Tag: 2013 News

Months of heavy lobbying by the National Football League and other professional sports team owners paid off when lawmakers gave final passage to a bill to limit most workers’ compensation claims by out-of-state professional athletes.

The bill, AB 1309 by Assemblyman Henry T. Perea (D-Fresno), cleared the Assembly on a 66-3 vote and was sent to Gov. Jerry Brown. The governor is expected to sign the bill into law, Perea’s office said.

The Los Angeles Times says that last week, the measure received an overwhelming endorsement in the state Senate with a 34-2 vote. Perea’s proposal, which was opposed by the NFL Players’ Assn. and the AFL-CIO, would close a provision in California law that allowed players from out of state to file workers’ compensation claims for so-called cumulative trauma, including head injuries that manifested themselves years after their careers had ended.

Many of those players may have participated in just a handful of games in California over the course of their careers.

During the bill’s eight-month transit through the Legislature, team owners argued that California had become a de facto forum for claims filed against football, baseball, basketball, hockey and soccer franchises and their insurance companies.

Players unions countered that the employers don’t want to be responsible for their former workers’ head injuries and other ailments.

Former athletes have filed more than 4,400 claims involving head and brain injuries since 2006. This bill would not affect pending claims. Provisions that initially would have had a retroactive effect were removed by a September 5 amendment to the bill. The bill now contains language in paragraph 3600.5 (h) tat says “the amendments made to this section by the act adding this subdivision apply to all claims for benefits pursuant to this division filed on or after September 15 2013.” The previous version of the bill had provisions that would have applied retroactively to all pending claims not yet adjudicated. Thus thousands of these claims already in the system will continue to move forward.

Pundits say that Governor Brown will sign this bill into law. The governor has until Oct. 13 to sign or veto the bill.

Edward Frazier, a peace officer with the Department of Corrections, had a presumptive (L.C. 3212.1 0) industrial heart trouble with diagnosed hypertensive heart disease accompanied by mild left ventricular hypertrophy.

The AME, Dr. Ng, provided an analysis that in his opinion that under the American Medical Association Guides to the Evaluation of Permanent Impairment, Fifth Edition,Table 4-2, (Criteria for Rating Permanent Impairment Due To Hypertensive Cardiovascular Disease AMA 5lh edition) would require a finding that he has a 30% Whole Person Impairment. l

However, the AME was of the opinion that this WPI while appropriate is not an accurate representation of the injured worker’s impairment. Doctor Ng referred to the new AMA Guides 6th Edition as a “standard text or recent research data” to support his conclusion that 30%WPI was too high. He concluded the writers of this recent publication decided that the 30% WPI was too high for asymptomatic mild ventricular hypertrophy. The 6th edition he states shows that for a gentleman with the same mild left ventricular hypertrophy an impairment of 23% WPI is recommended. He concludes that the authors of the AMA guides sixth edition have recognized the accuracy problem (in the 5th edition) and reduced the whole person impairment to a rating of 24% for left ventricular hypertrophy. By inference it is his clinical judgment this lower WPI is more accurate.

In conclusion the AME chose 24% as the most accurate description of this injured workers impairment. This percentage was a combination of his consideration of the analysis of the writers of the AMA 6th edition, his clinical judgment as well as his analogizing with the Coumadin paragraph 9.6C of the AMA 5th edition which has a lower impairment for asymptomatic conditions with serious health risks.

The 24% impairment after the formal rating resulted in a permanent partial disability of 44% which was awarded by the WCJ.

The WCAB denied reconsideration in the panel decision of Edward Frazier v State of California, CDCR – Correctional Training Facility.

The Imperial Valley Press claims that past behavior of City Council members of the city of Calexico has put the city in some hot water with the California Joint Powers Insurance Authority, which issued the city a warning letter earlier this year.

The California Joint Powers Insurance Authority is an organization that provides members with coverage such as liability protection, a workers’ compensation program, property insurance program and more.

In a letter to City Manager Oscar Rodriquez, California JPIA Assistant Executive Officer Norman A. Lefmann wrote, “It has come to our attention that members of the City Council may be inserting themselves into the interactive process for workers’ compensation claims which is inconsistent with good governance.”

The California JPIA periodically reviews members’ risk management practices as part of the authority’s Loss Control Action Plan program. The city was evaluated in June 2009 and the action plan was presented in March 2010. However, “the city has made very little effort in reducing the number of action items,” Lefmann wrote in the letter.

“We believe that good governance is about the City Council largely being policy setting in terms of their actions and concerns and to leave it to the city administration to manage the affairs of the operations, including hiring and firing employees, reviews of workers compensation injuries, how they respond to claims, etc,” Lefmann explained. He did not cite any particular City Council member or specific action but said “when we see that the City Council is interfering with best practices and recruiting a police chief and creating potential divisiveness on who might replace the police chief,” there’s “another concern as potential claims may arise.”

