Wednesday, April 1, 2015

Give And Take


California is considering the adoption of a prescription drug formulary and a bill has been introduced into the Assembly directing the Division of Workers' Compensation to do so.

Assemblyman Henry Perea, D-Fresno, on Feb. 27 introduced AB 1124, on his own, rather than carrying the measure for a sponsor, according to his press secretary, Alicia Isaacs, in order to "start the conversation."

A formulary is essentially a list of approved drugs for which carriers would have to pay without much debate or review, if any.

The conversation had been started a couple of years ago, frankly, when the California Workers' Compensation Institute, among other research agencies, started noting the increasing burden that drugs have on the workers' compensation system in terms of costs, and the detriment to injured workers that were being given drugs for "off label" use - primarily opioid variants to control pain.

Bernardo de la Torre, president of the California Applicants' Attorneys Association, indicated to WorkCompCentral Monday that the organization isn't necessarily against a formulary, but that there must be alternative provisions in case a person can not tolerate a particular drug or if what is in the formulary is not effective.

He said a formulary should include all medications and drug therapies that are available for a covered medical condition. Additionally, CAAA believes a formulary that includes only generic drugs "constitutes an unreasonable restriction" on the treatment of injured workers, he said.

Finally, he said prescriptions for a formulary drug from a network provider should not be subject to utilization review and IMR, de la Torre said.

Inclusion of "all" medications and drug therapies for a given medical condition does not seem workable to me, but the other requests seem reasonable.
Abraham Verghese on the failed human component of medicine.

There are two extreme examples of drug formularies in existence now: Washington and Texas.

Washington is seen as a more conservative formulary and much more restrictive than the one adopted by Texas a few years ago.

Both have been instrumental in controlling pharmaceutical expenses and have resulted in fewer opioid consequences - largely because those drugs aren't authorized for much.

In the WorkCompCentral article, president of Voters Injured at Work, Jesse Ceniceros, was critical of the talk of a formulary adoption, characterizing the plan as another attempt at cutting benefits under the guise of controlling costs.

"Who's saving what? All they're doing is taking away," he said. "It continues year in and year out."

And frankly Ceniceros makes a good point - study after study has affirmed that different treatments, such as physical therapy and cognitive pain management adaptations, are as good if not better than a fistful of drugs.

But by and large workers' compensation does not pay for these alternatives, or does not pay adequately so physicians are loath to engage them.

Reimbursement rates for office visits, where bed side listening can occur and is often very effective (sometimes folks just need someone to "listen") are generally too low, if there's any reimbursement at all, so physicians don't practice this important part of the care delivery equation.

In California, chiropractic therapy is limited to 24 visits - an artificial number that was a compromise arrived at when there was huge abuse by a few bad apples in the chiropractic community. But certainly there are instances when paying for an adjustment is cheaper than paying for the aftermath of prescription drugs gone bad.

In other words, what has happened over time is that treatment alternatives have been constricted so that handing an injured worker a bottle of pills is the only reasonable option.

We certainly can't discount the financial incentives that drug manufacturers and their distributors wave in front of physicians either - these conflicts of interest exacerbate an already volatile situation.

But, as Abraham Verghese pointed out in his excellent TED talk that I blogged about some time ago, there is a medical ritual that is transformative to patient healing: listening and then examining. The message this conveys to the patient is, "I will always, always, always be there. I will see you through this. I will never abandon you. I will be with you through the end."

Workers' compensation on the other hand seems all about abandonment.

Imagine if workers' compensation actually communicated "I will always be there."

So here's the bottom line:

The debate over a drug formulary needs to include as discussion points exclusion of formulary prescriptions from utilization and independent medical reviews, and a review of alternative therapies that can take the place of drugs in the first instance with adequate reimbursement schedules to promote those alternatives.

Give and take. Don't just take.

Tuesday, March 31, 2015

Bragging Rights

"The fish REALLY was THAT big!"

In perhaps the biggest news of the year in California workers' compensation is the real possibility that the Workers' Compensation Insurance Rating Bureau may ultimately recommend a near double digit mid-year rate decrease.

If this occurs this would be the first mid-year filing since 2012 and the first recommended decrease since 2007.

In 2012, the WCIRB recommended a 9.1% increase in the advisory pure premium rates effective July 1.

In 2007, the Rating Bureau recommended an 11.3% rate reduction in the middle of the year.

