2004-2005 Workers’ Compensation Reform
Treatment Pre 2004
Prior to 4-19-04, an injured employee could select his own primary treating physician. This physician controlled and regulated all of the injured workers modalities of treatment.
Treatment post 1-1-05
An injured employee, must be treated by an employers network of treating physicians this network of treating physicians is selected and agreed upon by the employer and insurance carrier
1. The employer was required to provide treatment that was reasonable and necessary based on the presumptively correct treating doctor’s opinion.
Post 4-19-04, all dates of injuries are not governed by the extremely conservative ACOEM guidelines. Treating doctors’ presumption has now been repealed and the ACOME guidelines are presumptively correct.
An injured worker was entitled to all chiropractic care, physical therapy or occupational therapy necessary to cure or relieve from the effects of the injury.
An injured worker is only entitled to a maximum of 24, chiropractic, physical therapy and occupational therapy visits.
Pre 4-19-04 an injured worker had the right to pre designate a treating doctor, by simply electing a physician.
An injured worker can only select a physician who has treated the injured worker, manages his medical records and agrees to be the primary treating doctor.
Based on work restrictions, subjective complaints of pain, objective findings modified by the injured workers age, occupation and ability to compete in the open labor market.
Permanent disability is based on the AMA guidelines to be used by the physician to determine objective findings from testing such as MRI, EMG, NCS and their affect on the Impairment of function in the activities of daily living. These guidelines do not take into consideration work restrictions, only activities such as self-care, communication, physical activity, travel, sexual function and sleep.
Defendants had to prove the existence of disability at the time of a new injury in order to reduce any monetary recovery.
There is a conclusive presumption of permanent disability if a prior award exists.
Very difficult to apportion to non industrial factors
The employers are now arguing that permanent disability can be apportioned to non-industrial factors.
An injured worker was entitled to unlimited temporary disability benefits during the time he was recovering from the injury.
An injured worker is only entitled to a maximum of two years of temporary disability benefits from the start date of said benefits.