Tag: California

Independent medical reviews dip in California: Study

Independent medical reviews dip in California: Study

The volume of independent medical reviews in California declined in 2017 for the first time since the state adopted its practice of reviewing medical claims for injured workers, according to a report released Thursday by the Oakland, California-based California Workers Compensation Institute.
The Division of Workers Compensation data show 3,808 fewer cases in 2017 than in 2016, which translates to a 2.2% decline, the institute announced in its study.
State lawmakers adopted review standards in 2012, anticipating that once doctors, attorneys and others came to know which services could be approved as meeting evidence-based medicine standards the process would reduce treatment disputes, but 2017 marks the first time in the five years since its inception that IMR volume has declined, the institute stated in the report.
Further study of 648,450 IMR decision letters issued from 2014 to 2017 found that outcomes were unchanged as reviewing physicians again upheld 91.2% of modified or denied medical service requests that they reviewed, the institute revealed.
The figure remained unchanged since 2014.
The mix of service requests reviewed by IMR physicians in 2017 showed only minor changes from 2016.
Prescription drug requests — 29.1% of which were for opioids — again accounted for the largest share of the review requests at 46.0%, down from 47.9% in 2016, the study showed.

Nearly half of Calif. injured workers on opioids weaned after two years: Study

Nearly half of Calif. injured workers on opioids weaned after two years: Study

A new study found that 47% of injured workers with chronic opioid use weaned off the painkillers completely within 24 months and that those who did not wean reduced their opioid dosage by an average of 52%, the Workers Compensation Insurance Rating Bureau of California announced Thursday.
The Oakland, California-based ratings agency studied its databases of medical transaction records and unit statistical reports since July 2012 to examine the cost implications of chronic opioid use and the process of weaning injured workers off opioids statewide.
The study also found that claims involving chronic opioid use cost more than nine times in physician services than the average workers comp claim and that the median time from chronic opioid use to weaning completely was eight months.
Meanwhile, the median time from accident date to when the worker was weaned off completely was 19 months.
The study also examined types of injuries treated, finding that “over 80% of transactions associated with chronic opioid claimants had primary diagnoses of soft tissue injuries.
Injured workers who weaned off were more likely to have Nature of Injury codes for Fractures, and less likely to have Unspecified Injuries than those who did not wean off.”

California statute of limitations for temporary disability awards upheld

California statute of limitations for temporary disability awards upheld

Reprints Gloria Gonzalez A California appeals court nullified an award to an injured worker for temporary disability benefits occurring five years after the employee’s injury.
While employed by the county as a deputy sheriff, Kyle Pike suffered an injury to his right shoulder on July 31, 2010, and was granted a 12% permanent disability award in May 2011, according to court documents in County of San Diego v. Workers’ Compensation Appeals Board and Kyle Pike.
Mr. Pike sought to reopen the petition and receive temporary disability benefits on May 26, 2015, arguing that his shoulder injury had worsened.
The county paid all benefits owed to him for the five years from the date of the injury up to July 31, 2015, but declined to provide additional benefits after that date.
A workers compensation judge issued an order determining that Mr. Pike was entitled to the additional benefits — a decision upheld by a majority of the board, which concluded that the judge was “authorized to award temporary disability indemnity within the five-year period, to continue until the 104-week limitation is exhausted or period of temporary disability ends.” However, the dissenting board panel member concluded that the language of the statute “is not susceptible of an interpretation that permits an award of temporary disability more than five years after July 31, 2010, the date of (Mr. Pike’s) injury.” In its appeal, the county argued against awarding temporary disability payments for periods of disability occurring more than five years after the date of the underlying injury that Mr. Pike suffered while working for the county.
The question at the heart of the appeal is “straightforward,” the Court of Appeal, 4th Appellate District, Division 1 in California said in ruling in favor of the county, concluding that the plain language of the statute indicates that the county’s view was correct.
The court annulled a board order affirming the judge’s order awarding the temporary disability benefits beyond the five-year period.
The appeals court remanded the case to the board with directions to grant the county’s petition for reconsideration.
Attorneys of record for multiple parties involved in the case could not be reached for comment.

