State Audit Of Workers Compensation Uncovers Lengthy Delays In Claims for Californians Injured On The Job

California’s first-ever audit of its Division of Workers Compensation finds that people who are injured on the job may have to wait years to receive the benefits they are entitled to by law. In addition, medical evaluations approved by the employer are increasingly more difficult to obtain. In some cases, the delays prevent patients from obtaining a determination in how disabled they are from their injury.

The reason for the backlog is the state has a shortage of physicians signed up to work with the state’s program to serve as experts. The audit noted it has been 13-years since the state increased the pay schedule for doctors known as Qualified Medical Evaluators. The report made by Auditor Elaine Howle shows that doctors are getting paid the same rate offered in 2006 at $625. If that salary was adjusted for inflation the rate today should be $812.

The state legislature is now getting involved. A bill to boost pay for medical evaluators may be heard this month. The bill would base the pay increase based on inflation since 2006 and offer regular raises in efforts to retain and attract doctors.

According to the audit:

• The state had 100,000 new requests for evaluations but only 2,800 medical evaluators in 2017-2018.
• Doctors were inappropriately disciplined for over billing issues by not reappointing them.
• Evaluators reports did not meet quality standards along with no one tracking how often a judge rejects a report as a result.

Delayed hearings and long wait times for decisions to be made on a case often lead to the injured worker’s health getting worse, and financial hardships that create precarious situations like losing a home. The worker may be unable to work until an evaluation is complete. An incomplete evaluation means they may not receive disability payments or access to medical care.

Administrative Director George Parisotto of DWC, who was appointed to his position in 2017 by Governor Jerry Brown, wrote they are aware of the decrease in doctors evaluating worker compensation cases and are making recommendations.

Howle recommended in the report for the legislature to do the following:

• Require the department to review and update when needed, the fee schedule for compensating QMEs at least every two years.
•    Increase the number of QMEs on the panels the department provides.

The department should develop and implement the following:

• A plan for increasing the number of QMEs that prioritizes the specialties with greatest shortages;
• Written policies and processes for disciplining and reappointing QMEs; and
• A plan to continuously review QME reports for quality and report findings annually.

There seems to be a litany of nefarious situations that are wreaking havoc in the department of worker’s compensation including a pattern of behavior that may be pushing doctors away from the workers compensation system. That pattern showed when an insurer accuses a reviewing doctor of over-billing, the division denies the doctors reappointment instead of performing a review of the accusation.

The report listed at least ten state agencies who purchased Workers Compensation Insurance who overpaid millions of dollars to cover their employees.

In 2018, a secret investigation took place concerning allegations that the Department of Industrial Relations former director, Christine Baker, showed favoritism toward her brother and daughter, who were both employed in the department.

The audit also showed the DIR has not tracked when judges rejected reports that failed to meet standards such as accuracy or completeness.

Jerry Azevedo, a spokesman for the Worker‘s Compensation Action Network acknowledged the evaluator system needs revamped.