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California Workers' Compensation "Fixed" So That Insurer Profits Are Greater Than Benefits Paid to Workers

Judge Declares Schedule of Payments to Permanently Disabled Workers is Illegal
Julius-Young.jpg

By Julius Young

Governor Schwarzenegger has recently promised to fix California’s healthcare, claiming that his 2004 reforms “fixed” the California workers' comp system. But recent developments in California workers’ comp reveal a system that remains broken. Like the declaration of victory in Iraq by President Bush on an aircraft carrier several years ago, Schwarzenegger’s claims that he “fixed comp”, despite constant repetition, are misleading.

2006-comp-benefits.jpg
Insurer profits now exceed workers’ benefits according to a study released on April 30, 2007 by an industry rate setting organization, the Workers Compensation Insurance Rating Bureau (WCIRB). Since enactment of Schwarzenegger’s SB 899 in 2004, insurer profits have totaled $27.7 billion and benefits to workers (including medical treatment, temporary disability payments and permanent disability benefits for diminished earning capacity) have totaled $19.8 billion. That’s right. In what is fundamentally a social program designed to care for injured and disabled workers, benefits paid out to workers and to their medical providers were less than insurer profits!

How much was paid to workers? WCIRB figures show that in 2004 out of total premiums of $23.6 billion, benefits paid to workers were $7.8 billion. In 2005, total premiums were $21.4 billion, but benefits paid to workers only $5.8 billion. By 2006 total premium had shrunk to $16.6 billion, but benefits to workers amounted to only $6.2 million.

Weekly benefits for permanently disabled workers in California are now 4th lowest in the nation.

Graph-loss-of-eye.jpg
Want some examples? The following are from a U.S. Chamber of Commerce comparative analysis of state workers’ comp laws. The national average award for loss of a leg at the hip is $114, 522. In California it is $61,435, 6th lowest in the nation. Loss of an eye? The national average award is $74,558. In California it’s $17,714, lowest in the nation. For loss of a foot the national average is $80,977. In California it’s $28,820. Loss of a thumb? California’s benefits are 7th lowest in the nation.

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Many employers have benefited from lower workers’ comp premiums, but even with lower premium volume comp insurers have managed to maintain huge profits due to the fact benefits to workers have been reduced. Keep in mind that these figures do not factor in additional insurer profits from investment income.

A May 2007 decision by a San Francisco workers’ comp judge cast a cloud over Schwarzenegger claims that the comp system is “fixed” and a successful model for healthcare reform. In the case, Boughner vs. Comp USA, Judge Jacqueline Duncan issued a 51 page ruling, concluding that the new California rating system is invalid. Finding that SB 899 required that the new rating schedule be based on empirical data, Duncan gave failing marks to the Schwarzenegger administration staffers who designed the new disability rating schedule.

Meanwhile multiple studies, including one undertaken by CHSWC, the California Commission on Health, Safety and Workers’ Compensation, have shown that permanent disability income replacement benefits to disabled workers have been cut by over 50%. An administration study of the issue is being undertaken, but Schwarzenegger appears to be in no rush to address the issue.

Last year Schwarzenegger vetoed a benefits increase bill, SB 815, authored by Senate President pro Tem Don Perata. This year both Perata and Assembly Speaker Fabian Nunez are back with bills to address the issue.

But the elephant in the room may be insurer profits. Can there be benefits which adequately compensate disabled workers if insurer overhead and profits are well over one half of premiums paid by employers? How long can the Governor maintain that he fixed a system that pays out such pitiful benefits? Does the Governor have a plan to address adequacy of benefits? And when will the press begin to focus on the sad state of California’s workers’ comp system? A system that remains broken.

Starting in 1979, Julius Young has represented thousands of individuals who have sustained life-changing injuries or illnesses while on the job. His goal is to secure the medical treatment his clients need and the maximum benefits they are allowed so they and their families can survive potentially devastating injuries. A partner of Boxer & Gerson since 1988, he practices workers’ compensation and disability law in Oakland.

