled guilty to one felony count of Insurance Code section 1871.4(a)(1), commonly known as Worker’s Compensation Fraud. Sifuentez was employed by the Metropolitan Transit District (MTD) as a bus driver.

An investigation conducted by the California Department of Insurance revealed that Sifuentez went to see his physician complaining of a back injury he received while working out in the gym. Three days later Sifuentez filed a claim with the MTD, fraudulently stating that he injured his back on the job. The investigation further revealed that Sifuentez again lied about his pre-existing back injury during his deposition regarding the claim, and told MTD coworkers that he disliked the MTD and “was going to get even with them.” Sifuentez received $5,386.89 in disability payments as well as $3,485 in medical benefits before the fraud was discovered and benefits were terminated. The investigation led to his arrest last July. He was charged with two counts of felony Workers’ Compensation fraud, two counts of insurance fraud, and one count of perjury.

“Filing a fraudulent Worker’s Compensation Claim or making a false or misleading statement which could affect the way the claim is handled is a felony,” noted Deputy District Attorney Gary Gemberling, who prosecuted the case. Gemberling continued, “Additionally, if someone is untruthful during a deposition about a material fact or intentionally fails to disclose a pre- existing injury or medical treatment, they can be prosecuted for Worker’s Compensation Fraud.”

CWCI Says Los Angeles is “Hotbed” for Comp Litigation

A new California Workers’ Compensation Institute (CWCI) analysis of closed and resolved work injury claims from accident years 2005 through 2010 finds that statewide, attorneys were involved in 11.6 percent of all claims (including medical-only cases), 38 percent of lost-time claims and 80 percent of permanent disability claims. The study also confirms that the area in and around Los Angeles remains a hotbed for California workers’ compensation litigation, especially compared to Northern California — including San Francisco and most of the Bay Area — where attorney involvement rates on lost-time claims are nearly 15 percentage points lower.

Medical-only claims make up about 75 percent of all California workers’ comp claims, but because less than 2 percent of them involve an attorney, and those that do account for less than 1 percent of workers’ comp benefits statewide, the Institute study focuses on a sample of 262,490 closed and resolved indemnity claims with 2005 through 2010 injury dates. These claims, all of which involved either temporary and/or permanent disability payments, accounted for $7.6 billion in total payments – nearly $7.1 billion in medical and indemnity benefits, and another $523 million in allocated loss adjustment expenses (ALAE). A total of 99,913 (38.1 percent) of these indemnity claims involved an applicant attorney, a defense attorney, or both, with paid benefits and expenses on those claims averaging $62,652 ($57,679 benefits + $4,973 ALAE ) which translates to $6.26 billion, or 82 percent of all payments in the indemnity claim sample.

Though the attorney involvement rate for closed and resolved indemnity claims statewide was 38 percent, as in past studies, litigation was more prevalent in the Los Angeles Basin, where 46 percent of all lost-time cases in Los Angeles County involved an attorney. The attorney involvement rate also was above the statewide level in Orange County, Ventura/Santa Barbara/San Luis Obispo Counties, and in the Inland Empire, though it was slightly below the statewide rate in San Diego. In comparison, attorneys were involved in 34 percent of similar cases in San Jose, which was the highest rate in Northern California, while the rate for rest of the Bay Area was 31.4 percent, well below the statewide rate. Limiting the analysis to just permanent disability (PD) claims, the study found attorney involvement rates ranging from a low of 75.2 percent of the Bay Area PD claims to 83.8 percent of the PD claims in Los Angeles County. The study also found Orange and Los Angeles Counties and the Inland Empire have the lowest closure rate for attorney involvement claims in the state, while average claim costs are among the highest.

CWCI has published more details, including regional data on attorney involvement rates, claim payments and closure rates in a report, “Attorney Involvement in California Workers’ Compensation, AY 2005-2010”, which is available to CWCI members and nonmember subscribers who log in to the Institute’s website at