Q1, 2016 – May 18, 2016
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Research Inpatient Hospital Utilization in California Workers’ Compensation. An analysis of inpatient services and procedures in California workers’ comp vs. Medicare, Medi-Cal and private coverage, based on a review of OSHPD discharge data and payment data from CWCI’s IRIS database. In addition to quantifying reductions in workers’ compensation inpatient hospitalizations in 2014 and over the past 7 years, the study identifies the 10 most common inpatient diagnosis-related group codes (MS-DRGs) in California workers’ comp for 2013 and 2014; calculates average charged and paid amounts for the top 10 workers’ comp MS-DRGs; and measures changes in the volume of implant-eligible spinal surgeries and in the proportion of spinal fusion MS-DRG discharges to total discharges across time for each payer group. Spotlight Report (3/3/16) (members only) Bulletin (3/3/16) (members only) Executive Briefing (2/26/16) (members only) News Release (3/3/16) (public) Independent Medical Review Decisions, January – December 2015. A study that provides an updated look at California workers’ compensation independent medical review (IMR) decisions rendered in 2015. The results show that even though IMR physicians continued to uphold the vast majority of utilization review (UR) physicians’ denials or modifications of treatment, total IMR volume rose 19% last year. CWCI Spotlight Report (2/18/16) (members only) Bulletin (2/18/16) (members only) Executive Briefing (2/26/16) (members only) News Release (2/18/16) (public) The Changing Nature and Cost of the Med-Legal Process in California Workers’ Compensation. A CWCI report that reviews the legislative reforms, regulatory changes and judicial decisions that have reshaped the medical-legal process for resolving workers’ comp claim disputes over the past quarter century; provides an update on the quantity, mix and average payments for medical-legal services in the wake of the 2002-2004 reforms; and generates benchmark data for use in future studies on the impact of the 2012 reforms, which introduced independent medical review as a new means for resolving treatment disputes. CWCI Spotlight Report (2/1/16) (members only) Bulletin (2/1/16) (members only) Executive Briefing (2/26/16) (members only) News Release (2/18/16) (public) NAIC Reports on Insurer Profitability for CY 2014. CWCI reports on data compiled by the National Association of Insurance Commissioners and compares California workers’ compensation insurer profitability for calendar year 2014 to other states and other lines of insurance. Bulletin (1/7/16) (members only)
Legal Chorn v. WCAB. The 2nd DCA. Citing the opinion in Angelotti, noted the extensive legislative history regarding the lien backlog and abuses of the system, and rejected all of the plaintiff’s constitutional challenges, finding that the $150 filing fee was a rational exercise of legislative authority. Significant Decision Summary (3/28/16) (members only) California Highway Patrol and SCIF v. WCAB and Dorothy Margaris. Where an employer timely conducts UR, an Administrative Director’s subsequent IMR decision issued outside the statutory time constraints does not vest the WCAB with jurisdiction to decide the disputed medical issue. Moreover, as a judicial body of limited jurisdiction, with no powers beyond those conferred on it by the Constitution and Labor Code, the WCAB lacks authority to review an employer’s timely Utilization Review decision. The sole statutory remedy for a defective IMR determination is a new IMR decision, and the WCAB is expressly prohibited from making a determination of medical necessity contrary to an IMR decision. CWCI Amicus Brief (dated 2/23/16) (members only) CWCI Supplemental Amicus Brief (dated 3/31/16) (members only) 4th DCA Ruling in King v. CompPartners. IA controversial ruling that allowed an injured worker to attempt to establish existence of a physician-patient relationship between the worker and the UR doc who had denied renewal of his psychotropic drug prescription. The worker’s intent was to establish that a UR decision is a form of treatment so he could then file a malpractice suit against the UR doctor for failing to allow him to be weaned off of the powerful meds that had been prescribed for his work injury. Because the 4th DCA ruling was issued