California comp dispute resolution could slow amid QME shortage

California comp dispute resolution could slow amid QME shortage

Qualified medical evaluators are qualified physicians certified by the California Division of Workers’ Compensation Medical Unit to examine injured workers to evaluate disability and write medical-legal reports used to determine an injured worker’s eligibility for workers compensation benefits, according to the division.
In California’s workers comp system, the medical-legal process includes a panel, or list of three qualified medical evaluators, issued to an injured worker when a question arises about whether or not an injury is work-related or if there is a medical dispute that has not been resolved by the treating physician’s report, according to the division.
The number of qualified medical evaluators declined 20% between January 2012 and September 2017, according to a recently released California Workers Compensation Institute study.
The study compared data from the list of physicians certified in California as QMEs in 2012 to the certified QME list from September 2017 to analyze changes in the QME population.
“If you look at the average age of the people who do most of the medical legal evaluations, they are a lot of the baby boomers,” said William Zachry, San Francisco-based senior fellow at the Sedgwick Institute.
In California, there has always been a problem with getting good medical legal evaluations in the rural area … that is one of the challenges that has been problematic for as long as there has been comp in California.” Despite the drop, available QMEs are taking on more evaluations, said Mr. Zachry.
“The question becomes quality and timeliness: Are the injured workers having to wait a long time to get an evaluation?” he said.
Other experts say that the QME drop will have a definite effect.
“It doesn’t matter whether they have 1, 2, or 5 offices, less QMEs means longer wait time for appointments and for reports.” The division should be actively recruiting QMEs in the specialties of urology, pulmonary, gastrointestinal and oncology as well as increasing the overall numbers.
“Less friction and more timely evaluations and reports.”

California sees drop in qualified medical evaluators

California sees drop in qualified medical evaluators

The number of qualified medical evaluators who resolve disputes over California workers compensation claims fell 20% between January 2012 and September 2017, according to a California Workers’ Compensation Institute study released Wednesday.
The study compares data from the list of physicians certified in California as QMEs in 2012 to the certified QME list from September 2017 to analyze changes in the QME population.
The average payment per medical-legal service leveled off in 2015 and 2016 after climbing steadily from 2007 through 2014, with data from the first half of 2017 suggesting the average may now be declining, the CWCI said in the study.
The majority of job injury claims involve musculoskeletal injuries, and orthopedists provided more than half of all medical-legal services in both 2012 and 2017, according to the study.
They represented only one in six QMEs in both years.
One in five QMEs was a chiropractor, but they only accounted for 5.1% of medical-legal services in 2012 and 6.7% in 2017, according to the study.
In 2017, orthopedic surgeons, spine specialists or chiropractors, or mental health specialists accounted for almost 70% of all medical-legal services.
More than 85% of injured workers who requested these specialists would have access to five or more QME’s within a 30-mile radius, according to the study.

US jobless claims drop to near 45-year low

US jobless claims drop to near 45-year low

WASHINGTON (Reuters) – The number of Americans filing for unemployment benefits fell to a near 45-year low last week, pointing to strong job growth in February, which should continue to underpin the economy.
Initial claims for state unemployment benefits dropped 7,000 to a seasonally adjusted 222,000 for the week ended Feb. 17, the Labor Department said on Thursday.
While that probably distorted last week’s data, the underlying trend in claims was consistent with a robust labor market. “Firms are extraordinarily unwilling to part company with workers reflecting, in all likelihood, the difficulty of replacing them,” said John Ryding, chief economist at RDQ Economics in New York.
The four-week moving average of initial claims, considered a better measure of labor market trends as it irons out week-to-week volatility, fell 2,250 to 226,000 last week.
The four-week average of claims dropped 17,500 between the January and February survey weeks, suggesting solid job growth this month.
Payrolls increased by 200,000 jobs in January.
Strong employment gains in February would seal the case for an interest rate increase next month.
The Fed has forecast three rate increases this year.
The four-week moving average of the so-called continuing claims fell 16,250 to 1.93 million.