Posted on May 17, 2007

Comments

One Way to "FIX" the workers comp is for WORKERS ADVOCATES and INJURED WORKERS to FILE a CLASS ACTION SUIT against the INDUSTRY and those that made this SCAM possible. Legislature should be held responsible in making sure that we have LAWS in place that would deter this corruption and disparity from spreading, and make it a HIGH CRIME against public and society. I understand that there are LAWS that has been done to protect and enabler. This should be removed and put in place some LAWS to hold those accountable. The industry should be regulated again. This system of INSURANCE was suppose to be designed to protect the society, protect our way of life, protect our asset, AND MOSTLY to protect and preserve our individual rights to maintain our sense of dignity when thing go wrong beyond our control. Instead the very industry and government that was designed to secure this IS robbing us blind. By dipping into the peoples collective pool of reserves. WHAT THE HELL IS GOING ON! WE THE PEOPLE are getting ROBBED. Public servants are treating the citizens who pay their salary are like a NOBODY. THEY are treating our contributed TAXES and INSURANCE premium contributions LIKE it was their OWN, dipping into it as they please, and when they are caught, gagging the mouths, as if the whissle blower was in fact the ROBBER. WORKERS should be OUTRAGED! This is exploitation of the AMERICAN WORKERS! This is extortion! This is IMMORAL!

This is looking like BUSHIES FEDERAL attack on the AMERICAN working people, in a STATE level assault. WE should NO longer sit in idle while these neo-con rob us blind. GAS GOUGING. RISE IN PRICES of the very basic of LIVING. BANKING INDUSTRIES are extorting money from ALL of us. Many people are losing their HOMES. Teaser mortgages designed rob the working people. Product recalls are appearing everywhere even though we have paid taxes to make sure this does not happen. IT IS A MESS! Police Departments, Fire Departments, VA Hospitals, Schools, shopping Mall and Parks are no longer SAFE for the public. Crime is every where even in our WHITE HOUSE. This is madness!

AMERICA should beware! The disease of GREED, cronism, and Corruption may have reached your LOCAL level of government. BE on high ALERT! This is becoming attack on the working class is a National Crisis.

Evidently the City of San Jose has seen some signs of this infectious disease. Remember RON GONZALES?

WE THE PEOPLE, should put an end to this! ENOUGH IS ENOUGH!. We have to cure this PROBLEM inside and out, and from top to bottom.

HOW COULD WE ALLOW this to HAPPEN?

Posted by: Outraged at May 17, 2007 09:42 AM

waths the profit in california when you injured your lower bark ( a disc)

Posted by: jose at May 17, 2007 06:14 PM

May 27, 2007

On June 21, 2004, I received a serious work-related injury while employed by California Department of (Corruption)Corrections & Rehabilitation (CDCR).

It's been nearly three long years of total injustice
by CDCR and California's wicked, criminal and demon
ran Workers' Compensation System.

Both above mentioned entities and many of their staff
will answer to God Almighty on Judgment Day.

In this life, they hide behind Sworn Peace Officer and Political status, when in reality, "THEY ARE FULL OF DEAD MEN'S BONES".

CDCR and WC are ran by low-down and greedy human beings that have sold their souls to the devil and are more criminally minded than the inmates in CDCR.

Every statement in this e-mail can be verified and substantiated.

The Governor is guilty of balancing the state's
budget at the expense of injured workers.

Sincerely,

Dr. Benjamin C. Burnette

Posted by: Dr. Benjamin C. Burnette at May 27, 2007 07:53 PM

Based on recent ruling, the reforms made by Adrea Hoch, California Judge was clearly convinced that It's bases for the reform that impacted the injured worker's benefits were not based on "empirical data" but arbitrary based on Ad Hock's mis-calculation. It took only several weeks to dismantle the Injured Worker's benefits and now it has taken SEVERAL years to try to get it corrected. In the duration, the injured had to live with the injustices, while the Insurers and Employers celebrate it record profits and rate cuts. Injured clearly lost in this equation.

Despite the clear court findings and Andrea Hocks testimony and other experts in the industries. The medical providers, the insurance actuaries, Rand, CAAA, Accountants, Lawyers, DWC employees, and the injured's testimonies, California Governor and the State Assembly continue to allow this injustices to go on. Defending the reform and refusing to accept the realities of the IMPACT on the injured workers. Because it is good for "Business" it encourage "growth" in California's Economy?