Mid-year filings are important to the insurance industry because they have been a consistent barometer of where the market is going. In most years, when the WCIRB submitted a mid-year filing the recommended change has been close to what gets recommended in the WCIRB's subsequent annual filing.

What's holding up any recommendation at this point is finalization by actuaries of certain loss adjustment expenses.

Giovanni A. Muzzarelli, a senior casualty actuary for the Insurance Department, told WorkCompCentral Monday the loss-adjustment expense methodology pointed to an approximate 5% increase in those costs.

But taken against the 13% decrease indicated by trends on benefit costs, and accounting for the fact that loss adjustment expenses are not a direct one-to-one offset against benefit trends, "it sounds like it's ending up minus 10-ish," Muzzarelli said.

Dave Bellusci, WCIRB executive vice president and chief actuary, would not speculate on how the Governing Committee would actually vote; a vote on whether to submit a mid-year filing for 2015 when members meet today at 9:30 a.m. in Oakland, CA.

So far, here's what the numbers are reflecting:

Allocated loss-adjustment expenses, costs that can be attributed to a specific claim, increased 12.1% from 2013 to 2014.

In 2014, carriers paid $886 in ALAE per indemnity claim at the 12-month valuation point, up from $790 in 2013. The WCIRB speculates that this increase experience is related to the Workers' Compensation Appeals Board decision in Dubon I, which provided an invalidation path on independent medical reviews. Dubon II closed that hole, but issued too late in 2014 to affect the numbers.

"In addition to IMR, we saw a big spike in expedited hearings and prior to Dubon II, there were challenges to the expedited hearing," Bellusci said. "So you had this dual-track, you had to go to IMR, but you're also paying lawyers to attend the expedited hearing."
The Rating Bureau is projecting from 2013 to 2014, estimated ultimate ALAE per indemnity claim will increase 12.3%, following a 5.7% increase from 2012 to 2013.

The WCIRB is projecting the ultimate ALAE per indemnity claim will account for 19.6% of losses for policies incepting on or after July 1, 2015. The Jan. 1, 2015, pure premium rate filing projected an ALAE-to-loss ratio of 15.4%.

Unallocated expenses, those costs that are not directly attributable to specific claims, such as office rent and overhead, is now projected to be 6.5% of losses for policies incepting July 1, 2015, compared to the 5.5% ratio projected in the Jan. 1 filing.

Paid medical cost containment per open indemnity claim increased 4.7% in 2013 to $1,019 from $973 in 2012, consistent with the Rating Bureau's severity trend that assumes a 5% annual increase.

Of course, California is an open market, and carriers can rate as they please, and rates don't necessarily translate to net paid premium, which has a host of other factors more personal to an employer's actual experience.

But this news certainly gives SB 863 proponents something to brag about.

Monday, March 30, 2015

Year of Awareness

This is The Year of Awareness.

Awareness by the General Public about workers' compensation issues.

There is the series by ProPublica, with 3 installments so far, and more to come. You might not like it, but Michael Grabell and his team are accurately portraying pain points in workers' compensation.

The Federal Occupation Safety and Health Administration's review of the literature over the past couple decades also fuels the fire about the inadequacy of workers' compensation, and the spill of employer obligations onto the general taxpaying population.

Last year the Texas Tribune ran a series, "Hurting for Work" that criticized that state's work injury protection system (or lack of it).
Is this the road to enlightenment?

And a Florida trial judge has taken the position that work comp is no longer of Constitutional grade.

Now, Mother Jones has published an article it says exposes the true intent of the opt-out movement: to take a model of unaccountable diminution of benefits across the nation.

Opt-out supporters contest that conclusion and say they only want employers (in this case, only Big Business can afford the resources to opt out) to be able to provide better benefits in a more consolidated manner to their workers.

They are not, however, shy in confirming that their intent is to take opt-out nationwide, to all states.

The latest test case is Tennessee, where Senator Mark Green's SB 721 has gone through several amendments in an attempt to address critics - albeit in my opinion these amendments fall far short.

There are two major issues with opt-out, and in particular with SB 721 if it is to be used as a model: 1) capping life time medical benefits; 2) no accountability to public regulators.

Most state workers' compensation systems have a limitation on both temporary disability indemnity and permanent disability indemnity.

There is, and has been for a long time, a debate as to the adequacy of indemnity benefits to keep the paycheck-to-paycheck worker sustained during recovery and those benefits differ greatly from state to state. This debate is sure to continue regardless of what "reform" ever gets passed.

