So imagine the surprise when I read that a broker backed interest group is seeking new legislation in California to constrict benefits to injured workers claiming cumulative trauma (CT) and psyche injuries, and taking on chiropractors and "AGO" (Almaraz/Guzman & Ogilvie - a pair of court opinions that critics say detrimentally eroded objective disability ratings contrary to the intent of the 2004 reforms implementing the AMA Guides 5th).
Jamie Reid, a broker at the Michael Ehrenfield Co. Insurance Agents & Brokers firm in San Diego County, together with broker Gabe Erle, last year started Workers’ Compensation Fraud Fighters.
They are seeking laws that would:
- Determine an objective disability rating system for cumulative trauma.
- Eliminate the ability for injured workers to file psychological claims or other stress claims.
- Prohibit chiropractors from serving as medical evaluators and eliminate the requirement that a medical provider network include chiropractors.
- Restore the objectivity in disability rating that has been eroded by the Almaraz/Guzman and Ogilvie court decisions.
The group uses the same tired arguments for "reform" that have been tirelessly used in the past and which just don't hold water: employer flight, carrier contraction, increasing costs.
Reid said Nevada and other states have been targeting California business owners using workers’ compensation costs as one of the reasons to relocate.
Nevada has always targeted California businesses with a more favorable tax situation, cheaper real estate, and cheaper labor. Nevada would LOVE California businesses to come rescue the worst unemployment rate in the nation - but let's face it, that AIN'T happening.
The insurance market is hardening - that is no surprise. Reid says the market has already hardened. I don't think so. Yes, rates are going up, and carriers are being more selective in their risks, but there are only a few that seek double digit increases and they are small carriers with very little market share. The big market share is relatively stable - it is still a competitive market.
The experience modification standards are changing, but that is an attribute of the Workers' Compensation Insurance Rating Bureau (WCIRB) fixing a system that hasn't changed in many years and didn't reflect economic growth and other changes.
And of course costs are increasing - they always increase. That's called inflation. It is a normal fact of financial life. Where they increase, how much they increase, and what stimulates the increase are more what the issues and debate should be about.
Why does there need to be a different rating system for CT claims? That makes no sense. On one hand this group wants consistency in ratings, and on the other they want a different standard for CT claims - completely illogical.
Labor Code 3208.3 was put into law in the late 1990s to curb psyche claim abuse - mainly targeted at psyche "mills" that used the lax standard of "injury" to generate profits for reporting and treatment for mental issues that the general population would not consider injurious.
Chiropractors were targeted with limitations on the quantity of treatments they could provide without further authorization to curb the endless cycle of lifetime care some would prescribe that would go beyond generally accepted recommendations.
"Objectivity" in the medical-legal sense is a subjective term - even the authors of the AMA Guides essentially admit that there is no way to objectify every element of impairment and converting impairment to disability is still fraught with subjective determinations.
So I am perplexed at what this group is really trying to accomplish, and why it is coming from insurance brokers - a group of insurance professionals that are more concerned generally with the underwriting process rather than the claims process.
Jesse Ceniceros, president of Voters Injured at Work, opined to WorkCompCentral that he thought that this latest maneuver was just changing the topic of conversation - a distraction to the present undercurrent of reform talks going on at the highest levels of the Brown Administration.
Ceniceros said injured workers won’t allow a repeat of 2004 and would consider a ballot initiative in 2013 “to eliminate work comp as we know it” if the reform proposal doesn’t provide fair and adequate benefits for injured workers.
“If the injured worker can’t be protected by these laws, what we need to do is eliminate (comp) and start over again,” he said. “If it can’t be reformed properly, we need to eliminate it altogether.”
Now THAT would be disruptive to the economy!