NPR Reports Insurers Gaining Control in the California Worker’s Compensation System

According to a recent report by NPR, the California Worker’s Compensation System is giving too much control regarding medical decisions to employers and insurers. The State Compensation Insurance Fund, a quasi-governmental agency, employs anonymous independent medical reviewers. The reviewers, who are not required to be licensed in the state, have the power to make decisions regarding treatments without ever examining the worker. Many believe that too much deference is given to the reviewers, who side with the insurance companies 90% of the time.

In the case of a worker who was injured in a work accident in 1997, reforms made to the California worker’s compensation system have denied her the continuation of effective treatment which included pain medications and a home aide. This worker might never be able to use her feet again, and suffers from what is known as chronic or complex regional pain syndrome. After the State Compensation Fund reviewed only the worker’s medical paperwork, and not her actual injuries, the reviewer determined that the medication and the home aide were not helping her recover and thus, denied her request.

Because the reviewers are anonymous, it is impossible to override their decisions or even depose them for trial purposes.

In another heartbreaking case, a worker who suffered from job related injuries which resulted in paralysis is unable to live at home because his request for modifications to his home for wheelchair access were denied. Even though his doctor prescribed $170,000 in home modifications, an independent medical reviewer employed by the California Insurance Guarantee Association rejected the prescribed modifications. However, after NBC4 News in Los Angeles featured the story, the CIGA approved the modifications and publicly announced that the claim was not handled properly.

Click here to read the full NPR story.

If you have suffered from a workplace injury, contact an experienced worker’s compensation attorney who will fight for your rights. The attorneys at McIntyre, Donohue, Accardi, Salmonson & Riordan, LLP have experience representing clients before Workers’ Compensation boards throughout New York City and Long Island, including Manhattan, the Bronx, Queens, Brooklyn, Staten Island, Nassau County, and Suffolk County. For a consultation, call (866)557-7500.

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