Overhaul Has Injured Workers Nervous

Injured workers have long had complaints about the state’s workers’ compensation system. They include hostile company doctors, months-long delays in treatments and disability checks, inadequate payments and a dense bureaucracy some say they can penetrate only with the help of lawyers.

Now, some workers’ advocates say, things are bound to get even worse.

The massive workers’ comp bill expected to win legislative approval today calls for cutting some disability payments and reducing penalties on insurance companies that pay late. It also would reduce benefits for workers who can return to work, even for light duty.

What rankles workers’ attorneys the most, however, is a provision allowing employers to form networks of doctors to treat injured workers. Currently, an injured worker first sees an employer-contracted doctor, but if the worker is unhappy, he or she can move to any doctor of choice after 30 days. Under the plan, choices would be limited to other doctors in the employer-contracted pool. If a worker was unhappy after a third choice in that pool, the case would be reviewed by a state-sanctioned investigator.

This setup, some worry, may shift the balance of power back toward employers, moving toward a situation like in the 1940s and 1950s when employees were often stuck with company doctors.

“I fear that we’re moving back into the days of the [company] clinics, where people are patched up and sent back to work,” said Art Azevedo, president of the California Applicants’ Attorneys Assn., which represents lawyers for injured workers. “That only delays medical care and ends up costing more in the long run.”

Certainly, not everything in the bill is bad for workers. Employees, for instance, would get immediate treatment for injuries rather than waiting for a claim to be investigated. Severely injured workers who cannot return to work would be eligible for 15% higher benefits.

Worker advocates were still trying to make sense of the huge document late Thursday and had different interpretations of some clauses. Attorneys representing injured workers were far more negative about the overall package than were labor leaders, who characterized the legislation as more of a “mixed bag.” Union officials said they got the best deal they could given the demands by the business community to lower workers’ comp costs, which have doubled or tripled for many employers in recent years.

“The deck was stacked against injured workers from the beginning,” said Nathan Ballard, a spokesman for the California Labor Federation.

The overhaul package, developed after weeks of negotiations between Gov. Arnold Schwarzenegger and legislative leaders, is seen as a vital first step in the governor’s crusade to boost job creation and improve the state’s business climate.

Some changes could begin immediately and affect settlements for those with pending claims.

The revisions could make it more difficult for workers to win claims for conditions such as carpal tunnel injuries, back strains and migraines because all injuries and illnesses must be documented by “objective criteria.” Pain alone will no longer be sufficient, attorneys said. Employers have complained that the current system is wide open to fraud.

For the first time, payments for injuries and illnesses will be reduced if a preexisting condition contributed to the work-related problem. For example, if an undiagnosed case of diabetes aggravated a work injury, payments would be reduced by whatever portion was caused by the diabetes.

The plan also cuts off payments for temporary disabilities after two years, with a short list of exceptions such as for burns and eye injuries. Although most cases wrap up sooner, some extend beyond two years, in part because of insurer delays.

And while workers with severe injuries that make them unable to work will be eligible for higher benefits, benefits will be cut for workers who can return to work, even for light duty.

Dianne Fitzpatrick, 62, is worried about anything that might cut benefits. The former Placerville preschool teacher was injured in 2001 after a tussle with a large child left her disabled with a spinal injury and leg problems.

She has been to court to get permission to see a specific doctor without restrictions, and different doctors have told her different things. One recently told her it was too late to get the surgery she needed.

A widow whose son recently returned from Iraq, Fitzpatrick has been collecting monthly disability payments since her injury, although a March check failed to appear and she doesn’t know why.

“I don’t know what I’d do without my disability. I’m on very limited Social Security,” said Fitzpatrick, who has borrowed money and cashed out her retirement savings to make ends meet. “In Arnold’s new reforms, everything is for the insurance company. I’m going to write him a letter.”

Former bellman Rickie Alexander, 39, who worked at the W Hotel in Westwood for 10 years, said his getting a lawyer was the only reason workers’ comp authorities took his injury claims seriously.

Alexander, who is married and has a 14-year-old daughter, gets $635 a month in temporary total disability payments since injuring his back in August moving some crates.

“I’ve been hearing they are going to cut a lot of benefits,” Alexander said. “I think we have a governor who’s really not in touch with the common everyday worker. He doesn’t know how it feels to be working in a job for 10 years and then you hurt yourself and all of a sudden you wonder what you’re going to be doing.”

Vince Connor also took issue with Schwarzenegger. “I question this governor,” said the 62-year-old, who was a chaplain at a correctional facility in Chino before stress-related injuries knocked him out of work with neck and back problems in 2002. “He says he’s the governor for the people, the working man, but he’s really the governor of the insurance companies.”

Connor said he had a bad experience with doctors referred to him by the workers’ comp system, and only when he sought out other medical counsel did he get help. “I was treated horribly,” Connor said. He has a lawsuit pending.

In Beverly Hills, chiropractor Lauren Papa said the reforms would have a chilling effect on her clients, mostly unskilled Latino workers.

“What the governor is doing here is talking about limiting treatment,” Papa said. “This is not the answer. It’s beyond scary. It’s going to mean more people are too hurt to work and ultimately just put more people on welfare.”

Papa, who treats Alexander and others, said that because insurance companies delay authorizing claims, the patient can get worse and have a prolonged recovery period. Or the patient might need additional surgery, which costs employers even more in rehabilitation therapy.

“As a chiropractor all I can do is treat the patient and keep them walking until their lawyer can get a court date and argue before the judge, in order to get the claim authorized,” she said.

Although the overhaul package intends to reduce litigation within the workers’ comp system, thereby streamlining treatments and getting people back to work faster, many specialists predicted that litigation would increase.

“Whenever you are talking about litigation, you are talking about the devil that lives within the details,” said Richard Wooley, also with the California Applicants Attorneys Assn. “A lot of the things they are coming up with ... will in fact increase litigation, but exactly to what extent remains to be seen.”

The proposed changes come on the heels of a workers’ comp measure passed last year that went into effect Jan. 1.

That legislation established standardized rates for every medical-care provider, including outpatient surgery centers. It also set fee schedules for pharmaceuticals, capped visits to chiropractors and physical therapists and required “utilization reviews” that would set care standards for injuries.

Although the changes were hailed as a major reform of workers’ comp by former Gov. Gray Davis, who maintained that they would cut more than $6 billion in workers’ comp costs, business leaders questioned the savings estimates.

A leading insurance industry research group calculated that the reforms would save only $3 billion to $5 billion.

California’s current system grew out of the Progressive era early in the 20th century, when workplace injuries began to rise. California was one of the first states to adopt a workers’ comp system, with the first law adopted in 1911. The system then was voluntary.

Two years later, a compulsory system was adopted, with employers required to provide benefits. But employees were generally prohibited from suing employers over their injuries.

In recent years, inflation, benefit increases, fraudulent injury claims, economic conditions, various attempts at reforms and other factors have all contributed to the increasing complexity and cost of the system.

Times staff writer Marc Lifsher contributed to this report.