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Evaluating the workers' compensation system: a first look

The process of making California's workers' compensation system function for both workers and employers and insurers is a complex, years-long one. Three years ago, the state enacted a reform it hoped would save time and money and restore some benefits to injured workers.

While business leaders and insurance companies seem pleased with the reform, there are still complaints voiced by workers and increasingly by another group: physicians who treat injured workers, according to a report.

In a recent state senate hearing that is part of efforts to evaluate the reform, a representative of the California Labor Federation said the state must do more to stop insurers and employers who are using the law to deny medical benefits to injured workers. Plus, she said, some of the new rules providing for medical reviews are giving employers and insurers more opportunities to deny claims, ProPublica and NPR report.

She said some of the reforms have simply shifted too much control to insurers, who often want to deny or limit medical care. In the new system, insurers send injured workers to particular doctors in medical provider networkers; if the insurer doesn't agree with the doctor's decision, they pick a physician outside the network to review the decision.

If workers then challenge the decision of the outside doctor, the decision on the matter goes for final review to an anonymous doctor selected by a state contractor. Those final reviews, the Labor Federation spokesperson said, are almost always in agreement with the insurers.

While insurers and businesses appear to love the contentious law, it isn't universally hailed among doctors, however. "Not all reform is good reform," a pain specialist said. This law has "unintended consequences,” the head of the California Society of Industrial Medicine and Surgery said. He said the reforms are driving many good doctors away from treating injured workers in the system.

Our law firm is committed to fighting for injured workers, however. We will never be driven from the system. Please see our Workers' Compensation Process page for more information about how the attorneys of English Lloyd & Armenta can help you fight for your benefits.

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