California’s workers’ comp reforms have made some good improvement, but it still has the most expensive system in the nation.
In 2013, the state implemented reforms and medical trends stabilized indicating that many components of the reform are working. However, relative to other states, California has the highest incidences of partial and permanent disability claims. Furthermore, it has the greatest workers’ comp premium rates in the nation, according to the California Workers’ Compensation Institute.
Although there are higher claim numbers, the state also offers a great amount of care for injured workers. However, according to research relative to workers’ compensation compliance and practice, the CWCI stats don’t include cases that are harder to pursue.
CALIFORNIA VERSUS TEXAS
If you compare California to states like Texas Texas had an independent medical review of 1,209 appeals in 2015. California had a whopping 160,000. One factor credited to Texas’ being able to keep requests down is communication according to the Texas Department of Insurance.
For instance, before an issue is denied, the insurer’s review agent has a “reasonable opportunity” to engage in discussion. The more that people engage in healthy dialogue, the more that concerns can be answered. If the issue is denied due to lack of medical records, an insurer-provider discussion should be able to settle the matter.
In California, companies prefer managing initial care requests in-house. The preference is having people in medicine responsible for decisions regarding medical treatment. In this scenario, examiners handle all the utilization review requests internally and authorize internally.
BOTTOM LINE
Ultimately, it is prudent to workers receive proper care quickly and efficiently. However, there has to be a balance so that employers can compensate for it.