as a published decision, it set a precedent that had to be followed by the WCAB in future rulings, but the Supreme Court subsequently granted review so the 4th DCA ruling no longer sets a non-binding precedent. Executive Briefing (2/26/16) (members only) CWCI letter in support of defendants Petition for Review (2/22/16) (members only) CWCI Request For Depublication (1/25/16) (members only) Significant Decision Summary (1/11/16) (members only) California Supreme Court Declines to Review Stevens v. WCAB. On February 17, the California Supreme Court declined to review the 1st District Court of Appeal’s October 2015 ruling in Stevens v. WCAB (Outspoken Entertainment) in which the Appeals Court ruled that IMR is not unconstitutional because the Legislature has plenary power over the workers’ comp system and that IMR does not violate an injured worker’s due process rights under the U.S. Constitution. Bulletin (2/22/16) (members only) Minutes from the Legal Committee Meeting The meeting was held February 11 via conference call. The agenda included a review of amicus requests, a status report on current amicus activity, discussion of recent rulings, and updates on regulations, legislation, and lien litigation. Meeting Minutes (2/11/16) (members only) Final Act for Challenge to Lien Activation Fees. Seven plaintiffs in Angelotti v. Baker filed a petition for relief with the U.S. Supreme Court on 1/6/16, again asserting that lien activation fees constitute an illegal taking of private property without just compensation, and that the fees are in conflict with Federal Circuit, Court of Federal Claims and Alaska Supreme Court rulings in which claims that had not been reduced to final judgment were treated as vested property interests protected from governmental taking. The odds that the Supreme Court will review the case are minute given that it receives about 10,000 petitions a year, of which it hears about 75 to 80 cases. Executive Briefing (2/4/16) (members only) Dreher v. WCAB. A live-in apartment manager/maintenance worker’s slip and fall on a rain-soaked walkway was clearly foreseeable as within the ordinary risks and hazards of his occupation, and thus not the result of an extraordinary employment condition within the meaning of LC 3208.3(d). CWCI’s amicus curiae brief (dated 1/16/16) (members only) Cornejo v. Younique Café Inc. En Banc decision that B&P Code registration & bonding requirements don’t apply to lien claimant copy services seeking to recover fees that are med-legal expenses under LC 4620(a) if lien claimant is an agent/independent contractor of a State Bar member when documents are photocopied. Significant Decision Summary (1/5/16) (members only)
Statutory/Regulatory Posting Reminders: State law requires employers to post their 2015 summary of work injuries & illnesses (Cal-OSHA 300 form at each worksite from Feb 1 to April 30. Employers also must complete a separate Cal-OSHA Form 300A summary, though that form does not need to be posted. Executive Briefing (2/4/16) (members only) 2014 Claim Audit Results…DWC’s report on it 2014 results audits is out, and the findings note the number of files audited, the number and type of violations cited and the amount of an undisputed compensation found due and unpaid to the injured worker, and the performance rankings of claims administrators audited in 2014. Executive Briefing (2/4/16) (members only) Member Advisory: Annual Report of Inventory Due April 1. CCR §10104 requires insurers, TPAs and self-administered, self-insured employers and JPAs to complete an Annual Report of Claims Inventory form noting the number of claims reported at each adjusting location during the preceding calendar year and to submit it to the DWC Audit Unit by April 1. Executive Briefing (2/4/16) (members only) WCIS Standards and Medical FROI/SROI Guides. . CWCI’s 45-day public comments on proposed regulations governing the Workers’ Compensation Information System Standards and the Medical First Report of Injury and Subsequent Report of Injury Guides. 45-day Public Comment (3/28/16) (public) First Forum Comments on DWC’s Draft Guidelines on Mental Illness and Stress. CWCI’s first forum comments on proposed guidelines for work-related Mental Illness and Mental Stress as drafted by the Division of Workers’ Compensation. 1st Forum Comments (2/16/16) (public)
