Insurance Commissioner Dave Jones has approved a Universal Claims Certification (UCC) program from Claims and Litigation Management Alliance (CLM) designed to streamline the licensing process for independent insurance adjusters.

The UCC makes the process of licensing independent insurance adjusters who wish to acquire and manage their independent insurance adjuster licenses in multiple states more efficient. The UCC does not replace an independent insurance adjuster license, but makes the process of securing a license more efficient. Both licensed and unlicensed individuals can acquire a UCC. However, unlicensed individuals must first go through an intensive training by completing a 40-hour online pre-certification education program and successfully pass an examination to earn the UCC.

Insurance Commissioner Dave Jones said “The Universal Claims Certification process is designed to streamline the independent insurance adjuster licensing process and reduce costs. Also, the UCC program sets requirements for licensees that exceed the requirements under current California law, meaning it requires licensees to complete more continuing education, which greatly benefits the independent insurance adjusters and consumers.”

Currently, independent insurance adjuster applicants are not required to complete any prelicensing education. California’s applicants are only required to take and pass the independent insurance adjuster license examination and meet the license requirements to receive an independent insurance adjuster license.

For a licensee to maintain the UCC, the independent insurance adjusters must complete 24 hours of continuing education every two years including five hours of insurance law and ethics. The UCC program’s insurance law and ethics requirement exceeds California’s required three hours of law and ethics that is a part of and not in addition to the 24-hour continuing education requirement.

Once independent insurance adjusters acquire the UCC, they will be able to more quickly obtain a license in the states where the UCC is currently approved, including Alabama, Florida, Georgia, Mississippi, Texas, and now California. This will allow out-of-state adjusters to be more readily available when a natural disaster occurs.

“For years, the CLM membership has complained of the tedious state-by-state adjuster licensing process. We first worked to tackle the process of managing multiple licenses with our Tracker product, then we started to work with various states to actually change the licensing process,” says CLM Founder and former CEO Adam Potter. “It’s exciting to see this work come to life as we launch the UCC.”

CLM is an insurance industry association with more than 45,000 members that focuses on education and resources. CLM offers over 300 live courses, events and conferences annually.

A WCJ found Dean Fitzpatrick “100 percent permanently totally disabled” as a result of injury to his heart and psyche sustained during the course of his employment as a correctional officer. The award was based on the reports of two doctors regarding Fitzpatrick’s injury — Peter Chang-Sing for his heart and Richard Lieberman for his psyche.

Chang-Sing rated Fitzpatrick’s WPI for his heart at 75 percent and his resulting permanent disability at 97 percent. Lieberman rated Fitzpatrick’s GAF score at 45, resulting in 40 percent WPI, and permanent disability of 71 percent for his psyche. It is undisputed that, combining the 97 percent and 71 percent ratings under the Combined Values Chart Fitzpatrick’s permanent disability scheduled rating is 99 percent — permanent partial disability.

Thus Fitzpatrick’s permanent disability scheduled rating is 99 percent — permanent partial disability.

In the July 16, 2015 report, Dr. Lieberman felt that applicant was”on strict psychiatric grounds totally and permanently disabled” . . . Dr. Lieberman elaborated further: “I am dubious that this patient will return to work in any capacity.”

The ALJ concluded: “Based upon [Fitzpatrick’s] credible testimony, the medical reports of Dr. Chang-Sing and Dr. Lieberman, and in accordance with the facts (see Labor Code §4662(b)), it is found that applicant is permanently totally disabled.” The administrative law judge did not mention or discuss the combined rating under the 2005 Schedule. No vocational expert presented evidence in the case.

The Board affirmed the Decision in its opinion and order denying the petition for reconsideration. However, the Court of Appeal reversed in the published case of Department of Corrections v WCAB (Dean Fitzpatrick).

The question presented on appeal is whether the Board correctly interpreted and applied sections 4660 and 4662, subdivision (b).

“We easily harmonize sections 4660 and 4662, subdivision (b). Section 4662, subdivision (b), provides that, in nonconclusively presumed permanent total disability cases (i.e., those cases not enumerated in section 4662, subdivision (a)), permanent total disability may be found ‘in accordance with the fact.’ This section does not, however, address how such a determination shall be made; read plainly, it merely provides that a determination of permanent total disability shall be made on the facts of the case.”

Section 4660 addresses how the determination on the facts shall be made in each case for injuries occurring before January 1, 2013. Indeed, section 4660 expressly applies to the determination of “the percentages of permanent disability.” A “final permanent disability rating” is obtained by going through the steps outlined in the 2005 Schedule.

“Our interpretation of sections 4660 and 4662, subdivision (b), is squarely at odds with the Board panel’s interpretation of those statutes in Jaramillo (on which the administrative law judge and the Board relied in this case).” [Coca-Cola Enterprises, Inc. v. Workers’ Comp. Appeals Bd. (Jaramillo) (2012) 77 Cal.Comp.Cases 445 [writ. den.].

“We thus disapprove of Jaramillo with respect to its analysis on this issue, and annul the Board’s Opinion for the same reason.”

Governor Brown has signed new provisions that apply to California Workers’ Compensation Benefits. Here are highlights of new law that will take effect next January.

