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Case involving worker’s death sparks grief, outrage throughout California

Posted on 09 May 2013 by admin

A ruling by the state Workers Compensation Appeals Board has ignited both sorrow and anger over the death of an injured worker five years ago this week.

 

Compounding the indignation over the details of how Charles Romano died is outrage at the meager fines—still to be issued in the case—that advocates say highlight the weakness of state oversight and the failure of state lawmakers to hold insurers accountable.

“I mourn the loss of Charles Romano and the suffering that preceded it,” says Jesse Ceniceros, board president of Voters Injured At Work.

 

“The facts of his case–how the rule of law in this great and wealthy state turned its back on this hardworking man–cast shame upon his employer and its insurer. His case also shows once more how powerful interests have rigged the workers compensation system against ordinary Californians. If it can happen to him, cut down in the prime of his life, it can happen to anyone.”

 

Charles Romano, a grocery worker at Ralph’s in Camarillo, died at the age of 47 in early May 2008, ending a five-year effort to recover from a shoulder and neck injury he suffered on the job in 2003. Frustrating that effort, as the appeals board found, were repeated delays and denials of care by Romano’s employer, part of the Kroger foods chain, and its claims administrator, Sedgwick CMS.

 

The ruling denied an appeal by Ralph’s and Sedgwick of their liability in the case (Romano v. Kroger, or ADJ1372133). It revealed that Sedgwick “continued to deny or delay care through the end of applicant’s life,” failing to pay even for Romano’s final hospitalization for more than 4 months after his death.

 

Facts of the case elicited unusually blunt and evocative language from the appeal board. The “horrifically ill” Romano repeatedly sought authorization and attention to his claims from Sedgwick, which showed only “blithe disregard for its legal and ethical obligation to provide medical care to a critically injured worker.”

 

Despite its determination that Sedgwick “unreasonably delayed medical care in 11 separate instances,” the board cited the limitations of state law in setting the maximum penalty of “25 percent of the delayed medical benefit, not to exceed $10,000.” The maximum fine Sedgwick faces stemming from the death is thus only $110,000.

 

“Adding insult to injury in the case is the trifling amount of state penalties,” adds Ceniceros. “Such fines are an affront to working people. They mock the notion of fair play and the American way. They fail to provide a deterrent to unconscionable abuses and invite multi-billion-dollar companies to treat the lives of workers as a cost of doing business. Unless state lawmakers act to fix the systemic problems exposed once again by this case, they risk being complicit in shame. The death of Charles Romano must not be in vain.”

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Senate Bill 36 (Hueso) – Sponsor

Posted on 18 April 2013 by admin

Voters Injured at Work (VIAW) is a non-profit, grass-roots organization that represents injured workers throughout the state of California. VIAW has a network of more than 10,000 working people in California who have suffered injuries at work, as well as their families. VIAW’s primary goal is to ensure that the Comp system provides sufficient treatment and resources to injured workers. Our economy and our families depend upon critical medical treatment and vocational services to return to the workforce. When the system disproportionally harms the injured worker we all lose.

VIAW is proud to sponsor Senate Bill 36 (Hueso), which would require that the Department of Insurance publish the annual and quarterly financial statements filed by workers’ compensation insurers on its website. This will increase transparency in the workers’ compensation system in California, an increase that is greatly needed. The solvency of some insurers has become a concern, and publishing these financial statements will help improve the public’s awareness of which, if any, insurers are in financial trouble.

Official Letter Submitted is at this link

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JOIN US in SACRAMENTO to PASS SB 626

Posted on 18 April 2013 by admin

JOIN US
Wednesday, April 24
in
SACRAMENTO
to
PASS SB 626

Gather just one block from the Capitol at
Chicory Coffee & Tea
1131 11th St.
Sacramento, CA 95814
8:30 a.m.
April 24

We will proceed to the Capitol at 9:00 a.m.
to the Rose Ann Vuich Hearing Room (2040)
for the 9:30 a.m. hearing with SB 626 on agenda
of the
State Senate’s Committee on
Labor & Industrial Relations

Make Sure Your Voice Gets Heard
RSVP:
administrator@VIAW.org
or Text Your Name to 323-807-2785

For Tips on Reaching Committee Members or Talking Points on Passing SB 626, Visit www.VIAW.org or Call 323-807-2785

DOWNLOAD OFFICIAL FLYER ON THIS LINK

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Support SB 36: Sunlight on Insurance Carriers

Posted on 17 April 2013 by admin

Newest state senator Ben Hueso (D-San Diego), a strong labor ally, is already making an impact for workers and Californians hurt on the job in his first weeks of service in the upper chamber. Fresh from his March 12 special-election victory, Hueso on April 8 hit the ground running with SB 36 to ensure that quarterly and annual disclosure reports filed by companies providing workers compensation insurance in California get posted on the Web site of the state Department of Insurance. The bill is set for a hearing on April 24 in the Senate Insurance Committee.

