Friday, March 13, 2015

Do Your Job

Bowzer senses trail skat...
It's time.

The California Division of Workers' Compensation, and the People of the State of California, deserve better treatment and respect for the law and the regulations.

The worker's compensation claims community in California obviously have a disdain for the rules, and the administration of the state needs to put on the "big boy pants" and do what it is authorized to do in order to get compliance from a rogue industry: impose and collect fines.

Based on the latest numbers accidentally leaked by Maximus, Inc. and acquired by WorkCompCentral, the contract Independent Medical Review company that is tasked with the final stages of IMR as a consequence of SB 863, claims payers don't take the system seriously.

There are 128 entities handling California workers' compensation cases that have at least one IMR case for which they have not submitted medical records in 90 days.

Ninety days.

The regulatory time limit is only fifteen days.

In the meantime there's some poor claimant at the end of that decision process waiting to find out if the treatment requested will be approved, and is likely getting indemnity benefits to sit around and wait, rot, or otherwise.

Records are still missing on 1,722 cases submitted to Maximus in December, January and February.

That's 26% of the 6,743 cases with missing records as of Monday. There are more cases with missing records from January of this year than any other period.

And while the number of cases with missing records decreased to 6,783 as of March 9, cases with records missing for 90 or more days increased to 5,021.

There are still 148 entities that have failed to submit medical records on at least one case, out of which 137 have fewer than 100 cases in which they failed to submit records, and 110 have 10 or fewer cases without records.

Seven entities have between 100 and 300 cases on which they've failed to submit records, while four entities have not submitted records on more than 500 cases.

Labor Code Section 4610.5(i) authorizes the division to assess penalties against an entity that engages in conduct that delays the IMR process.

California Code of Regulations Section 9792.12(c)(6) establishes a penalty of $500 each day IMR records are untimely, up to a maximum penalty of $5,000.

Maximum penalties of $5,000 for each of the 5,021 cases with records missing for at least 90 days would total $25.1 million.

Though the DWC said in November of last year that they're going to start fining violators, nothing has been done.

"DWC has not yet issued any Orders to Show Cause for not submitting missing medical records," Peter Melton, spokesman for DWC, told WorkCompCentral via email.

He did not answer the question of why the division has not started the process to assess penalties.

Folks, SB 863 and IMR is now over 2 years old. Frankly, this is simply unacceptable.

If the California DWC, and the system it regulates, is to have any credibility whatsoever, and if IMR really is going to work, then the bottom line is that DWC needs to fine AND COLLECT ON THOSE FINES, pursuant to its statutory authority.

The People deserve at a minimum that attention.

Stop fooling around, pull up those pants, and enforce the rules, DWC.

It's your job. That's what you're paid for.

Do your job.


  1. 4.5 months to do the last IMR I had, I have an AME appointment set for 6 months from now and I much rather wait this out over doing another IMR, at least I know I will have a fair shot.

  2. WOW hitting the out of the ball park again. So True.

    Labor and patients are getting taken for a ride in our broken comp systems as they are, state by state being used against one another to intently break WC admin laws at the bedside, knowing that it will take the iw's decades to ever get justice for the so called frivolous admin violations being imposed upon them. Many times on only a sniff and a grin and not the objective medical evidence. Sad. We NEED Federal over site to standardized the rules and police those rules, so as labor stop being fleece in our workers comp systems. Deny, Delay, & Defend. When what our Grand Bargain called for was Repair, Retrain, or Retire.

    1. I just love that little bowser. He's seems a lot like my little dog RAGE, he like to dig up the stuff, and then he just rolls in it. Im guess Im a lot like that as well. Hmm? I guess I have to work on modifying that behavior. Hmm? Peace and keep digging up them bone and ya know, the other stuff as well. Rock.ON