7/6 Oakland Protest "Stop Corporate Murder and Terror Against Injured Workers!"

There will be a demonstration and speak-out by injured workers on July 6 at this State Commission on Health and Safety and Workers' Compensation Meeting from 9:30 AM to 10:00 AM. The main slogan is

Stop Corporate Murder and Terror Against Injured Workers!

We will then go into the commission to testify about the criminal activities of the insurance companies. Bring signs and posters with information about who is violating your rights.

In Solidarity,

California Coalition For Workers Memorial Day
http://www.workersmemorialday.com


http://www.dir.ca.gov/CHSWC/Meetings/2006/CHSWC_Agenda07062006.html


- commission
meeting

Date: Thursday - July 6, 2006
Time: 10:00 AM
Place: Elihu M. Harris State Building
First Floor, Auditorium
1515 Clay Street
Oakland, California


AGENDA

I. Call to Order
* Approval of minutes from the April 6, 2006 CHSWC meeting in Oakland
Angie Wei, CHSWC Chair
II. * Supplemental Disability Insurance (SDI) Study Update – Proposal
for Further Analysis
Frank Neuhauser, UCB
III. * A Report on the Pharmacy Study
Frank Neuhauser, UCB
IV. * Update on the Permanent Disability Study
Division of Workers’ Compensation
Frank Neuhauser, Survey Research Center, UC Berkeley
V. * WOSHTEP proposals
Christine Baker, CHSWC Executive Officer
Linda Delp, Director Labor Occupational Safety and Health Program
(LOSH), UCLA
Robin Baker, Director, Labor Occupational Health Program (LOHP),
University of California at Berkeley
VI. * Report on the California Disaster Preparedness Forum
Christine Baker, CHSWC Executive Officer
VII. * Executive Officer Report
Christine Baker, CHSWC Executive Officer
VIII. * Other Business / Proposals
IX. Public Questions and Comments**
(All general public comments will be presented at this time)

* May result in an action item for CHSWC consideration and/or vote
**Please Note: Public comments are limited to three minutes per speaker.
Topics are subject to CHSWC review and approval.
The agenda may be adjusted, if necessary, depending upon the time needed
for discussion of each item.

