Commissioner Urges Governor to sign SB 621

September 9, 2011

NEWS RELEASE
Insurance Commissioner Jones Announces Passage of Bill to Prohibit Insurers from Overriding a Physician's Opinion and Deny Disability Coverage
Commissioner Urges Governor to sign SB 621

Insurance Commissioner Dave Jones today announced that the Legislature unanimously passed a Department-sponsored bill which would prohibit insurers from overriding a doctor's opinion and deny coverage on a disability claim. SB 621, authored by Senator Ron Calderon (D-Montebello), would prohibit disability insurance policies from containing a discretionary clause which gives an insurer the authority to decide whether someone is eligible for benefits or coverage.

"Discretionary clauses give insurance companies the freedom to easily justify coverage denials when a policyholder takes a carrier to court over denied benefits and claims," said Commissioner Jones. "It's like the fox guarding the henhouse. This bill levels the playing field for consumers so they can have their day in court and get the benefits they paid for with their premiums."

A discretionary clause allows the insurer to override an insured's own doctor's certification of disability benefits. The Insurance Commissioner currently has authority to challenge such clauses on a case-by-case basis, and while they are disfavored, they are not clearly banned under California law. This bill would prohibit the Insurance Commissioner from approving disability insurance policies that contain a discretionary clause

The above press release from the California Insurance Commissioner Dave Jones is a huge step for the injured workers in California. While the California Workers compensation system was designed to treat and help the injured worker, the system was all but destroyed when former California Governor Arnold Schwarzenegger signed into law senate bill 899. This bill made it easier to deny and delay treatment for injured workers. The results have been catastrophic for the injured and the taxpayers, while the Insurance companies rewarded themselves with record profits. The systematic denial and delay of claims has shifted the injured into State and Federal programs while their case drags out in court, and they go untreated for job related injuries.





Some of the flaws in the California system are that injured employees must pick from a list of Doctors supplied to them by the Insurance company. This shrinking list gives injured patients few choices and the remaining Doctors seem beholden to the Insurance companies. The fact that nearly fifty percent of the Doctors who use to treat injured workers no longer are willing to provide treatment is just part of the problem. Doctors in the California workers compensation system must also treat injured employees in accordance to treatment guidelines, which can be easily traced back to special interest groups representing BIG BUSINESS. These treatment guidelines have tied the few remaining Doctors in the broken systems hands behind their backs, unable to provide cutting edge medical treatments California is known for. While Doctors can receive a ten percent penalty for not being reimbursed for treatment by the Insurance companies within sixty days. The Insurance companies seem to have a powerful tool to persuade Doctors in their direction of denying claims. Simply put give a worker a evaluation that helps us to deny his claim and we will reimburse you sooner, if you choose to side on behalf of the injured worker we will slow pay you. This ten percent penalty is only a few hundred dollars, while the cost of proper treatment or a settlement is far greater. Injured workers are also forced to wait long periods of time between Doctors evaluations. These delays many times lead to the workers injuries becoming worse, sometimes taking away corrective procedures as to much scar tissue has developed.



InJured Workers and their families urge Governor Brown to take action and sign SB 621 into law. This will help to restore the rights of injured workers and stop the shifting of injured workers costs to the taxpayers of California. Insurance Companies must no longer be able to just wait out the injured employee hoping that he will drop his claim or settle for a amount that will not cover future medical expenses.