It's a scenario that all workers dread: suffering a serious on-the-job injury and being denied the care they need. While workers' comp is supposed to help these injured workers, the truth is that many are having their surgeries and other necessary procedures denied, despite their doctors' recommendations.
According to a recent KCRW investigative story, many of these denied workers are simply victims of legal "reforms" made to the California workers' compensation system in 2012 -- reforms that were supposed to weed out fraud, but now may be having unintended consequences on legitimately injured workers.
So what changed?
One of the reforms made to the workers' comp system was the establishment of a "utilization review process" in which so-called independent medical reviewers now decide if a particular treatment is approved or denied based on a set of guidelines and without examining the injured worker themselves.
However, as mentioned in the recent KCRW report, many doctors and lawyers are troubled by the independent medical review system given its perceived risk of hidden conflicts of interest -- conflicts that could influence patient care and treatment. For instance, some doctors, who spoke to KCRW anonymously due to fear of being blacklisted by insurers, raised concerns about the financial links between insurers, utilization review companies and the third party administrators who manage the claims.
In fact, George Parisotto, the acting Administrative Director of the Division of Workers Compensation, admitted to KCRW that he has heard worries that some utilization reviewers may be motivated to deny treatment and care to injured workers in order to maintain their contracts with the insurers/administrators. While he did note that the parties would be penalized if any such an arrangement was discovered, that doesn't mean it's not occurring.
Ultimately, as with every state, California's workers' compensation system has its share of problems. This is why it is always best to seek experienced legal guidance should you suffer an on-the-job injury. A skilled and knowledgeable lawyer can protect your rights and help you navigate the complex workers' comp system. Your well-being is important -- get the assistance you need today.