See attached additional information

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Block Transportation Security Administration Policy Decision to Accept Pre-9/11 Weapons

Posted on 03 April 2013 by admin

WE PETITION THE OBAMA ADMINISTRATION TO:
Keep Knives Off the Plane.
Before the morning of September 11, 2001, the threat of using commercial aircraft as a weapon was unknown. At great cost, we know better today. The TSA was created because blades on airplanes were used to cause this deadly attack on U.S. soil.

There’s no excuse for reversal on the policy to ban knives from the aircraft cabin. Multi-layered security, including prohibition of items that could pose a threat, ensures U.S. aviation is the safest in the world. The ban on dangerous objects is an integral layer in aviation security.

Flight Attendants serve as the last line of defense in aviation security – responsible for ensuring the safety, health and security of the passengers in our care. Join us in keeping our aircraft cabin safe. TELL THE TSA TO KEEP KNIVES OUT OF THE CABIN.

Sign the PETITION here

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CA DWC, WCAB revise Policy and Procedural Manual

Posted on 02 April 2013 by admin

Oakland, CA – The Division of Workers’ Compensation (DWC) and Workers’ Compensation Appeals Board (WCAB) have revised their Policy and Procedural Manual (PPM) and posted it on the WCAB website.
The PPM is an internal employee guide, prepared under the authority of the administrative director of DWC and the chair of the WCAB. The manual is designed to promote uniformity and provide direction to judges and other employees in the day-to-day operation of DWC’s district offices and the Appeals Board. It is also a resource for attorneys, claims administrators and other parties wanting information on the rules of court. Because it an internal document, the PPM is not subject to regulations, which require formal rulemaking procedures and public hearings.

Read Full Article Here

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CA Division of Workers’ Compensation Posts Updated Fact Sheets for Injured Workers

Posted on 02 April 2013 by admin

Oakland, CA – The Division of Workers’ Compensation (DWC) has posted updated fact sheets for injured workers on its website. The updated fact sheets provide injured workers with answers to frequently asked questions about issues affecting their benefits, and include changes mandated by Senate Bill 863.
“The fact sheets help injured workers and other parties understand the sometimes complicated process of workers’ compensation,” said DWC acting Administrative Director Destie Overpeck. “We have updated the fact sheets to reflect the changes made by SB 863.”
The fact sheets cover such topics as temporary disability benefits, permanent disability benefits, supplemental job displacement benefits, and medical care. They are available to employers and insurers who are required to comply with benefit notice regulations.
The updated fact sheets are available for immediate use in English and Spanish.

Full Article here

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This safety net has holes

Posted on 11 February 2013 by admin

Voters Injured At Work continues to lead the fight for fairness for injured workers and their families throughout California. Please share our message with friends and colleagues who might join our push to fix state law, assist injured workers, and win justice.

This safety net has holes

Advocate for injured employees says state workers’ compensation law needs further revision

Jesse Ceniceros

The new year marks the onset of major reforms in how our state manages
cases of Californians hurt on the job. Far from easing frustration, the
new workers’ compensation law heightens the need for proper reform.

The law may hasten relief for a small group of very seriously injured
workers. But it shortchanges most of the 440,000 Californians injured on
the job each year and leaves us clamoring for a say in its implementation.

By eliminating coverage for mental-health injuries, the new law weakens
the safety net for workers. It also leaves a major problem unattended: the
liens on insurers that are supposed to allow workers to access care, but
which create tangles that can delay and drive up costs of that care or
deprive us of needed treatments altogether.

The third major problem with this law is that injured workers have been
left without a seat at the table. New appointees to the state’s
eight-member Commission on Health and Safety and Workers’ Compensation, announced last month, fail to include an injured worker. That’s a shame.

The appointments reflect a pattern of favoring employers,
management-friendly law firms and union lobbyists.

These are the same interests that cut the voices of people with the most
firsthand knowledge and the greatest stake in our workers’ comp
system–injured workers–out of the loop in the last two rounds of reform.