Let me remind them....the WORKERS are the Biggest factor in the ECONOMY. The Workers are also the consumers. When you assault the employee's rights, it cost! It assaults the Economy, it assaults the premises that encourages a SAFE WORK PLACE. It damages the credibility of INSURANCE industry. It severely impacts the security and morale of the working people.

The SB899 reform should be reformed to bring justices bact to those who got hurt the most....The Injured Workers.

Posted by: anon at May 30, 2007 10:25 AM

Injured 10-16-97- After 3 back surgeries they have rated me 68% disabled.I have not worked since first surgery 12-29-99. Work Comp doctor made me p&S failed 2001 and I have been in limbo since. Now I get an offer to settle and there are social security liens and disability liens to get it all back leaving mewith nothing. THis is a night mare and has been in delays constantly. I am a nurse, case manager and would like to meet with Schwartzenager to see the real mess out here. Kate

Posted by: Kathleen Tallcott at May 31, 2007 05:49 PM

I was injured on the job when my former employer Netafim Irrigation knowingly exposed me to high levels of toxins on a daily basis for over a year and a half.
Three weeks after I left Netafim, my body went into detoxification and I was diagnosed with a rare blood disease that almost took my life. The doctors say the disease can reoccur and survival is statistically rare--not to mention renal failure is inevitable.
Thanks to California's workers compensation laws, Netafim is legally protected from liability while I'm stuck paying the medical bills with no compensation for my illness--what so ever!
Before this diagnoses, I was a very healthy young lady. As a result of my illness, I have no immune system, short term memory loss, constant fatigue, and credit collectors threatening to take everything I own. I've spent the last two years trying to get legal help but every where I turn, my potential case is turned down. Recently I talked to a workers compensation attorney that told me "I was a statistic that takes place every day in California."
I think those of us who have been victimized by the bias in workers comp laws should pursue a class action suit against the state of California. If anyone is iterested, feel free to discuss further with me. For serious inquiries, contact me at: auttaknow1@aol.com

Posted by: Tina L Kane at June 18, 2007 03:27 PM

Amen to Dr. Benjamin C. Burnette!

I am an educator who specializes in teaching students with Autism. While teaching a lovely classroom of 11 students in Lompoc, CA, I received broken teeth and serious jaw and foot injuries. Due to the expenses occupied by my injuries, our family had to relocate to another state where we could afford to eat and have housing. We moved all the way to Iowa, where we purchased a home out right. At this current date we have paid nearly $147,000.00 out of our pockets to cover extra expenses which transpired due to my injuries. The workers compensation company is to reimburse us, but has to this date not done so. Had this happened to my sister’s family, they would not have had the cash to cover such expenses.

I find it amazing that, while my husband and I are both extremely educated, due to on-the-job injuries, we were forced to leave our home just to survive. I know that conditions of our family finances are the norm and not the exception for families dealing with injuries received while on the job. I am praying that God will change the heart of the law makers in California. It is an injustice to be treated worse than criminals, for at least they have a roof over their heads and food on their table.

We have never been on the government take, but now, due to the injustice of the California Workman’s Compensation Laws, my husband and I are contemplating divorce, just so that we can stay afloat and play within the system that has been set up by our lawmakers. We can not fight the system.

California, please correct this unfair system so that no other families have to go through what our family has had to endure.

Posted by: Sharron McKee at June 19, 2007 12:39 PM

Thank you for writing this article. The Workers Comp "System" IS rediculous in Calif. The Corporations are getting away with this thanks to their friend Arnold. The people of Calif have no friend to protect them from unscrupulous employers who overwork & endanger their employees daily.

Posted by: Charlie Haley at June 27, 2007 09:11 AM

I'm living the workers compensation night mare as well. There is a system in place, but how it is worked by those involved in this system is a whole different animal. I think it is time to place blame on not only the laws governing it, but on Insurance companies delivering the care and also on the employees who are responsible for our individual claim. It is also time to have our physicians held accountable for timely reports, and the judges who deem a physician "credible" in his court. I have had unbelivable delays in getting the approriate authorizations to do the examinations necessary in my case. The continuity of my care has been poor at best. I know there are a ton of Physicians out there who are good doctors, not selected because some judge or attorney think they can't write a decent report. That is just hog wash.