AB 1749 Workers’ compensation: off-duty peace officers.  This new law was created as a result of the October 1, 2017, mass shooting in Las Vegas, Nevada.  The new law provides that an employer, at its discretion or in accordance with specified policies, is not precluded from accepting liability for compensation for an injury sustained by a peace officer by reason of engaging in the apprehension or attempted apprehension of law violators or suspected law violators, or protection or preservation of life or property, or the preservation of the peace, outside the state of California.

AB 2046 Workers’ compensation insurance fraud reporting. Requires data sharing between governmental agencies involved in combating workers’ compensation fraud, and grants the Fraud Assessment Commission (FAC) discretion to augment an assessment with unused funds from a prior year’s assessment.

SB 880 Workers’ compensation prepaid cards. This bill would authorize an employer, with the written consent of the employee, to deposit disability indemnity payments for the employee in a prepaid card account. The bill would require the Commission on Health and Safety and Workers’ Compensation to issue a report  to the Legislature regarding payments made to those prepaid card accounts.

SB 1086 Workers’ compensation: firefighters and peace officers. Section 5406.7 of the Labor Code currently sets extended time limits for death claims for firefighters and peace officers. By its terms, this provision was to expire on January 1, 2019.  The new law  deletes the January 1, 2019, date of repeal of Section 5406.7 so that the time limits will now apply to death cases after January 2019.

Governor Brown has vetoed several bills passed by the legislature that pertain to California Workers’ Compensation Benefits. Here are highlights of what he chose not to sign into law.

AB 479 Workers’ compensation: permanent disability apportionment. This proposed law would have set limits to apportionment of permanent disability in cases involving breast cancer. The veto message notes that is similar to three previous measures that he has vetoed, Assembly Bill 570 in 2017, Assembly Bill 1643 in 2016 and Assembly 305 in 2015. He said that this bill and its predecessors have repeatedly singled out specific conditions and proposed a special set of rules that apply to them. This would result in an even more complex workers’ compensation system that would essentially be “disease by statute,” which would ultimately burden injured workers seeking quick resolution to their claims.

AB 553 Workers’ compensation: return-to-work program. This bill would have required the Department of Industrial Relations to completely disburse $120 million annually from the Workers’ Compensation Return to Work Fund to eligible injured workers. The veto message noted that the Return-to-Work Program began in 2015 and is relatively new. He was concerned this measure proposes sweeping revisions to the Return-to-Work program that are premature.

AB 1697 Workers’ compensation fraud unit. This would have required the DIR  to establish an anti-fraud unit within the DWC. The veto message notes that the work required by this measure is already underway.

AB 2496 Janitorial employees.The proposed law was a codification of the California Supreme Court new ABC test for an employment relationship in Dynamex Operations West, Inc. v. Superior Court (2018) 4 Cal.5th 903. The bill was vetoed because the Administration and the Legislature are still reviewing this decision and any statutory changes to such tests would be premature.

SB 899 Workers’ compensation permanent disability apportionment. This measure seeks to preclude a physician from using race, gender, or national origin as a basis for apportionment. The Governor vetoed this bill for many of the same reasons that he returned a similar measure in 2011 – Assembly Bill 1155. This bill is unnecessary as it would not change existing law and may disturb settled court decisions, which already provide protection from the inappropriate application of the apportionment statutes.

“Incidence rates for deaths directly attributable to medical care gone awry haven’t been recognized in any standardized method for collecting national statistics,” says Martin Makary, M.D., M.P.H., professor of surgery at the Johns Hopkins University School of Medicine and an authority on health reform.

“The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used.” In 1949, Makary says, the U.S. adopted an international form that used International Classification of Diseases (ICD) billing codes to tally causes of death.

“At that time, it was under-recognized that diagnostic errors, medical mistakes and the absence of safety nets could result in someone’s death, and because of that, medical errors were unintentionally excluded from national health statistics,” says Makary.

The researchers say that since that time, national mortality statistics have been tabulated using billing codes, which don’t have a built-in way to recognize incidence rates of mortality due to medical care gone wrong.

In their study, the researchers examined four separate studies that analyzed medical death rate data from 2000 to 2008, including one by the U.S. Department of Health and Human Services’ Office of the Inspector General and the Agency for Healthcare Research and Quality.

Then, using hospital admission rates from 2013, they extrapolated that based on a total of 35,416,020 hospitalizations, 251,454 deaths stemmed from a medical error, which the researchers say now translates to 9.5 percent of all deaths each year in the U.S.

According to the CDC, in 2013, 611,105 people died of heart disease, 584,881 died of cancer and 149,205 died of chronic respiratory disease – the top three causes of death in the U.S. The newly calculated figure for medical errors puts this cause of death behind cancer but ahead of respiratory disease.

“Top-ranked causes of death as reported by the CDC inform our country’s research funding and public health priorities,” says Makary. “Right now, cancer and heart disease get a ton of attention, but since medical errors don’t appear on the list, the problem doesn’t get the funding and attention it deserves.”

The researchers caution that most of medical errors aren’t due to inherently bad doctors, and that reporting these errors shouldn’t be addressed by punishment or legal action.

Rather, they say, most errors represent systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols, in addition to unwarranted variation in physician practice patterns that lack accountability.