This debate also applies to the adequacy of permanent disability indemnity; whether it adequately compensates for the loss of an eye, etc. Again, where one gets hurt makes a huge difference in how much money a disability is "worth," and the debate about this adequacy will never settle.

The provision of medical benefits for the lifetime of an injured worker, however, has never been on the table - that is a topic that is simply sacrosanct, for the very simple reason that it was part of the Original Grand Bargain.

State reforms have, however, over the past two decades done as much as possible to eviscerate life time medical by requiring adherence to guidelines, by scaling based on co-morbidities, by forcing third party reviews, by trimming reimbursement and/or rebalancing fee schedules, among other tactics.

These efforts have been in reaction to perceptions that employers are unfairly paying for someone else's problem, or because of abuses in the right to lifetime medical by unscrupulous providers. Broad brush attempts to correct these issues reel in unsuspecting victims, like tuna nets capture innocent dolphins.

The Mother Jones article is critical of the lobbying efforts of the Association for Responsible Alternatives to Workers' Compensation, implying that its big company sponsorships and money spend is sinful.

It's not - it's just political reality. Just because a bunch of people with resources get together on a specific mission is not a reason to castigate either the people or the mission. It's done on both sides of nearly any debate. That's how we do things in America.

Painful as it is for this industry, though, the fact is that workers' compensation is under attack - from all sides.

Employers are sick and tired of the cost of the system and how little control they have over it. They're paying for it and don't see much if any value or return on investment.

And guess what? Workers who go through workers' compensation are likewise sick and tired over the cost of the system and how little control they have over it. They are the beneficiaries of what employers buy, but don't see much value if disputes are piled on top of the trauma of injury sequelae.

Is this the fault of us, the professionals who are tasked with administering benefits?

In part, yes.

But the larger issue is what society wants and what all this attention lately is telling me is that society wants a way to provide security to both business and workers.

In a manner that is better than what workers' compensation has devolved into.

I don't view opt-out as evil. I do view it as a necessary element in the debate about the adequacy of workers' compensation to deliver on its original promise: protect employers from economic ruin when someone gets hurt, and protect the worker who is the unfortunate victim of getting hurt.

If you take ARAWC's mission at face value, what the group wants to do is laudable. They are saying that state work comp systems no longer are a viable piece of the social contract; that private industry can do it better.

Maybe it can, if there are reasonable protections that meet the essential elements of work injury protection and that means taking care of an injury for life and not stacking dispute resolution in favor of one party or the other.

But this column isn't about ARAWC, or opt-out; it's about an awareness that is developing.

Workers' compensation used to hide in the shadows of health care and disability. Ask anyone just a few years ago about work injuries and you'd get an earful about "workman's compersation" and how a neighbor is cheating the system.

Now the public is beginning to ask: What are all these businesses doing for their pay when there's all these people that are being thrown to the curb for trash pick-up day? Why are businesses paying for services that don't seem to be delivered on time or in enough quantity? How is it that an insurance company that agreed to take care of an injured person for life can delegate that obligation to public welfare?

As I see it, the public assault on workers' compensation, the trend that is developing towards opt-out systems, and the overall malaise that seems to have settled over work comp portends a much needed, long deserved, debate.

The public is asking questions. Hard questions.

Because the public isn't seeing the value in work comp that had been promised (and delivered) for so long.

We're entering into a whole new era of Business versus Labor dispute. The Haves and the Have Nots are drawing lines in the sand.

The last time this happened the Federal government threatened imposition. It could happen again.

What we rely on for work injury protection systems will be vastly different in 10 years than what exists now. It's clear to me this is what's happening.

Less clear is what will actually exist in 10 years.

Friday, March 27, 2015

It's A Digital World

If one waits long enough opportunities appear, almost magically.

Early EAMS observers will remember this scene...
Medical records reproduction companies in California have been waiting now for 2 years to get a fee schedule.

Still waiting.

In the meantime the California Division of Workers' Compensation has come up with an alternative revenue generation program for them assuming the record companies wish to adapt and change their business models: mandating electronic medical records for the review process, specifically Independent Medical Review.

Timely submission (and more to the point, receipt) of medical records has been cited as a significant problem with the IMR process.

WorkCompCentral ran a series of articles a couple weeks ago based on a spreadsheet inadvertently obtained from Maximus Federal Services, the IMR contractor for California, highlighting the records problem.

Commentators, and the Division itself, lay a big chunk of the blame on Maximus for failing to have an adequate records management system.