My interest lays in getting well and returning to work. However due to the slowness in getting authorizations to have the surgery, medication, physical therepy after 3 back surgeries is unbelievable. No thought is given to the level of pain a patient is experiencing from the insurance carrier, employer, attorney, judge, over worked physician, pharmacist, on down the line. Their names need to be published, so that if nothing else, embarrassment or lose of business may induce them to do their jobs appropriately. They need to have their positions scrutenized and evaluated just as each of us has had in our jobs. Any physician who can't get out a timely report within 24 hours of seeing a patient needs to be disqualified from doing workers compenstation cases.

I hope you realize that many physicians get into the workers comp business and make big bucks working on volume. If they are going to work on volume they need to hire the help to produce the paperwork that needs to be generated. Unfortunately that is what workers compensation is about, reports.

I too, have run in to financial difficulty, not because I haven't applied for all the benefits I have been entitled to but because of untiimely reporting, working with public sector state disability personnel who don't know how to handle claims. Not only is the printed form one needs to fill out, inadequate, but they don't read any of the attachments mailed to them with detailed information regarding your claim. I was denied benefits for nearly a year, and when I finely requested a date to go in front of a judge, I was mailed my check for $17,000.00. Of course by that time my credit was ruined, and my home sold. It is so sad that when you are ill or injured that you have to go see a movie called SICKO to understand how corporate health Insurance in america works! Think of all the taxes we each have paid to run our State departments and who they hire to run those offices. Mostly unskilled labor who have been unemployable for years to begin with, that we have paid to exist prior anyway. There are plenty of over qualified unemployed individuals who could do the job of 6 employees of the state of california. As I am sure you are aware there has been migration out of the state of california to the mid western states where affordibility is the inducement to move. I realize that San Diego has desirable weaather and a great location, but I've also traveled the world and many other places offer much the same. I'm leaving as soon as my health is taken care of, I've had enough of this nonsense.

Posted by: Lenay L. Henkes at July 11, 2007 10:29 AM

Any experience with anxiety caused by work?

Posted by: Sam at July 12, 2007 10:56 PM

I need help? if I was finally awarded Voc rehab in April 2007 and I had a meeting with a counsler, who by the pretended to care but what now??? I am wasting away? My injury was 12/2003. I guess thank god for that part! I know She pretended to care because there was a hearimg at the end of May and she need to meet with me!I know for a report (status)! HELP, I need to know how to go about getting what I need?
I fought for this rehab, but now the counsler is MIA? I am so frustrated! Anyone have any words of advice?

Posted by: ARC LOST employee at August 24, 2007 10:11 PM

We all can vent our frustrations over & over here right? But,shouldn't all of us be there every time Gov. Aaahnoolld & those with a smile on their faces
the state reps. appear in a newspaper pic? The only reason they are smiling is because that piece of paper being signed assures them of a paycheck. You know the Governator & any other rep. can make an appearance on a job site to show support & be propped in front of a camera as though they sympathize with a working person...yet,what nobody really knows is that they immediately go to the restroom & wash their hands & their next concern is to get them "outta" here & onto the next issue to supposedly make the public happy.Think about it...were required to pay taxes by law & they will tell you I'm working for the taxpayer while all along living like a rock star on tour!!! We should demand they dress down & do some blue collar work for @ least a month.Do as we do...on a daily basis.Like work an 8 hr.day,take your 10-15 minute break , back to work ,lunch , back to work,etc.. Go home each day & at the end of a week look over your paycheck to make sure you were paid properly...huh? Those are the only numbers we crunch with a calculator & not the luxury of having consultants to do it for us. Yeh, thats where the real waste of $$$ comes into play.Bottomline here is: the majority of us aren't abusing the system & it doesn't need to be fixed for the sake of making sure government reps will get their hefty salaries.The politicians of any state are paid a wage of 2-3 times what the average American worker makes.Not to mention the govt.benefits provided medically! Instead of us being encouraged to write like I've done how about literally laying these facts on the table for them to respond to ? Send this to the governator & let him know his policies do not sit well with the truly injured workers for whom cannot bounce back from a fantasy movie like induced laser beam & NO most won't be back......