Other CWCI Elects Board of Directors for 2016. The Institute members elected the new CWCI Board of Directors at its annual meeting. Susan Gordon, Head of Workers’ Compensation Underwriting at Zurich North America was elected to Chair the Board. News Release (3/18/16) (public) Minutes from the Claims and Medical Care Committee Meeting. The meeting was held March 16 at the 5 Star Conference Center in Oakland. The agenda included a preview of the annual meeting research presentations and updates on regulations, case law and legislative proposals from the current session. Meeting Minutes (3/10/16) (members only) CWCI’s 18th Annual Case Law Seminar. The Institute has scheduled its annual California Workers’ Compensation Case Law Update Seminar for May 23 in Long Beach and May 25 in San Francisco. Executive Briefing (2/26/16) (members only) Executive Memo (2/19/16) (members only) News Release (2/19/16) (public) Seminar Flyer (2/19/16) (public) CWCI’s 52nd Annual Meeting. The announcement of the 3/17/16 meeting at the Oakland Marriott. The agenda included Alex Swedlow’s presentation on disputes and the cost of delivering injured worker benefits, Rena David’s review of current policy research, and a roundtable discussion featuring six panelists who addressed ways to identify and reduce workers’ comp disputes. The program also featured an afternoon session that previewed joint CWCI/WCIRB research on cumulative trauma claims. Executive Briefing (2/26/16) (members only) Opioid Prescriber Convicted of Murder. A Southern California physician became the first doctor in the nation to be convicted of murder for prescribing unnecessary painkillers, and in February she was sentenced to 30 years to life in prison. Executive Briefing (2/26/16) (members only) Changes in Top Brass at DWC. A rundown on recent changes among key staffers at the DWC and WCAB: DWC Chief Judge Richard Newman left the DWC at the end of November to become Sec’y & Deputy Commissioner of the WCAB, replacing the retiring Rick Dietrich, and Paige Levy, presiding judge of the Marina Del Rey WCAB succeeded Newman on February 1. DWC Exec. Medical Director Rupali Das retired from state service in December to take a position as SVP/California Medical Director at Zenith Insurance, so Associate Medical Director Dr. Raymond Meister has assumed interim responsibilities while DWC conducts a search for her permanent replacement. DWC Administrative Director Destie Overpeck is leaving at the end of next week to join the Office of the General Counsel at the State Bar, and DWC Chief Counsel George Parisotto will assume the acting AD responsibilities. Executive Briefing (2/4/16) (members only) Ellen Langille to Succeed Mike McClain as CWCI General Counsel. Ellen Sims Langille was named to succeed Michael McClain as general counsel of the California Workers’ Compensation Institute. Executive Briefing (2/4/16) (members only) Potential Approval of New Subdermal Opioid Draws Concern. The FDA’s Psychopharmacologic Drugs Advisory Committee recommended approval for Probuphine, a subdermal rod that is surgically implanted into a patient’s arm to deliver a daily dose of the Schedule III drug buprenorphine for up to 6 months. Like methadone, buprenorphine is used to wean people off of opioids, but for pain management prescriptions often continue for the long term, which may become a concern for workers’ compensation payors. Also, unlike methadone, which must be dispensed from a structured clinical setting, buprenorphine can be prescribed or dispensed in physician offices. The FDA is scheduled to make a decision by Feb. 27, but doesn’t have to follow the committee’s recommendation. Executive Briefing (2/4/16) (members only) CWCI’s 18th Annual Case Law Seminar. The Institute has scheduled its annual California Workers’ Compensation Case Law Update Seminar for May 23 in Long Beach and May 25 in San Francisco. Executive Briefing (2/26/16) (members only) CWCI Hotlinks Update. Quarterly listings of all CWCI publications, including publication dates, brief summaries of each topic and the various formats in which the information is available (e.g., research report, Bulletin, Executive Briefing, news release), so users can choose the level of detail they want to view. Listings include live links so users can click into the CWCI website to access specific documents quickly and easily. Hotlinks Q4/15 (1/5/16) (members only) |