Based on the spreadsheet, 6,743 IMR cases were missing medical records past the 15-day time limit for administrators to submit the documents. The records had been missing for 90 days or more in the majority of those cases.

Rupali Das, the Division of Workers' Compensation's medical director, presented statistics at Thursday's Commission on Health Safety and Workers' Compensation's review of SB 863 showing that the amount of time Maximus takes to issue a final determination letter dropped from an average of about 60 days in September last year to 24 days this month – but only in cases where complete medical records have been submitted. 

The average age for an IMR, including cases where Maximus has yet to receive records, has risen from about 60 days to 91 during the same time period.

DWC is now proposing that electronic records be mandated to hopefully eliminate this records management issue.

“One of the main issues right now is the paper process that is slowing down our (system),” Das said, noting during the meeting that claims administrators can already provide medical records electronically if they choose.

“We are working with claims administrations to encourage electronic submission of medical records,” she told the commission.

CHSWC voted to endorse the proposition and voted at its Thursday meeting to ask DWC to devote staff time to the issue with an aim toward putting out regulations.

I think this is a good idea, IF done correctly - it's one thing to mandate TRANSMISSION of electronic records, and another to mandate RECEIPT of electronic records.

Remember the key issue seemed to be failure by Maximus to match records to cases, so expert technical guidance will be necessary to promulgate effective regulations on a technical level to ensure smooth, accurate and seamless digital transactions. 

The sender has to be told what to send, and Maximus has to be told how to receive what is sent.

It occurs to me that the much-maligned document copy services have this expertise in place already; perhaps in this new age of records management these companies actually have a compelling place in the system post SB 863.

Regardless, this is a positive step towards modernizing California's system. 

My only caveat - recall all of the painful lessons from the design, development, release and maintenance of the Electronic Adjudication Management System...

Thursday, March 26, 2015

Henley's Song


Yesterday fellow blogger Bob Wilson of WorkersCompensation.com wrote that Tennessee's pending opt-out bill, SB 721, was "complete and utter bullshit."

Wilson chastised the proponent's attempt to cap medical costs at $500,000, which was recently increased from the really miserly $300,000.

As Wilson states, "That means an employee with catastrophic injuries such as paralysis or Traumatic Brain Injury will be eligible for treatment up to the point where they meet the $500,000 threshold. Then their sorry asses will be rolled to the curb, waiting with the trash. Their only hope of refuge at that point will be for the Medicare/SSDI bus to roll by and pick them up."

Curiously, a big segment of the insurance industry seems to agree.

The other day the American Insurance Association has released a statement calling SB 721 “an uncommonly bad bill” because it “eliminates an entire genre of benefits.”

“Indeed, the bill’s mandated plan benefits do not provide for any permanency benefits: No permanent partial or permanent total benefits. It eliminates lifetime medical benefits, capping medical at $300,000 [at the time of the statement, since raised to $500,000], thereby jeopardizing treatment of workers with the most serious injuries,” the statement said. “Nor are there funeral benefits, nor for ancillary benefits common in workers’ compensation systems – van and home modification, custodial care, hearing aids, and artificial limbs.”

Those concerns were recently addressed by the same amendment that increased the medical cap:
  • Permanent partial disability benefits of at least 70% of the employee’s AWW, up to 110% of the state AWW, based on the criteria of the American Medical Association’s Guides to the Evaluation of Permanent Impairment that is in effect when the employee’s impairment is rated. The benefits are subject to a whole-body maximum of 405 weeks.
  • Permanent total disability benefits of at least 70% of the employee’s AWW, also capped at 110% of the state AWW, for at least 260 weeks or whenever the employee becomes eligible for Social Security benefits, whichever is later.
  • Death benefits either three times the employee’s average annualized wages or $300,000, whichever is less. If the deceased employee does not leave a surviving spouse or dependents, however, the death benefit may be reduced to no less than $20,000. The death benefit will include a funeral benefit of at least $7,500 for burial expenses. However, any other disability benefits payable to the employee may be deducted from the overall death benefit.

The worst part, AIA says, it is the employer who determines what an occupational injury is and the appeal process is limited to whom the employer pays for arbitration - i.e. the proverbial loaded gun.

Though Green's bill was recently amended to add minimum disability indemnity rates for both permanent and temporary disability, the truth of the matter is that SB 721 plays right into recent criticisms of the evolution of workers' compensation in the general media - it distinctly and intentionally pushes an employer's responsibility onto the public sector.