Posted by: mac at August 28, 2007 04:29 AM

I GOT HIT BY A BACKHOE AT WORK HAD BACK SURGERY AND CAN NOT RETURN BACK TO MY OCCUPATION WORK COMP SAYS THAT IF I CAN MAKE $100 A WEEK OR $400 MO TOUGH . BY THE WAY I USED TO MAKE $1200 WK PLUS BENIFITS I WOULD LIKE TO SEE OUR GOV LIVE ON THIS WAGE . THATS HOW HE THINKS HE IS TAKING CARE OF US . KEEP VOTING FOR HIM AND WATCH ALL THE INGURED PEOPLE LOSE EVERTHING THEY WORKED FOR THERE WHOLE LIFE!!!

Posted by: ross stone at September 13, 2007 03:25 PM

Dear Governor,
Can those of us for whom have suffered a genuine work
related on the job injury no longer rely on being
provided the opportunity of being returned to our normal condition because of a monetary factor for
which benefits only the insurance companies profits?
Lay it all on the line is all we ask by stating the
everyday taxpaying individual's opinion isn't worth
the time of day.But,as well relay the true factor of why you need to provide for these conglomerate corporation's needs. Remind the public they charge their clients a fee for a policy for which usually in most cases doesn't ever have a claim...until that one/two eventually comes up & then all will suffer. Why? Easy, while all the premiums were being paid naturally all the executives of these insurance companies were as well being paid. And by no means do we the public taxpayer want to cut them short !!! Revamp your workmans compensation policies to make it user friendly & equal. Back off on the poor -pity the insurance company & or the state budget. You cannot neglect & push those hardworking individuals back to work while still injured.Here's the bottom-line...It hurt's us all!!!

Posted by: light duty at September 23, 2007 05:10 AM

Are we all nutts? The only way to change the Governor's mind is to picket the schools where his children attend and where his wife goes to meetings etc. This might sound repulsive but how about the children that the Governor has made homeless because their parent's can't work? Fair is fair. Having the big protests in Sacramento isn't cutting it. He has destroyed our family lives and his family should know what he's doing. We should also picket the homes of the Insurance CEO's and the state leaders of the Worker's Comp System. They will continue to act discracefully until their friends and neighbors know what's really happening. Thank You.

Posted by: mike talbot at October 15, 2007 08:06 PM

Dear Governor,

Thank you for cracking down on worker's compensation fraud. Over the last 15 years of owning a buisness in Southern California I have paid nearly a million dollars in Worker's Compensation insurance. We have had 3 claims to date. All three claims were false claims. All three claims were paid because they were less than $10,000 each. It was carte blanche due to the dollar amounts. All three times I was punished with higher rates despite the low accident occurrence level.

Keep up the good work.

Posted by: Jim Eichman at November 6, 2007 11:57 AM

Dear Mr. Eichman,
How fortunate of you to have the opportunity to own a business and to have salary to hire employees. How fortunate were to have had the Workers Compensation Insurance you needed to protect you from the fraudulant cases you were accused of as well. But it is unfortunate you unable to walk in others shoes that have legitmate claims and have suffered unwrongfully due to the incompetence of a Governor who gives little creedance to those who fall between the cracks of a system that was initiated to protect the employee from abusive work ethics. You obviously have no idea what it is to lose all you have. When all you were doing was your job and then got hurt , who is suppose to be responisble for that? When your scared to lose your job or lift a 90lb lamp or work around electricity where it is damp and wet. People make choices , but they are based on economic,obligation and survival when they work for a company who is suppose to follow union as well as non union guidelines. Im so tired of hearing small business complain about their high fees for WC. Damn it would never have gotten to this point if the employer did not demand and abuse their responsibility and exceed the limitations of what a human being can do without getting hurt. Granted many are accidents but neverthelss the injured party is the one that has to live through the misery, not only FINANCIALLY but PHYSICALLY. Now how would you like to have both of those hardships jim? I think not... you can even handle three small fraud cases.

