Published on January 30, 2017 by WorkCompCentral, authored by Sherri Okamoto
SAN DIEGO — Tensions ran high at the California Applicants' Attorneys Association 2017 winter convention on Friday when the administrators of the state comp system faced a packed ballroom to discuss their efforts at implementing the latest round of statutory directives from the Legislature.
The audience became increasingly restive as Christine Baker, the director of the Department of Industrial Relations, began singing the praises for changes wrought by the passage of Senate Bill 863 in 2012.
Baker credited this legislation with increasing the amount of permanent disability benefits available to workers and expediting the resolution of medical treatment disputes through the "more transparent" process provided by independent medical review.
Her upbeat remarks drew mutterings from the crowd, but only one person shouted out an objection regarding the difficulty he'd had in getting treatment authorized for a client.
The heckler was swiftly shut down by CAAA President-Elect Jason Marcus, who sternly instructed the audience that such conduct was not acceptable.
The appearance of Baker and George Parisotto, the acting administrative director of the Division of Workers' Compensation, was a break in tradition for CAAA, which in past conventions had featured a panel comprising commissioners from the Workers' Compensation Appeals Board. Once the audience settled down, Baker picked up the thread of her claim that the comp system has been improving, although she conceded that it is far from perfect.
She said it is "outrageous" when a worker is being denied something as simple as an ice pack or an over-the-counter pain medication. But, Baker said it is "equally outrageous" that other workers are simultaneously getting opioid medications and referrals for rehabilitation.
Baker suggested it was incumbent on everyone who participates in the system to keep "raising the bar for workers' compensation," and she said the administration is doing its part by cracking down on rogue doctors.
As of Jan. 1, the terms of Assembly Bill 1244 require that the DIR suspend doctors who are convicted of fraud from participating in the comp system. The bill also requires the Division of Workers' Compensation to freeze any liens filed by medical providers accused of fraud, and the dismissal of liens if the providers are convicted.
So far, Baker said, the DWC has placed a stay on more than 200,000 liens filed by 75 providers, valued at more than $1.3 billion.
One provider alone was responsible for 27,000 liens, and $450,000 in prescribed drugs, Baker said.
She said she considered it a priority to get these liens out of the hearing system so that injured workers can have access to the administrative law judges and get their cases resolved.
Chief Judge Paige Levy said that the DWC is in the process of identifying all the liens potentially subject to dismissal. She said the process of consolidating liens will start in March or April.
Levy said she will be assigning judges to preside over hearings to determine which liens should be dismissed. For some of them, it will be a full-time assignment, she added.
Another thing the administrators are working on is a prescription drug formulary, Baker said. She predicted that this will "go a long way towards expediting care."
Parisotto said he expects to start the formal rule-making process to implement a drug formulary next month.
The DWC had issued a draft version last summer for public comment and it previously said it hoped to start the rule-making process this month.
Unfortunately, Parisotto said, the proposal is still being reviewed by the Department of Finance.
The establishment of a formulary was another mandate contained in AB 1124, which set the deadline for adoption for this coming July 1.
Parisotto said he was hoping that the establishment of a drug formulary would help reduce the number of cases being submitted to IMR. He said 43% of applications for IMR in 2016 had involved requests for medications, and 40% of them were opioids.
The number of cases going through IMR hasn't changed much since 2015, although the turnaround time for a decision has improved. Maximus, the state's IMR contractor, generally gets a decision out within 14 days of receiving the medical records for a claim.
At the end of 2015, it was taking Maximus an average of 24 days.
Maximus received 253,000 applications in 2015, and about 250,000 in 2016. Some 165,000 of the applications submitted in 2015 were actually eligible to go through IMR, and that number climbed to approximately 170,000 in 2016.
Parisotto said there were a total of about 175,000 IMR decisions issued in 2016, and the vast majority upheld the UR determination.
About 86.5% of IMR decisions agree with the UR decision to deny authorization for the requested treatment, he said.
While these are treated as his decisions, Parisotto admitted that he does not personally review all of them. But that's not to say he turns "a blind eye" to what Maximus does.
He said he reviews many of the decisions and that the DWC meets with Maximus representatives every week.
Parisotto also asked applicants' attorneys to help with "quality control."
If anyone receives an IMR decision that "flat out dropped the ball," Parisotto said he welcomed emails sent directly to him, at email@example.com, so that the problem can be addressed as quickly as possible.
Parisotto said he also needed input from the applicants' bar for establishing the parameters for what ought to qualify as a "reasonable" fee for attending a deposition. That responsibility was placed on his shoulders by the passage of Senate Bill 1160 last year.
Parisotto said he is also trying to finalize a fee schedule for interpreters by no later than March.
If time allows, Parisotto said, he would like to update the medical-legal fee schedule this year as well.
Time for the panel session ran out at the CAAA convention very quickly. The audience was told it could submit only written questions to the panel, and Levy collected a sizable stack of papers. The panel addressed about a half-dozen of inquiries before its time was up.
The CAAA convention drew an estimated 1,200 attendees, according to organizer Alan Gurvey. The four-day event at the San Diego Sheraton Hotel & Marina wrapped up Sunday.
CORRECTION: Judge Paige Levy said the process of consolidating liens will start in March or April. WorkCompCentral incorrectly reported in an earlier version of this story that dismissals would start in that time frame. Also, Christine Baker said a single provider was responsible for 27,000 liens. WorkCompCentral provided an incorrect number.