Injured Cops, Firefighters Blast Proposed Cuts in Calif. Injured Workers’ Benefits

April 9, 2004

Injured California cops and firefighters, their advocates and union leaders on Thursday blasted a reported proposal on cutting benefits to injured workers.

The injured workers, their advocates and consumer advocates said the proposal would harm those who could least afford it, the injured workers whom the system is supposed to protect. They pointed in particular to three provisions of the reported proposal: forcing injured workers to be treated only by a company-selected doctor, absence of any real regulation requiring insurers to reduce rates or pass on savings to employers, and taking away compensation from many injured workers with permanent partial disabilities.

“Many injured workers with severe permanent injuries will receive little or no compensation under the reported proposal,” said Afrack Vargas, legislative advocate for the California State Firefighters’ Association. “This proposal will make it virtually impossible for most injured workers to ever select their own doctor. Labor fought for many years to obtain this right for its members. This proposal turns back the clock to the bad old days when injured workers were given shoddy care by medical providers controlled by the company.”

“The proposal hurts certain workers more than others. Older workers take the hardest hit, along with minimum wage workers.” added Art Azevedo, president of the California Applicants Attorneys Association (CAAA), whose members represent injured workers. “The proposal robs injured workers while letting insurance companies off the hook for the crisis they created. The proposal is one-sided, all takeaways from injured workers and benefits for big insurance companies. I cannot believe that any Democrat would support such a proposal, and every Republican with a sense of fairness should reject this proposal.”

Current law allows injured workers to select their own treating physician 30 days after the injury is reported to the employer (the employer controls selection of the treating physician for the first 30 days).

The reported proposal would require that injured workers get treatment only from a closed pool of doctors selected by an insurance company. This proposal would reportedly not allow the injured worker to get outside of this company-doctor pool until they had seen at least three insurance company doctors.

“Such a scheme would be a disaster for injured workers. The purpose of such a proposal is to silence the workers: their description of their pain and limitations will no longer be considered,” said Azevedo. “They will be relegated to seeing company doctors who rely for their business on keeping the insurance companies happy. If those doctors fail to keep the insurance companies happy, they will be eliminated from the insurance companies’ pool of physicians.”

Current law provides permanent disability benefits for workers who have a lifetime disability as a consequence of a work injury or illness. The amount of compensation is calculated according to a schedule that bases a permanent disability rating on the physical elements of the injury or disfigurement, the age and occupation of the worker, and the “diminished ability of such injured employee to compete in an open labor market.”

The proposed proposal reportedly ignores the lifetime consequences experienced by workers, severely disadvantages lower wage workers, and penalizes workers who return to work despite their disability. Mandating use of the AMA Guides will reportedly harm workers because the Guides measure impairment and not disability. This will reportedly eliminate benefits for many workers because medical science is not always able to identify an “objective” cause of disabling pain.

Currently permanent disability benefits compensate for the lifetime disadvantages in competing in an open labor market, not just short-term wage differences. Return to work incentives were included in AB 749 but have not been funded.

The proposed proposal would reportedly reduce benefits by 15 percent for workers who receive an offer to return to work, and increase benefits by 15 percent if there is no offer to return to work.

“The only real impact of this proposal will be a huge windfall to larger employers, most of which already have return to work programs. This will add significant costs to smaller employers who are unable to take employees back,” said Mark Gerlach, insurance expert for CAAA.

According to CAAA, current law regulates all property/casualty lines of insurance, except workers’ compensation. Every workers’ compensation company sets its own rates subject to statutory rules that rates may not be inadequate or unfairly discriminate. There is no prohibition against the use of excessive rates, although this prohibition applies to all other lines of insurance in California. The pure premium rates set by the Insurance Commissioner are advisory only.

The reported proposal would reportedly require that California declare its workers’ comp market to be “non-competitive” before regulating rates in any way. There are currently more than 250 insurers selling workers’ comp policies in California. States that have similar provisions have not triggered regulation.

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