What does 2019 hold for California workers’ comp?
2018 is kaput, but you can check out my recap of important 2018 developments here:
http://www.workerscompzone.com/2019/01/01/the-top-10-2018-california-workers-comp-developments/
Early each year I do a quiz on the likely developments in workers’ comp for the coming year.
Just how prescient are you? Put on your thinking cap and let’s get started with the 2019 quiz (note there may be more than one correct answer):
1.The impact on workers’ comp claimants from the current federal government shutdown and any resolution of the border wall controversy will be:
a) No effect from the shutdown;
b) MSA processing will be severely backlogged;
c) Small scale tangential impact from claims due to reduced food safety, aircraft safety and other federal agency functions causing a handful of injuries;
d) Potential impacts depending on whether a broader comprehensive immigration bill is part of the shutdown resolution;
2. In 2019:
a) Governor Newsom will signal he has little interest in workers’ comp issues unless circumstances dictate it;
b) Newsom will make it clear he intends to continue the legacy of the Jerry Brown 2012 reforms and the employer/labor alliance that forged the reforms;
c) Newsom will look favorably on applicant attempts to loosen some of the SB 863 provisions and regulations;
d) Newsom will cede workers’ comp policy to his appointees and intervene only to broker deals between stakeholders;
3. In 2019:
a) The volume of IMR requests will continue at a high level, and though stakeholders will bemoan that, nothing will be done to address the problem;
b) IMR requests will fall significantly as doctors are given online access to ACOEM;
c) Data mining reveals more detail about a subset of doctors who drive high volume IMR requests, with increasing calls for measures to address that problem;
d) Labor members on CHSWC and some legislators begin to agitate for changes to the UR and IMR system
4. In 2019:
a) Legislation is passed and signed that replaces the Borello employment test with the Dynamex employment test in California workers’ comp;
b) Legislation is passed and signed which overrules Dynamex and prohibits its use in all employment cases, including workers’ comp and wage and hour cases;
c) In exchange for agreeing to the abrogation of Dynamex, labor advocates get other things in trade-offs, but those do not include workers’ comp concessions;
d) The legislature does not pass any Dynamex related bills in 2019;
e) Several WCAB panels determine that the Dynamex employment test does not apply to the issue of employment for workers’ comp purposes;
5. The festering issue of what if any changes should be made to the way QMEs are paid for doing medical-legal reports will in 2019:
a) Be resolved by the adoption of new regulations that largely bases payment for exams and reports on a flat fee schedule basis with some specific add-ons
b) Not be resolved in 2019, as key stakeholders remain unable to agree on a workable alternative to the current system;
c) Complexity will be removed as a payment factor and other specific criteria inserted as a payment multiplier;
d) California will look to the system used in Nevada and other states as it designs a new payment schedule;
e) Be part of a larger discussion about the declining numbers of QMEs, QME availability, the quality of reports and other issues;
6. In 2019:
a) Universal healthcare/healthcare for all is a big and divisive issue in the legislature, but there is no discussion of how workers’ comp would fit in such a system;
b) Newly elected Insurance Commissioner Ricardo Lara pushes for workers’ comp to be included in a universal healthcare system;
c) Despite all the talk, universal healthcare makes no progress in the legislature, and it is a non-issue for workers’ comp;
d) The Affordable Care Act is declared unconstitutional, throwing the ACA into crisis and causing injured workers with no coverage to lose coverage;
e) the ACA continues to be stable in California, and many injured workers continue their coverage;
7. Regarding payments from the $12o million Return to Work fund:
a) No changes are made to the administration of the fund;
b) The DIR/DWC proposes that payments from the fund be automatically provided to workers who receive a retraining voucher
c) A bill is proposed to require the DIR/DWC to actually distribute $120 million each year, and the bill is signed;
d) Same as c), but the bill is killed;
e) Usage of the RTWSP increases to the point that concerns about the administration of the fund begin to dissipate;
8. Regarding the prescription drug formulary that was instituted in 2018, by the end of 2019 it becomes clear that:
a) Pharmacy disputes are still a big portion of UR and IMR disputes, and the formulary has failed to change physician behavior:
b) UR and IMR friction over pharmacy issues has been drastically reduced due to the formulary;
c) Opioid use continues to fall in the comp system;
d) Pharmacy costs and disputes are down, but more modestly than anticipated;
9. Regarding cumulative trauma claims, in 2019:
a) A major employer effort to place limitations on cumulative claims and post-termination claims never materializes;
b) An effort to place limits on c/t claims fails as a more progressive Democratic supermajority never warms to the idea;
c) Why c/t claims are more common in parts of Southern California remains an issue under the microscope of regulators and policymakers, but the can gets kicked down the road;
d) Limits on c/t claims are traded for an increase in PD benefits;
e) Building trade unions, service worker unions and public safety officer/first responder unions block any attack on cumulative
10. After years of decreasing recommended workers’ comp rates approved by former Insurance Commissioner Dave Jones, in 2019 new Insurance Commissioner Ricardo Lara:
a) Approves one or more further recommended rate reductions in 2019;
b) Takes a stance aggressively questioning the insurance industry on the high level of ALAE and ULAE to benefits paid out;
c) Faces WCIRB requests for increasing pure premium rates and must deal with the fallout as workers comp costs begin to rise after years of cuts for most employers;
d) Shows little interest in workers’ comp as his focus remains on other types of insurance;
11. Bonus: The following will occur (more than one choice):
a) Intensified focus on fraud and abuse in the retraining voucher program;
b) Focus on workers’ comp entitlement of workers who suffer health problems from breathing smoky air from distant wildfires;
c) A report on workers’ comp from the State Auditor;
d) A revision of the California PD rating schedule;
e) Governor Newsom announces support for 24-hour care that would include workers’ comp;
f) National events result in a recession, and workers’ comp claim frequency increases as workers file claims;
g) Mass casualty events create problems for California self-insureds;
h) The DWC will have a quiet year focusing on improving execution of regs adopted during the Brown years;
i) Stakeholders will try to push the policy envelope to see what they can achieve under a new administration;
j) Administrative and overhead costs will eat up an increasing share of the comp pie to the point that policymakers will demand further reforms;
k) Geographic pricing differences for treating physicians will cause some physician shortages;
l) Increased focus on attorney involvement in capping schemes;
m) SCIF market share will continue to decline;
n) CAAA will have a legislative success after years in the wilderness under Governor Brown;
o) CAAA will continue to see its bills vetoed;
p) The more things change, the more they remain the same;
q) There is this thing called workers’ comp but the truth is that the public and policymakers don’t really care about it;
l) A golden era of stakeholder cooperation begins;
m) Get out your knives
You can grade yourself, or you can send me your answers.
Here is a link to last year’s quiz:
http://www.workerscompzone.com/2018/01/17/the-2018-california-workers-comp-quiz/
Stay tuned.
Julius Young