For instance, permanent total disability benefits are to be paid for at least 260 weeks or whenever the employee becomes eligible for Social Security benefits, whichever is later.

An employer's failure to properly manage its safety and claims management system should not be the responsibility of taxpayers.

A Tennessee employer's opt-out insurance policy, under the present SB 721, can have limits - presumably after that money runs out then there is no insurance, and, as Wilson states, the worker is put out with the trash.

Trey Gillespie, senior workers’ compensation director for the Property Casualty Insurers Association of America, told WorkCompCentral, “They created some interesting window dressing to make the bill look better. But it doesn’t change how opt-out works. And it really doesn’t give the injured worker any additional protections.”

Part 3 of the NPR/ProPublica series critical of worker's compensation as reformed over the years has been released, with vignettes of terrible things happening to good people because of the constant attack on benefits: caps on TTD, constrictions on care, blame on pre-existing conditions, revisiting previously approved treatment.

My guess is that the industry will again attack this piece of journalism for sensationalizing the worst cases, ignoring the majority of successful cases, and vilifying carriers and administrators.

Tough - these are the cases that need to be put out into the public view because there's no excuse for them. These are the cases that for which insurance is created. These are the cases where REAL help is needed, not constrictions, obstacles or obfuscations.

This is the backdrop against which opt-out plays.

As Wilson so aptly stated, "The push for opt out is, in my opinion, a reaction to failures and shortcomings within our own system."

Exactly. Will opt-out be passed in Tennessee? I think it will - the political power is in place to make that happeh. Will opt-out spread to even more states? Probably - those that back it, Big Business, have powerful lobbies everywhere they do business and opt-out is beneficial to the bottom line. Does anybody give a rat's ass? Not until their medical treatment has been delayed to the point where disability indemnity has run out so they can't afford to undergo such treatment.

Then they can be highlighted in a ProPublica article.

"Kick 'em when they're up, kick 'em when they're down." Don Henley was writing about gossip media, but he just as well may have been singing about the uninformed masses.

Don't you think the signs are there and that the message is loud? Work comp is being attacked with legislative options and public criticism because there are too many times when it doesn't work.

I love the good things that work comp accomplishes. Unfortunately, no one wants to face the truth: there are way too many times when it doesn't work.

"Dirty little secrets, dirty little lies
"We got our dirty little fingers in everybody's pie
"We love to cut you down to size, we love dirty laundry"

Yep - Henley's song IS about work comp.

Wednesday, March 25, 2015

A Family Affair

One of the interesting things about workers' compensation law is how it can differ from state to state, and how the "arm" of the law can extend to people who may, or may not, be intended to be covered.

Indeed, exclusive remedy is a tricky fellow.

For instance, recently the Texas Supreme Court extended the protection of exclusive remedy beyond the actual employer to the insurance carrier handling a claim on the employer's behalf.

And it can go the other way too.

Last week the Kentucky Court of Appeals ruled that a worker's settlement of his comp claim didn't bar his widow from seeking death benefits after he died from his injuries.

Stephen Baytos sustained a torn thoracic aorta while lifting heavy boxes at work in February 2006.

Such an injury is often fatal, however, Baytos survived.

He settled his workers' compensation claim with his employer, the Family Dollar Stores, and accepted a lump-sum payment of $100,000 in exchange for a release of future liability.

After Baytos died in December 2009, his wife, Mamie, filed a motion to reopen his claim in order to seek death benefits.

Administrative Law Judge Richard Joiner ruled that she could reopen the claim only if she could prove that her husband's death had been caused by his 2006 injury.

When Joiner retired, Mamie's claim for death benefits was transferred to ALJ Thomas Polites. He found that Stephen's death was causally related to his workplace accident three years before and awarded Mamie death benefits.

Family Dollar appealed to the Workers' Compensation Board, which reversed. The board reasoned that Stephen’s agreement with Family Dollar prohibited Mamie from seeking death benefits, as her claim was derivative of his.

The Court of Appeals disagreed and vacated the board's decision on Friday based on a state Supreme Court case from 1930, called Brashear v. Old Straight Creek Coal Corp.

Brashear established that a surviving spouse's entitlement to death benefits is a "clear and separate right" from the worker's right to seek compensation in the first place.

Since the settlement agreement between Stephen Baytos and Dollar Store was not signed by Mamie, and the agreement did not include references to any future rights that she might have, the court found that Mamie's independent rights were not compromised.

