Safety Member Concerns
In an effort to reduce growing insurance premiums, SB 899 was enacted. Unfortunately, SB899 had an adverse impact particularly on Safety Members. Due to the precarious nature of Safety member employment, these individuals are subject to a greater likelihood of injury to a larger number of body parts. This reform has created significant obstacles for Safety members when faced with a work related injury.
1. The provisions of SB 899 allow for a delay in medical treatment (UR review, ACOEM Guidelines)Safety members require immediate access to qualified medical treatment in order to return to work in an expeditious manner. The Majority of injured safety members attempt to return to work as soon as practical. Many times injured members receive salary continuation while approval for medical treatment is pending. The cost of salary continuation paid to the member often exceeds the cost of the denied/delayed medical procedure. Also, this process allows an employer to “legally” deny or delay necessary treatment without physical examination of an injured member. Safety members should be provided with immediate unfettered medical treatment that is not limited by utilization review or the ACOEM guidelines, but in accordance with the members treating physician.
2. SB 899 (L.C. 4616) allows an employer to create a network of managed care physicians. Under previous law the injured worker treated with an employer designated physician for the first 30 days following a claimed injury. Thereafter, the employee could be treated by a physician of their own choice. Safety members develop a myriad of serious illnesses (some of which are presumed) and should be allowed to choose qualified Physicians that will be rendering their care.
3. Under Current law orthopedic injuries are assessed based upon the AMA (American Medical Association) Guides, 5th edition, and the Permanent Disability Rating Schedule (PDRS). The overall effect to injured safety members has been devastating. Permanent disability for orthopedic injuries has been reduced to such a rate that it no longer accurately reflects true inability to compete in the open labor market. Therefore, orthopedic disability for safety members should be calculated based on the evaluation practices in effect prior to 1/1/05.
4. Currently (L.C. 4062) an injured safety member must undergo evaluation by a “lottery” style Panel QME issued by the office of the Administrative Director. This process has proved to be ineffective as the Physicians are unqualified, unwilling and unable to comply with examination and reporting requirements leading to additional evaluations and/or numerous supplemental reports. Additionally, the majority of the panel QME physicians are not familiar with safety member presumption, benefits or job duties. In order to expedite resolution of disputes the parties should either agree upon a neutral physician or obtain comprehensive medical evaluations.
5. (L.C.4656(c)(1)) mandates a two year maximum Temporary Disability payment from the commencement of Temporary Disability benefits. Potentially, if an injured safety member misses 1 day from work and pushes himself/herself back to work, and 2 years later requires surgery, they may not receive Temporary Disability benefits while recovering from the effects of the work related injury. There should be no limit as to the period of time that an injured safety member receives Temporary Disability consistent with law in effect prior to April 19, 2004.
6. With the implementation of Labor Code section 5402 (c) an employer is required to furnish the first $10,000.00 in medical treatment until a claim is rejected. Public entities have tackled this problem by denying claims without the requisite good faith investigation pursuant to title California Code of Regulations 10109. Unfortunately, there is no immediate remedy for the injured member, nor are there any consequences for the offending employer. Injured Safety members are being denied Temporary Disability/salary continuation benefits and treatment at the outset of their injuries. This process must stop. Penalties should be assessed and awarded to the aggrieved party in order to prevent further abuse.
7. Recent law has clouded the issue as to whether or not apportionment is applicable to presumptive injuries. Presumptive injuries should be excluded from the application of the newly enacted apportionment statutes and should not be subject to scrutiny under new law.