We Have Our Work Cut Out for Us

Why is workers’ compensation (WC) in such a shameful state? In April 2004, California Gov Arnold Schwarzenegger signed into law SB 899, which addresses WC issues and takes effect January 1, 2005. SB 899 created the Medical Provider Networks (MPNs), which gives employers or insurers the right to choose the MPN participants and to enter into agreements for the provision of medical care for their injured workers. Employers then will have the power to control medical care for the duration of a claim.

On November 10, injured workers and their advocates, including the California Applicants’ Attorneys Association (CAAA) filed an appeal to stop this practice. In a press release, CAAA President David Schwartz said, “The purpose of the suit is to overturn a new regulation adopted by the state that will allow insurance companies and employers to force injured workers to stop seeing their own doctors. Forcing these workers into a network and cutting their care will only add to the already high profits of the insurance companies, and won’t reduce insurance costs for employers.”

Kenneth Martin, DC, a CP editorial advisory board member who practices in Temple City, Calif, says, “I have a number of my patients who are worried about where they will receive their care or the level of quality that will be provided. This is making them very nervous and unsure if they will ever get a fair shake with the new laws, which are being used to take away care that was promised to them in their work injury settlements.”

But this scenario isn’t just limited to California. In January 2004, the Texas Medical Association (TMA) appealed to the Third Court of Appeals to rectify the failure of the Texas Worker’s Compensation Commission (TWCC) to provide prompt, quality medical care. This is a continuation of an ongoing case in which TMA successfully sought an injunction against TWCC in 2002 to stop implementation of arbitrary rates based solely on a TWCC employee’s best business judgment.

A study recently released by the Workers Compensation Research Institute (WCRI), a nonprofit, nonpartisan public policy research organization, compared WC costs in 12 large states and found that between 2001 and 2002 WC costs per claim in Texas was the highest. Other WCRI studies found that factors behind the rise of medical payments in Texas was due to the growing utilization of medical care by nonhospital providers, especially the higher use of chiropractic care. In California and Texas, attorneys and medical associations, respectively, have become involved because not only does it affect their clients and patients, but it also hurts them financially.

In response to this growing trend, Rene S. Lasanta, DC, of Lasanta Chiropractic, Houston, has proactively implemented an evaluation and treatment system that helps lower WC claims and costs. The estimated savings for an employer with 100 employees and a reported 3% claims of carpal tunnel syndrome is $34,000. Lasanta plans to hold an open house for employers, health care practitioners, and personal injury attorneys to review the new program. “I have been using low level laser therapy with very good results (decreased pain) starting with the first treatment, which will enhance and accelerate healing” says Lasanta. “The new muscle measurement tool has allowed me to isolate and test individual muscle groups more effectively, thus facilitating the implementation of a more personalized treatment plan based on the quantitative data that is printed.”

The injured workers of California and the chiropractor from Houston are just two examples of how you can be proactive and take back WC from the lobbyists and insurance companies. But are these actions only a bandage over the gaping wound that is the WC system? Have WC claims become too problematic and daunting to correct? Of course there are issues of fraud, but should the truly injured suffer even more because of the rotten few?

I would venture to guess that this is just the beginning. WC will be the topic of many debates and ideas. But it can truly be understood with your input and feedback. Why not start it here? I look forward to your comments.

Miwon Seo
mseo@medpubs.com