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CA -- UR Penalties Not Tough Enough, DWC Scolded: Regulatory 06/30/06
Frustration over denials and delays of prompt treatment for injured workers punctuated four hours of testimony Thursday in which a steady stream of speakers pleaded with the Division of Workers' Compensation to come down hard on insurers who abuse utilization review and withhold indemnity payments.
Mainly injured workers and their representatives pleaded with Administrative Director Carrie Nevans to toughen her proposed penalty regulations for utilization review violations. The maximum proposed fine for a single act is $50,000.
"Make them (insurers) do what the rest of us have to, which is obey the law, conform to the law and not take 90 days for a 30-day time-limit approval," said claimant Paula Morgan of Oakland.
Morgan said she gave up on the workers' compensation system altogether and instead sought group-health treatment for a disk injury suffered in a work-related car accident in 1997.
Morgan is still waiting for her employer's insurer to pay her mileage from nine years ago, she testified.
"Why can they do this?" she asked.
The Division of Workers' Compensation in April rolled out a set of proposed regulations for enforcement of the two-year-old utilization review process, Labor Code section 4610. David Rockwell, president of the California Applicants' Attorney Association, said the danger of delays and denials under the utilization review process is that the indemnity pay clock is ticking for the injured worker.
"Given that injured workers are now subject to a 104-week 'window' of temporary compensation benefits, these delays can be catastrophic," he wrote. "We urge you to adopt an aggressive system of surveillance and enforcement on an emergency basis to insure that injured workers are receiving appropriate and prompt medical care.
Labor Code section 4610 requires every employer to have and use a utilization-review process, and sets out timelines and conditions to be met whenever a request for authorization of medical treatment will be delayed, modified or denied.
Rockwell told Nevans that CAAA objects to applying the proposed fines on carriers and self-insurers for conduct after Aug. 1. That is not soon enough, CAAA believes.
"The penalties for violation of the utilization review process should, at minimum, be applied to conduct occurring on or after the adoption of the emergency regulations on Dec. 9, 2004, when claims administrators were clearly advised of the utilization review standards," Rockwell testified in a letter to the DWC.
The insurance industry was noticeably absent from Thursday's hearing, at which injured workers accused the workers' compensation carriers and self-insurers of lying about claims and being to blame for at least two suicides by claimants, one of whom was distraught because his pain medications were cut off.
The most emotional testimony of the day came from grief-stricken Kelley Sedam, whose husband, Robert, died June 12 of what she described as a blood clot. Robert Sedam worked as a helicopter mechanic for Omni Flight Helicopters and he severely injured his neck at work. He was granted a 100% disability and lifetime medical benefits, his widow said. He developed complications after his surgeries and his request to see a specialist was denied, she testified.
"He said to me, 'I'm going to die from a blood clot. They (the insurer) want me dead because it'll save them money," Kelley Sedam testified, based on a conversation with her 54-year-old husband.
She also told DWC officials that her husband's company's carrier cut off all of his medications for two weeks, apparently in violation of utilization review. A claims representative -- and not a physician as is required under the labor code section -- ordered her husband's prescription medication benefit suspended pending a review of his various prescriptions, she said.
The Sedams paid the $500 pharmacy bill for a two-week period while they waited for Robert's pharmacy benefits to be reinstated, she said.
Mrs. Sedam sobbed as she stepped to the podium, and needed a few minutes to compose herself before beginning to speak. Her two teen-age children accompanied her and sat in the audience.
"Who is responsible?" she said at one point. "They (insurer) are responsible."
Steve Cattolica, representing industrial physicians and surgeons, said the maximum $50,000 penalty that an insurer or self-insurer could be assessed for breaking utilization review rules was, in his opinion, much too low to be effective. The maximum fine is not any more than what insurers pay, on average, per indemnity claim, he said.
The proposed penalties are "not the level that would get some people's attention," said Cattolica, the government relations director for the California Society of Industrial Medicine and Surgery and the California Society of Physical Medicine and Rehabilitation.
In the case of multiple utilization review violations, the administrative director has the discretion of setting a lower penalty. Cattolica said the regulations would allow a fine of as little as $1.
He suggested to Nevans that the minumum penalty be set at 80% of the maximum.
The audit portion of the enforcement regulations are "the more glaring problem," according to CAAA President Rockwell. His group suggested that insurers and employers respond to the administrative director's audit request with a signed declaration about the truthfulness of the case materials.
"No proof of facts are required. This gives an unacceptable level of discretion to the investigator to ignore what may be a dishonest response," he wrote.
Several injured workers and advocates also suggested that Nevans write a perjury clause into the portion of the regulations dealing with audits.
An audit based on fraudulent documents isn't an investigation at all, former attorney Nina Bartholomew told Nevans. She charged that insurers are "no angels" when it comes to falsifying case records.
Rockwell of CAAA and others told Nevans that the penalty schedule that DWC drafted in the event of multiple infractions was confusing and needed clarification. The size of the penalty quadruples from $200 for 10 violations, $800 for 11-20, $3,200 for 21-30, and $6,400 for 40 or more violations involving:
* Failure to make a decision on an expedited review request in 72 hours or less;
* Failure to notify the requesting physician, the provider identified in the authorization request, the injured employee and his or her attorney that more information is needed to make a decision;
* A request for concurrent authorization;
* Each denial of authorization for lack of information in which the claims examiner does not document the request for the reasonable information from the request physician, provider or someone familiar with the case.
The hearing also addressed proposed enforcement for nonpayment of indemnity benefits under Labor Code Sec. 5814.6. That code section requires the division's administrative director to impose administrative penalties of up to $400,000 on employers and insurers who "knowingly and unreasonably" delayed or refused payment of indemnity benefits with a frequency that indicates a business practice.
Speakers, several of whom also testified about the utilization review enforcement proposal, asked for assurances from DWC that the penalties against carriers and employers would be enforced. Cattolica, who represents industrial medicine providers, questioned why the indemnity-payment delay rules let off payers scot-free for the first violation.
"Why would the violator be given a free bite of the apple?" he said.
The Division of Workers' Compensation will review all of the suggestions made Thursday, spokeswoman Susan Gard said.
By Rob McCarthy, WCC Editor