New Year's resolutions are a time-honored tradition in which people reflect on the past year and set goals for the year ahead. In the context of the California workers' compensation system, here are some changes and actions I would like to see taken by the California Workers’ Compensation system in 2023.
An impartial Administrative Director (AD) who applies the laws fairly and without prejudice.
Who is the AD?
The AD is the head of the Division of Workers Compensation (DWC) in California.
Too often it appears the AD is biased towards the insurance industry in the way they interpret and apply the laws. For example, in every filed request I make on behalf of an Injured Worker for a physician to perform an Independent Medical Review (IMR) of the treatment recommended for the injured worker, the AD always refuses to provide assignment of the physician to perform the IMR.
However, Injured Workers are allowed by the Medical Provider Network (MPN) laws to file a mandatory California State form indicating the Injured Worker’s objection to and dispute of the medical treatment recommended.
In every filing in our office, the AD denies our request claiming there is not a "true dispute" by the Injured Worker to the medical treatment requested for them. Thus, the AD will not assign a physician to perform the IMR.
The AD, an official agent of the State of California, is basically calling the Injured Worker a liar. Huh? And how dare the AD act so presumptuous to claim they know better than the Injured Worker as to whether the Injured Worker truly disputes a medical treatment recommendation!
These denials by the AD create unnecessary delays, denials, and increased costs for the Injured Worker. Who benefits from these delays, denials, and increased costs for the Injured Worker created by the AD? Yup, you guessed it, the insurance companies.
The AD’s failure to perform their tasks causes my office and the Injured Workers to go to trial to get an Order from a Judge telling the AD they must provide a physician to perform the IMR. Every Judge who hears my trial on these cases orders the AD to provide the physician to perform the IMR. And I mean EVERY judge.
Other attorneys representing Injured Workers had the same issue. In those cases, the Judges have decided the AD does not have the power to deny the appointment of the physician to perform the IMR. The only requirement for the Injured Worker is to file the form noting their request, objection, and medical dispute and the AD MUST provide the physician. The AD is not allowed to play Judge (or God) in interpreting the Injured Worker's intent as to whether they have a real medical dispute.
Despite these multiple decisions from various Judges, the AD continues with their questionable legal actions in not assigning a physician to perform IMR (which favors the insurance industry). Sadly, there are many more examples of the AD’s internal bias towards the insurance industry, but this is a New Year’s resolution list, not a "bitch list."