Riverside County supervisors pass resolution in support of DACA recipients

Riverside County supervisors pass resolution in support of DACA recipients

After an hour of emotional public testimony, the Riverside County Board of Supervisors unanimously approved a resolution to support the plight of DACA recipients.
The resolution urges federal legislators to provide a long-term solution that would allow participants of the Obama-era program – more than 13,000 of whom live in Riverside County – to remain in the country with a pathway to citizenship.
More: As Trump calls for border security, Coachella Valley youth vow to keep fighting for DACA “I don’t want my taxes going to anybody but law-abiding citizens,” speaker Judi Neal told the supervisors.
Agnes Gibboney told the board that they “should not reward illegal aliens.”
We owe American citizens everything.” “These dreamers are Americans, in their hearts, their minds in every single way but one: on paper,” Terrell told the board.
More: Here’s where you can get help applying for DACA in the Coachella Valley right now They have taken a special role in the debate around immigration, because of the circumstances under which they entered the country.
To qualify, applicants had to have entered the country under the age of 16 and have continuously resided in the U.S. without legal status for at least five years including the day the order was signed.
The employment of unauthorized immigrants was one of many brought up during public comment. “If we debate federal issues, there’s going to be no limit to the issues we are going to be debating,” Jeffries said.

California workers comp breast cancer bill moves forward

California workers comp breast cancer bill moves forward

A bill that aims to better align evaluations of work-related breast cancer with national standards is moving forward in California.
The state Assembly on Monday voted unanimously in favor of A.B.
497, sponsored by Assemblywoman Lorena Gonzalez Fletcher, D-San Diego.
The bill would require the state to utilize the American Medical Association’s guidelines on breast cancer evaluations and prevent doctors from using “child-bearing age” as a factor in determining the workers compensation award for a female employee whose work conditions caused her breast cancer, according to the bill, which now heads to the state Senate.
“It’s crazy that women with job-related breast cancer have to jump through so many hoops just to receive the compensation they’re rightly owed,” said Assemblywoman Gonzalez Fletcher in a statement.
Under the AMA guidelines, doctors are required to evaluate injured workers for all impairments that result from breast cancer and its treatment.
Assemblywoman Gonzalez Fletcher’s office accused the state’s current practice as running “afoul of guidelines set forth by the American Medical Association.”

Calif. retailer sentenced to prison for tax, workers comp fraud

Calif. retailer sentenced to prison for tax, workers comp fraud

The owner and operator of a Southern California retail chain was sentenced to two years in prison for sales tax evasion, false income tax returns, failure to pay taxes and workers compensation fraud, California Attorney General Xavier Becerra announced Wednesday.
Between 2010 and 2016, Jeong Kim, owner and operator of more than 50 Los Angeles-based Fashion Q and Q stores in Los Angeles, Orange, San Diego, San Bernardino and Ventura counties, failed to report more than $29 million in taxable sales, more than $39 million in taxable income, more than $8 million in wages, and evaded payment of $5.6 million in sales, income and payroll tax.
The owner also failed to report more than $7 million in wages to his insurance carriers and evaded payment of $353,792 in workers compensation insurance, according to a press release.
“Failing to pay payroll taxes, sales taxes and workers compensation insurance hurts employees, our local communities and businesses that are playing by the rules,” said Attorney General Becerra in a press statement.
“The California Department of Justice will continue to hold criminals accountable and protect the pockets of Californians who pay their fair share.”

Former hospital owner sentenced in multimillion-dollar kickback scheme

Former hospital owner sentenced in multimillion-dollar kickback scheme

A federal judge on Friday sentenced the former owner of a California hospital to 63 months in prison for leading a 15-year fraud scheme involving millions in illegal kickbacks paid to medical professionals in exchange for referring thousands of workers compensation patients for spinal surgeries.
Investigators found that from at least 1997 through 2013, Michael Drobot, who owned Pacific Hospital in Long Beach, California, ran a scheme in which he billed more than $500 million in fraudulent surgeries, much of which was paid by the California workers compensation system, according to a statement released Friday by the U.S. attorney’s office for the Central District of California in Los Angeles.
Mr. Drobot, 73, of Corona Del Mar, California, pleaded guilty in 2014 to charges of conspiracy and paying illegal kickbacks, admitting that he orchestrated a wide-ranging fraud scheme in which “(t)housands of patients received surgeries at Pacific Hospital not knowing that (Mr. Drobot) bribed their physician to perform their surgery at Pacific Hospital,” prosecutors wrote in a sentencing memorandum filed with the court, which was included in the statement.
It said Mr. Drobot “was motivated by greed and ultimately profited millions of dollars through the scheme.” The scheme involved dozens of doctors, chiropractors and others who were paid illegal kickbacks, according to the statement.
“The patients believed that they were receiving conflict-free medical advice when, in fact, (Mr. Drobot) illegally incentivized their physician to perform the surgery at Pacific Hospital,” the statement said.