Several states – including New Jersey, Idaho, Illinois, West Virginia, Colorado and New Mexico – share this view, the court noted.

Commentators to the WorkCompCentral story on the case say that the Kentucky court reached the right decision based on the law in that state, while others criticized it stating that it creates an unreasonable burden on employers to seek the signature of every dependent on a settlement.

So while workers' compensation may be the exclusive remedy for a worker's injury or death, that remedy may create rights and obligations that extend well beyond the actual worker.

The case is Baytos v. Family Dollar, No. 2014-CA-001053-WC.

Tuesday, March 24, 2015

Should Have Happened Earlier

The industry has taken the recent NPR/ProPublica series about workers' compensation hard.

Mark Walls of Safety National blogged a strong counterpoint. Robert Hartwig of Insurance Industry Institute published a terse challenge on the statistics. Others have lit up the various LinkedIn workers' compensation topic boards.

And the State of California's Division of Workers' Compensation has taken the series as a wake up call; perhaps some payers aren't playing nice after all...

Division spokesperson Peter Melton told WorkCompCentral reporter, Ben Miller, that a newsline it put out Thursday reminding payers and claims managers that Senate Bill 863 didn’t change their obligations to provide medical care to claimants was in response to the NPR/ProPublica investigation.
My daughter: "Look at yourself first."

The article told the story of Joel Ramirez, a warehouse supervisor in Rialto who suffered a spinal injury in 2009. Travelers paid for a home health aide for Ramirez for years, until SB 863 passed and the company allegedly cut off payments without a change in the claimant’s medical condition.

In addition to the newsline, DWC announced last week that it was auditing Travelers as a result of the story.

Other investigations have also been prompted by the series.

Retrospectively challenging old, pre-SB 863, medical awards via Utilization Review and Independent Medical Review is nothing new, folks tell WorkCompCentral.

Applicant's attorney Alan Gurvey told WorkCompCentral that he has seen the defense in many of his cases argue that SB 863 constituted a “change in circumstance” in seeking a UR/IMR combination in order to change the medical award, particularly when home health care is being provided.

Gurvey said it's simply an attempt at cost control, not an attempt to improve medical care.

“We'd had four orders after the agreement for the continuing provision of the home care and the defendant had filed a petition to terminate the agreement,” Gurvey said. “We went before the judge and the judge unequivocally said that without a change of circumstances she sees no reason why the agreement for the home health care provision should be changed. She said she would entertain penalties and attorney fees for having to try the issue when the defendant did not necessarily meet its burden to show change of circumstances.”

Last year the Workers’ Compensation Appeals Board issued a significant panel decision, Patterson v. The Oaks Farm, that said an injured worker didn’t need to go through utilization review to reinstate payments for a nurse case manager after her employer unilaterally cut off reimbursements.

Some defense people are arguing that such heavy handed enforcement is going to shy carriers away from voluntarily providing benefits.

That's nonsense in my opinion. There isn't any voluntary provision of benefits. Providing medical care is the law.

Discretion is the only option, and discretion should be meted carefully - DWC has said time and again that not everything needs to be elevated to UR and that, in accordance with case law, the claims examiner is the first line of UR and can approve or disallow any medical treatment request.

I for one am glad the NPR/ProPublica series is out and am glad the industry is up in arms about them - that means attention is getting paid to what we do, and more importantly exposing our shortcomings.

Work comp can and does great things for people in need ... most of the time. And certainly perfection is not possible. But improvement is always possible, and we as a industry should be committed to a continuous process of improvement.

Without critique, however, improvement can't be achieved. Critical review is essential to improvement. Criticism is hard to take, certainly, and the natural reaction is defensive.

The outliers on the bell curve of work comp care however, either the blatantly fraudulent claims or terribly catastrophic claims, comprise a small part of the overall experience, but make up a big chunk of the complaints. There's no reason why that has to be.

So what if NPR/ProPublica focused on disaster claims? So what if the stories are skewed? So what if the statistics used aren't representative?

If this is what it takes to bring those outliers back within the bell curve, so be it.

It's been said that negative press is better than no press at all, and I for one agree, particularly in these circumstances.

Maybe the industry doesn't like seeing itself in such negative light (the purpose of the series, by the way, wasn't to point out industry actions per se, but rather to challenge the adequacy of the laws). But sometimes one needs to look one's self in the mirror to observe the truth.

I'm heartened that the California DWC is taking action and doing its job in this instance.

Should have happened earlier.