Los Angeles city employees file workers' compensation claims at rates higher than employees in other large California cities, according to two audits released Tuesday by City Controller Ron Galperin.
L.A. needs to do more to control costs and ensure that the claimed injuries are actually job-related, according to the audits.
In 2013, there were 17 claims for every 100 Los Angeles employees, the audits show. That's compared with 12 claims per 100 employees in San Francisco and 11 claims per 100 employees in the County of Los Angeles.
Workers' compensation claims include requests for the city to pay for medical treatment, time off to recover and other expenses associated with workplace injuries. Last year, such claims cost the city $191 million.
"Do these numbers point to a system in crisis?" Galperin wrote in a cover letter for the audits. "They certainly … raise questions of whether the City and its administrative contractors are doing the best possible job of containing workers' compensation costs."
The audit expands on findings of a review last year by Galperin's predecessor, Wendy Greuel, who criticized high city workers' compensation costs and generous policies.
One of the claims management firms examined, AON, may have made $1.4 million in ove payments to healthcare providers from July 2010 through January 2013, according to the auditors. The company’s “medical payment accuracy was lower than medical insurance industry standards,” the report found.
Another vendor, Tristar, failed to ensure that the claimed injuries were job-related, the auditors said. They looked at 15 claims and found six cases in which Tristar had contacted the employee and his or her treating physician about the injury but had not contacted the employee's supervisor before accepting the claim – effectively taking the employee's word that the injury happened on the job.