Posted by: wendy scalzo at November 26, 2007 03:31 PM

get court records research for a small fee

Posted by: scar face at November 29, 2007 02:22 PM

I crushed my heel falling off a roof at work..feb 9 2005.Finally had surgery oct.1st 2007. but, work comp. temp. disability payments stop after 1.5 yrs. I am still fully disabled, and have no income. applied for Social disability in aug. still nothing...lost everything I owned since the accident..employer is NOT going to give me alt. work when Im able to...Dr. says I need to change careers as my foot had surgery but is not fixed new..perm. damage ect...get this...there is no more vocational training for injured workers. so, basically, I get to start a whole new, untrained career, broke, with a disability. From a jerk who's not even born in USA!!!also, Im a veteran, no help there either....what a great State we have...what a great system nobody pays attention about...I know I didnt before the injury...guess I am paying for it now....my life is finished...wish I died in Desert Storm..at least I'd have gone out Honorably..not a handicapped street person..which im going to be not too far in the future...thanks Arny!!!

Posted by: Robert K. Ferris at December 16, 2007 11:24 PM

I was injured in 1999. I was denied surgery for a year, then on day of surgery, my claim was accepted. Two back surgeries later, and two hip surgeries later, I am still in this nightmare. I Moved Out of State, when I was P&S ed in 2001. I had a relapse, and surgery on Back in 04. Hip replacement in 06. Now my surgeon has retired, and no one will take California worker's comp in my State. My Hip needs to be revised,as the components failed, and I am looking a two years of surgery and recovery. At every attemt to get treatment, it is denied or modified BY UR (utilazation review) by MD's that are not orthopedics. Now they (my adjuster and AME) want to send me to Stanford, over 450 miles away from my home for a hip revision, were I will be non wt bearing for 6 to 8 weeks, and only will be approved if AME agrees, and only if Dr at Stanford accepts SCIF payments. This proces has taken 3 months. My muscles are wasting away, my spirts are at a low. Its time for a class action against Arnord. this FIXED system, needs to be fixed, before more injured workers take their own lives, as is happening.

Posted by: Desmond robinson at January 19, 2008 10:10 AM

I was injured at work, 8/1999. I have double crushed syndrome, cervical damage at C4, C5, C6, C7, radiculopathy along with CTS (bilateral) and more... I had CTS releases in 2003, my disc fused with mechanical devices in 2006. I was left with chronic pain and... If the insurance company did not delay paying my doctor bills and the operation would have taken place years sooner, maybe the out-come would be different?

I take very strong medication and am rated as 82% disabled with restrictions to lay down 40 minutes in the morning, 40 minutes in the afternoon and must be able to walk around at will. The Insurance carrier's voc rehab specialist, Ann, says I can return to work and that with my high school education, some college courses I've taken along with my experience and the fact that I earned $39.00/hr + bonus, I am pleasant and employable. And you really think I want to be going through this system!!!

RESUME
Please, someone out there hire me... I cannot focus because of the morphine I take, and oh by the way, I also take many percocet pills per day, I take valium every day, ambien to sleep and more... If I don't take my meds. Then I am in emergency to bring the pain back to a level where I can function. By the way, I will miss more than 15 days of work per month (that is being conservative) due to pain and my inability to focus and so on... I will do my best not to hurt anyone else let alone myself because of "all" the medication I am on and the sleep I lack each night because of the pain. Oh, I can try to work part time. But, please note that my pain is here and real. Although I try to take control of my pain, the truth of the matter is that my pain controls me much of the time. My pain tells me when to move, get up, sit down, lay down, stand up and when and how I am going to pay attention or if I will be able to follow instructions or focus. I will do my very best!

Ann, you know better. 35 years of experience and you gave into who paid you and for what? More work from the insurance company? And, because you are one that will write a good report rather than doing the right thing, that is reporting the plain facts. No, you were not an agreed rehabilitation specialist; you worked for the insurance company. I will not give your last name or the name of the company you own. You will be judged by someone much higher than the insurance company that hired and paid you as an expert witness. Expert witness, WOW! And we speak about fraud.

I will keep the FAITH. They cannot TAKE THAT AWAY FROM ME!!!

Arnold, what company’s do you own and are protecting? This entire system or what you call a system for injured workers (workers comp), is a joke, corrupt and are meant to protect the rich!

Are we surprised?

People, don't give up - let's speak up!!!!


Posted by: Pauline at April 11, 2008 01:10 AM

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