The hiring of Police Chief Pompeyo Tabarez earlier this year was the end of a controversial hiring process that in many ways further divided the council.

Lefmann did say that the city has generally made a good effort to respond to the issues brought up and the city and the California JPIA is moving ahead to work more closely to address these kinds of concerns. Mayor Bill Hodge said Rodriquez has informed the council of the situation and “it has happened because of a series of incidents.”

He specifically cited “a lot of workman’s compensation claims” and the sexual harassment claims filed by council member Maritza Hurtado against councilmen Luis Castro, Joong Kim and Hodge. He said he was “surprised” by the reference to the police chief selection process. “It was an option for us as council people to participate in selection of a new chief which we did but they’re citing that also,” he said.

California JPIA representatives will be meeting with City Council members individually, he said, but added that he’s “not exactly sure what plans are to be carried out.”

The California Division of Workers’ Compensation (DWC) issued a notice reminding claims administrators that failure to provide a necessary interpreter at a medical treatment appointment may constitute a failure to provide medical treatment. Examples of a failure to provide medical treatment include a situation where the lack of an interpreter’s services prevents the exam from going forward or inhibits the injured worker’s ability to communicate with the primary treating physician. Such conduct could also result in penalties and/or sanctions against the claims administrator.

The notice goes on to say “It has come to DWC’s attention that some claims administrators are not responding timely to requests for provisional certification of interpreters, and not arranging for other interpreters to attend medical treatment appointments. As a result, some appointments are not going forward as scheduled.”

Labor Code Section 4600(g) provides that injured workers who cannot communicate effectively in English with their primary treating physician are entitled to the services of a qualified interpreter at all medical treatment appointments.

“Qualified interpreters” for purposes of medical treatment appointments may be, but are not required to be, formally certified. They can be provisionally certified by agreement of the employer prior to providing interpreting services. Employers are not required to pay for the services of interpreters who are not formally or provisionally certified.

Interpreters certified for medical treatment appointments or medical legal exams qualify through successfully passing the Certification Commission for Healthcare Interpreters (CCHI) exam or by passing the National Board of Certification for Medical Interpreters (National Board). Interpreter services FAQs and information on recently approved interpreter services regulations are posted on DWC’s website.

When it comes to reducing one’s hospital bills, a key factor is location, location, location. A patient who undergoes joint-replacement surgery in Ada, Oklahoma, might receive a $5,300 hospital invoice for services rendered. But, according to an article in The Atlantic Cities, somebody who gets the same operation in Monterey Park, California, could be staring down the barrel of a much huger bill – $223,000, to be exact.

These were the average lowest and highest prices in 2011 for one particular joint-swapping procedure in the United States, according to federal data. They show in stark light how hospitals charge vastly different amounts for almost identical services, a peculiarity of the American healthcare system that Steven Brill wrote about this year in a Time cover story. Brill spent months investigating how hospitals calculate the bills they stick to patients; here’s Time describing one of his findings:

“Hospitals arbitrarily set prices based on a mysterious internal list known as the “chargemaster.” These prices vary from hospital to hospital and are often ten times the actual cost of an item. Insurance companies and Medicare pay discounted prices, but don’t have enough leverage to bring fees down anywhere close to actual costs. While other countries restrain drug prices, in the United States federal law actually restricts the single biggest buyer – Medicare – from even trying to negotiate the price of drugs.”

While some people have taken issue with Brill’s facts, the basic point that hospital pricing is opaque and often unfair is on target. The Centers for Medicare and Medicaid Services seem to be on board with this assessment. After Brill’s article appeared, the centers disgorged a trove of information dealing with what hospitals charged and what Medicare actually paid for 100 common procedures in 2011. The data revealed not just major differences among the states, but local variations as well. Reports Health 2.0: “For example, average inpatient hospital charges for services that may be provided to treat heart failure range from a low of $21,000 to a high of $46,000 in Denver, Colo., and from a low of $9,000 to a high of $51,000 in Jackson, Miss.”

The higher-value hospitals are clumped in the center of the United States. Two of the best-ranked ones hail from Arkansas – the Surgical Hospital in Little Rock and the Physicians’ Specialty Hospital in Fayetteville – followed by medical centers in Villa Rica, Georgia; Grinnell, Iowa; Paola, Kansas; Boise, Idaho; and Wichita.

Some of the lowest-ranked hospitals can be found in California locales like Porterville, Hemet, and Fresno, and in Floridian burgs like Dade City, Fort Myers, and Saint Petersburg, with others in Illinois, Oklahoma, Tennessee, New Mexico and elsewhere: