Wednesday, November 13, 2013

Work Comp Lost Focus

As part of a cadre of bloggers that write about workers' compensation, one of the questions we are often asked to address is, "what is wrong with workers' compensation?".

The California Division of Workers' Compensation largely answered that question by announcing that they have issued a new, mandatory, Form 105 for unrepresented workers to request a panel qualified medical examination.

The new form is at Take a look at it, and tell me if you were not savvy about workers' compensation if you would not be intimidated and/or befuddled by this monstrosity of bureaucratic irrationality.

I know what the administration was thinking when this form was developed - that claims administrators would be the primary users.

But if it is an unrepresented injured worker the amount of data required, the exact procedure to be used, and the terms contained within the form all conspire against a fair outcome for the claimant.

For instance, is an injured worker going to understand that the reason for a QME panel request is based on Labor Code section 4060, 4061 or 4062?


And unless your claim is relatively simple, are you, as an unrepresented, likely unsophisticated consumer of workers' compensation resources really going to know which medical specialty should be performing the services?


And how about this daunting, foreboding warning: "If you do not select a QME from the panel, schedule an appointment with the QME and inform the employer/insurer of the choice within 10 days of the date the Medical Unit issued the panel, you may lose the right to choose the QME and the exam date."

Makes me want to run straight to the closest applicant's attorney I can find. I don't want to lose any rights, but I don't even know what my rights are, let alone having to deal with all of these time deadline pressures while simultaneously trying to recover from my injury!

I understand where DWC is coming from - they need to implement forms, procedures, actions that comply with the law. The legislature told the agency what it wants, so the agency is delivering what it interprets the needs are by issuing forms and rules.

These forms and rules deliver to the agency what it needs.

The problem is that these forms and rules assist the agency, not the injured worker.

In other words, Form 105, its mandatory nature, and the information required/requested (and the bewildering decisions required of an uninformed public) are forced upon persons with little to no understanding of what they are doing, let alone the impact such decisions can have on the outcome of their claims.

All during an exceedingly stressful period.

It's unnecessarily complex, confusing and harms injured workers.

The single biggest problem with workers' compensation, at least in California (and likely many other states) is that it has become a system to support itself, rather than the primary constituents - injured workers.

We have lost focus.

Want to "fix" workers' compensation? Get rid of this madness. Return to simplicity. Allow an injured worker to dispute a medical determination without debilitating rules, complex forms, procedural mandate.

Years ago I visited with Bryan Nix, the head of Nevada's administrative hearing officers, which included the state's workers' compensation system. He was very proud to show me that all an injured worker had to do to request a hearing was put the case number on a piece of paper - could have been a napkin - with the words, "I want a hearing."

I don't see why we can't be that simple.

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