Applicants’ Attorneys File Lawsuit to Block Physician Network Rules in Workers’ Comp Overhaul Plan
The California Applicants' Attorneys Association on Wednesday filed a lawsuit against the state in a Sacramento appellate court on behalf of "thousands of injured workers" who say new state workers' compensation regulations, which allow employers to require injured workers to be treated by newly established medical provider networks, could force patients to change doctors in the middle of treatment, the Sacramento Bee reports. According to the Bee, if the lawsuit is successful, "it would be a major blow" to the state workers' compensation system reform plan advocated by Gov. Arnold Schwarzenegger (R) (Chan, Sacramento Bee, 11/11).
The Division of Workers' Compensation in October issued new regulations authorized by a law (SB 899) to reform the state workers' compensation insurance system enacted in April that will govern the creation and operation of new HMO-like medical provider networks and reverse long-standing practices that generally allowed workers to choose any doctor. The rules require networks to:
- Include a variety of doctors and other providers with both general medical and occupational injury experience;
- Provide injured workers with primary and emergency care within 15 miles or 30 minutes; and
- Provide workers with specialist care within 30 miles or 60 minutes.
According to Lachlan Taylor, a workers' compensation appeals board judge who has reviewed the rules, the regulations allow employers to direct an injured worker to a specific provider for the initial diagnosis, but workers needing additional care can change providers within the network.
Workers also can receive outside opinions or seek an independent medical review if they disagree with initial examinations.
Medical providers will be allowed to establish the networks starting Jan. 1, 2005 (California Healthline, 10/25).
According to the Los Angeles Times, the networks were "a key provision" of the new workers' compensation law, but the lawsuit states that the new regulations should apply only to workers who were injured after Jan. 1, 2005.
The lawsuit names as defendants DWC and its director, Andrea Hoch.
CAAA President J. David Schwartz said that the rule could increase employers' workers' compensation insurance costs as existing cases are reevaluated and make it harder for people to receive treatment and return to work.
"It's one thing for workers injured next year to be forced to see a company doctor. But it's absolutely ridiculous for the state to rip a patient away from his or her doctor in the midst of treatment," Schwartz said (Lifsher, Los Angeles Times, 11/11). He added, "A lot of thought goes into choosing a doctor. Employers can disrupt existing doctor-patient relationships and force injured workers to go into these networks" (Sacramento Bee, 11/11).
State officials, insurance companies and business groups called the lawsuit "a ploy by [CAAA] to derail new workers' compensation laws even before they were fully implemented," the Times reports.
Jeanne Cain, senior vice president of the California Chamber of Commerce, said the doctor networks are needed to reduce employers' workers' compensation insurance costs and "are a critical component of bringing quality treatment and stability to the workers' compensation system by requiring that medical decisions are made by qualified medical professionals, not lawyers" (Los Angeles Times, 11/11).
Association of California Insurance Companies spokesperson Theo Pahos said most injured workers likely will keep their current doctors under the new rules, as "[m]any insurers do not plan on moving pre-2005 injuries into MPNs because it's a hassle." Pahos added that many doctors likely will be included in the networks (Sacramento Bee, 11/11).
Nicole Mahrt, a spokesperson for the American Insurance Association in Sacramento, said CAAA attorneys are "using the courts to protect the parts of the system that line their pocketbooks" (Los Angeles Times, 11/11).
Rick Rice, a spokesperson for the Labor and Workforce Development Agency, which oversees DWC, said, "There is nothing that says [injured workers] will be taken away from their doctors," adding that the rules exempt workers with serious and chronic conditions, upcoming surgery or a terminal illness. CAAA has "been opposed to these reforms. This group is litigating delay and delay," Rice said (Sacramento Bee, 11/11). He added, "We're going to fight this vigorously" (Los Angeles Times, 11/11).