Clear the decks – it’s Health Wonk Review day and Brady Augustine has posted Health Wonk Review: “The Relationship Rescue” edition over at medicaidfirstaid. It’s a Dr. Phil-themed issue replete with art, videos, and commentary on some of the best of the health policy blogosphere. Check it out.
The Power of Pink – Sometimes those of us who work in workers comp are so focused on the process, the insurance issues, and following the dollars that we lose sight of the fact that we are actually in the people business. Our friends at the Work Comp Complex Care blog have a refreshing post that demonstrates the difference one person can make: A little pink goes a long way.
The Bunkhouse Rule – Can an injury that occurs at home be compensable? Yes, if your home is your employer’s property, according to the South Carolina Supreme Court. Read more details on the ruling in Roberto Ceniceros’ article in Business Insurance, Migrant worker’s injury in company housing ruled compensable.
Misclassification – The L.A. Times features an article by Dave Gram on a topic that is near and dear to our heart (search for “FedEx”): how companies are slashing payrolls by calling workers independent contractors. The Internal Revenue Service and 37 states are cracking down on this practice, which resulted in an estimated underpayment of $2.72 billion in lost Social Security taxes, unemployment insurance taxes, and income taxes just in the year 2006, according to the Government Accountability Office. Many experts think that the economic downturn has exacerbated the problem of employee misclassification.
Good PT and bad PT – At Managed Care Matters, Joe Paduda asks How many dollars are wasted on physical therapy?. He suggests that while he’s a believer in the benefits of physical therapy, but advocates for clinical guidelines to separate the wheat from the chaff.
More on the Toyota mess – At Claims Magazine, Mary Anne Median writes that . Her article focuses on issues associated with claim-handling, subrogation, and litigation. It’s a fascinating read – here’s just a sampling:
“To break it down; damages, subrogation, and settlements will all be affected, not only for current, but also past and future accidents involving Toyotas.
This also leaves us with questions surrounding the diminished value of the vehicles. In determining that a vehicle is a total loss, what is the value? Can we apply this diminishing value factor when we are establishing what the insured’s or claimant’s vehicle is worth? How does this affect the resale and salvage value?”
Posts Tagged ‘physical therapy’
Fresh Health Wonk Review; also – the power of pink, the bunkhouse rule, and more
Thursday, February 18th, 2010Setting Limits in California
Wednesday, June 4th, 2008California had a long-standing reputation as a workers compensation nightmare: not because injured employees received generous benefits – they did not – but because doctors and lawyers exploited the system to generate enormous fees. Governor Schwarzenegger, AKA the Terminator, put an end to that with his extensive 2003-04 reforms. In the effort to contain costs, the reforms for the first time brought managed care tools into the comp system. The bottom line for employers has improved dramatically.
Among the many provisions of the reform was a limit on physical and occupational therapy treatments for an injury. Injured workers are now limited to 24 visits. Jose Facundo-Guerrero, a worker at a nursery in Half Moon Bay, challenged the limits on constitutinal grounds, alleging that he was entitled to the “full provision for such medical, surgical, hospital and other remedial treatment” promised in the CA Constitution. Jose had visited his chiropractor 76 times and he wanted the carrier to pay.
The First District Court of Appeal in San Francisco has upheld the limits in the comp reform package. They found that the Constitution does not require “unlimited” treatments and leaves the details up to the legislature.
Arbitrary Limits
There is no question that the 24 visit limit is arbitrary. This one size does not fit all. On the other hand, chiropractic treatment can be addicting. It feels good. Jose went 76 times and might well have continued on indefinitely, had the treatments been compensable.
One aspect of the reform language caught my eye: the 24 visit limit can be exceeded if the employer agrees. This raises an intriguing possibility. If valued employees require extensive physical therapy that goes beyond the arbitrary limit, enlightened employers might well authorize the carrier to cover a specific number of additional visits. This makes sense as long as it keeps the employee happy and productive.
As with so many workers comp issues, law makers struggle to find the middle ground between no limits and severely curtailed treatments. What’s missing is reliable and effective lines of communication among employers, their employees, medical providers and insurance carriers. The rigid limits on treatment in California are apparently legal, but that does not mean they are fair. There is no question that the reforms of 2003-04 have reduced costs. Ironically, injured workers were not the primary beneficiaries of the state’s pre-reform, out-of-control comp system. And it now appears likely that these same workers will pay the price for reforms as well.