This exclusion wasn’t smart or right when then-Gov. Schwarzenegger did it during a prior workers’ comp reform in 2004. And it was wrong again last year under Gov. Brown, advancing neither injured workers’ interests nor the public interest in a fair, cost-effective, and stable claims process.

I had great hopes for what reform might achieve for injured workers.
Forced to navigate a maze of authorizations and paperwork, we have some
recommendations for strengthening the system. But a handful of insiders
shut us out of drafting the bill. Starting in late 2011, for 10 months,
they huddled behind closed doors to write changes.

Then, in late August, sponsors sprang the new package on their colleagues,
substituting its contents into a prior bill. Prodded by the governor,
lawmakers passed the measure just hours before adjournment. No legislator admitted having read the bill entirely. As observers noted at the time, this was no way to fix workers’ comp. It was like sending first-aid kits to a disaster site, without detailed reports from the scene, much less diagnoses, then declaring it a humanitarian triumph.

What about psychological injuries? Under this reform, they’re removed from consideration in an injured worker’s claim. It’s a terrible step backward for California, at a time when state Senate president Darrell Steinberg and others are touting our state as a model of mental health policy in the wake of the Sandy Hook school shooting. Correcting this error in the new law tops my to-do list in 2013.

And what about the tangle of liens on insurance carriers? Thousands of
injured workers lose out on crucial components of medical attention and
rehabilitation because insurers do not authorize timely care or defer
approval or payment for needed treatments. Some conditions worsen in the meanwhile. Paying out of pocket is rarely on option for injured workers, given loss of income. So is court action, given tie-ups in caseloads due to budget cuts and layoffs. The crisis of liens has united some employers and insurers with injured workers to pursue a realistic, long-term remedy.

And so we shall in the months ahead.

From orchard to laboratory, from ski lift to offshore platform,
California’s workforce is a world-class example of diversity, resilience,
and safety. Lessons learned from thousands of workers injured or killed on
the job each year, then applied and enforced over time, have fueled our
state’s progress to the head of the pack on productivity.

That same dedication to honoring and heeding the voices of injured workers must extend to lawmakers and the executive branch in Sacramento. In fixing workers’ compensation, the new Legislature must improve on the lapses of the last one.

Jesse Ceniceros, a former aerospace mechanic, is board president of Voters Injured At Work, a California statewide advocacy group.

Link (may require subscription to view full content):

Sacramento Business Journal

http://www.bizjournals.com
***

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California Department of Industrial Relations Jump Starts Landmark Workers’ Compensation Reform To Protect Workers and Cut Costs

Posted on 08 January 2013 by admin

FOR IMMEDIATE RELEASE
IR #2013-01
January 04, 2013

CONTACT:
Erika Monterroza
Peter Melton
(510) 286-1161

Twitter @CA_DIR
facebook.com/CaliforniaDIR


California Department of Industrial Relations Jump Starts Landmark Workers’ Compensation Reform To Protect Workers and Cut Costs

Oakland, CA— The Department of Industrial Relations and its Division of Workers Compensation (DIR/DWC) today announced new regulations implementing provisions of Senate Bill 863, California’s landmark workers’ compensation reform signed last year by Governor Edmund G. Brown Jr. to save businesses millions of dollars in unnecessary costs while boosting worker protections.

“We are on track to implement the wide-ranging reform which was the result of extensive input by workers and employers,” said DIR Director Christine Baker. “These reforms are engineered to reduce unnecessary costs while redirecting some of the savings to increase benefits for disabled workers.”

Key components of Senate Bill 863, which became law on January 1, 2013, include a 30 percent increase in permanent disability indemnity rates for workers phased in over two years. Other aspects of the bill, including those designed to cut costs for businesses, will now be implemented through regulatory action. Today’s new regulations launch that full rulemaking process with public hearings scheduled to take place by March.
The new regulations, approved on an interim basis by the Office of Administrative Law, improve workers’ compensation by creating an independent medical panel to review injuries, streamlining billing disputes and curbing unnecessary liens. Details of these new regulations include:

Utilization Review, Independent Medical Review
For injuries on or after Jan. 1, 2013, and effective July 1, 2013 for all dates of injury, medical treatment disputes will be resolved by physicians through an efficient process known as independent medical review (IMR), rather than through the often cumbersome and costly adjudication system. If utilization review denies, delays or modifies a treating physician’s request for a specific course of medical treatment for the reason that the treatment is not medically necessary, the injured employee will have the right to request a review of that decision by IMR conducted by a physician. The physician review will be expeditious and based upon evidence-based standards to ensure that injured employees receive timely and appropriate medical treatment.

