Changes to Workers’ Compensation System Affect Medical Treatment for Claimants, CMA Report States
Some insurers are delaying treatment for workers' compensation claimants and some doctors are threatening to stop treating workers' compensation patients because of difficulty securing claims payments, according to a report released on Monday by the California Medical Association, the Los Angeles Times reports. The report indicates that the two-year overhaul of the workers' compensation program included changes that allow insurers greater power in determining the level of treatment that doctors can prescribe by underpaying or delaying claims payments to health care providers (Lifsher, Los Angeles Times, 11/1).
The report, which was based on a survey of 250 doctors who treat workers' compensation claimants, found that:
- 63% of doctors expected to reduce the number of workers' compensation cases they accept, and one-third of that group planned to stop accepting such cases altogether;
- 1% of physicians were able to contact an insurance claims reviewer in one telephone call;
- 68% of physicians had to place multiple phone calls to contact an insurance claims reviewer; and
- 40% of physicians said treatment requests had been denied because of new treatment guidelines, although 43% said their treatment requests were approved on appeal (Chan, Sacramento Bee, 11/1).
CMA has asked the Division of Workers' Compensation to increase auditing and punish insurers for denying or delaying care (Los Angeles Times, 11/1).
The agency has commissioned the University of California-Los Angeles to evaluate workers' compensation claimants' access to medical care (Sacramento Bee, 11/1).
In addition, acting DWC Administrator Carrie Nevans said the agency is developing regulations on penalties and treatment guidelines to help address some doctors' concerns about changes to the state workers' compensation insurance system.
The Legislature has said it will address the state workers' compensation insurance system when the legislative session begins in January (Los Angeles Times, 11/1). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.