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NBC Investigation Reveals CA Workers' Comp Challenges

NBC recently concluded a three-part investigation into California's workers' compensation program from the perspective of injured claimants. Disturbingly, it found what many of us have known for quite some time: that securing benefits is increasingly difficult, leaving many deserving workers without the care and relief they need.

Part 1: San Jose's Firefighters

The first part of NBC's investigation focuses on the complaints of 68 injured San Jose firefighters that claim that, since 2014, they've been denied care they were promised under their workers' compensation insurance. Fortunately, in this case, the city intervened and compelled Athens Administrators—the company hired to review the claims—to overturn nearly all of the rejections.

According to California Professional Firefighters, what happened in San Jose is just one happy ending among many serious issues with firefighter claims across the state. The organization polled departments statewide about their experience with workers' comp claims and received overwhelmingly negative responses. "It’s just a small sample of what the problem is," says CPF President Lou Paulson, "but unfortunately it just validates that we’ve got a big problem with the system."

Part III: Independent Medical Reviewers

In its third part, NBC's investigation delves into California's use of independent medical reviewers: anonymous, third-party medical professionals who review appealed claim rejections. These reviewers, which were established under Senate Bill 863 in 2013, are isolated from the rest of the appeals process. Previously, claimants could make their case before a judge. Now, this review policy puts the decision-making power in the hands of someone whose only familiarity with the case comes from the provided medical paperwork.

Even more disheartening is the fact that independent medical reviewers are very likely to uphold a rejection of a workers' compensation claim. NBC found that from 2013 to 2015, independent reviewers overturned a mere 59,697 rejections. A total of nearly 600,000 claims were reviewed over that time.

You can read more about this investigation at the NBC site.

You do not have to face this intimidating process without a knowledgeable advocate by your side. Contact a Fresno workers compensation lawyer today at (888) 298-6753 today.

For a free case evaluation with Berry, Smith & Bartell, a Professional Law Corporation call 1-800-848-6288 today!

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