Qualified Medical Evaluator Regulations and PDRS
The new regulations amend existing rules to clarify that independent medical review is the sole process for resolving disputes regarding ongoing medical treatment issues; limits the number of offices from which a Qualified Medical Evaluator (QME) may conduct evaluations; streamlines the application process for chiropractors; allows for factual corrections of a comprehensive medical-legal report from a QME panel; and amends a number of forms.

Independent Bill Review
Medical service billing disputes for dates of service on or after Jan. 1, 2013, will be resolved through a non-judicial process of independent bill review (IBR). The IBR applies to any medical service bill where the fee is determined by a fee schedule adopted by the DWC. If the medical provider disagrees with the amount paid by a claims administrator on a properly documented bill following a second review, he or she can request an IBR. This regulation will eliminate unnecessary, costly litigation.

Electronic document filing and lien filing fee
Any lien for reasonable medical expenses incurred by or on behalf of the injured employee (except disputes subject to independent medical review or independent bill review) and filed on or after Jan. 1, 2013, is subject to a lien filing fee of $150. For those liens filed before Jan. 1, 2013, there will be a $100 activation fee which must be paid prior to Jan. 1, 2014, or the lien will be subject to dismissal by operation of law.

Self-Insurance and Annual Actuarial Reports
These new regulations will implement SB 863’s requirement for all private self-insured employers and groups to obtain an actuarial report to more accurately establish the organization’s California workers’ compensation liability exposure. The regulations will further define new methods in how the OSIP establishes security deposit collateral requirements based on this additional information.

Interpreter Services
SB 863 amended Labor Code section 4600(g) to state that an injured worker is entitled to the services of a “qualified interpreter” at medical appointments if the injured worker is not proficient in English. These regulations define the “qualified interpreter for purposes of medical treatment appointments” as “…an interpreter who has a documented and demonstrated proficiency in both English and the other language; a fundamental knowledge in both languages of health care terminology and concepts relevant to health care delivery systems; and education and training in interpreting ethics, conduct and confidentiality …” so that employers can furnish, and non-English-speaking injured employees can receive, interpreter services at medical treatment in accordance with the statute.

Supplemental Job Displacement Benefits
Makes modifications reflecting regulatory changes regarding offers of work, notifications and vouchers for retraining workers injured on the job.

Hospital outpatient departments and ambulatory surgical centers fee schedule
The statute also amended the official medical fee schedule for hospital outpatient departments and ambulatory surgical centers, reducing the facility fee for ambulatory surgical center services to 80 percent of what Medicare bills for the same services in a hospital outpatient. This change will save an estimated $62 million plus additional savings in system costs. The regulation is effective Jan. 1, 2013.

Extensive information on workers’ rights and employers’ responsibilities as well as information for small business owners can be found on DIR’s website. DIR’s rulemakingweb page includes a quick overview of regulations and is updated regularly.

The DWC, a division within DIR, monitors the administration of workers’ compensation claims, and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers’ compensation benefits. The DIR was established to improve working conditions for California’s wage earners, and to advance opportunities for profitable employment in California. DIR is a department within the Labor and Workforce Development Agency.

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Division of Workers’ Compensation posts lien filing instructions

Posted on 02 January 2013 by admin

Newsline No. 72-12
December 31, 2012
Twitter @CA_DIR
Facebook

Division of Workers’ Compensation posts lien filing instructions

The Division of Workers’ Compensation has posted step by step instructions on new lien filing requirements which go into effect January 1, 2013 as part of its implementation for Senate Bill 863.

An “at a glance” guide is included so that those filing or activating liens can refer to easily:

Filing a Lien

How to file a lien for medical treatment expenses and pay the lien filing fee:

  • Anyone filing a lien for reasonable medical expenses incurred by the injured employee and filed on or after Jan. 1, 2013 is required to pay a lien filing fee of $150.
  • The lien must be filed electronically by one of two methods: : E-Form or Jet File.

Activating a Lien

How to activate a lien and pay the activation fee:

  • A $100 fee must be paid for any medical treatment expense lien filed prior to Jan. 1, 2013 in the following situations:
  • A lien claimant files a DOR for a lien conference
  • On or before a lien conference if the lien claimant did not file a DOR
  • To activate and pay for a lien by E-form or JET File use the step by step instructions.
  • All liens will be dismissed as a matter of law if the activation fee is not paid by Jan. 1, 2014.

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