DWC -- Looking Forward

Casey L. Young
Administrative Director, Division of Workers' Compensation

We are starting to see the light at the end of the tunnel.

The years leading up to the 1993 workers' compensation reforms were chaotic. Tempers ran high, accusatory fingers pointed in every direction, and DWC was caught in the middle -- the referee in a heated war for economic survival. Cases which in previous years settled easily became major battles. Our workload skyrocketed as the disputes, between medical providers and insurers, in particular, multiplied and intensified.

We were still living with some serious mistakes contained in the 1989 version of reform. One in particular created an impossible bottleneck and unnecessary costs in the processing of cases. It required that in each case where the employee may have some permanent disability, a state approved "qualified medical evaluator" evaluate the employee and send the evaluation to our Disability Evaluation Unit to calculate a permanent disability rating, or a so-called "summary rating." A competent treating physician's report cannot be used instead. Even the simple cases must be submitted to our disability evaluation specialists, even when both parties are competent to calculate the rating and don't want our help -- or the delay it involves.

Then came the 1993 reforms. To be ready for the January 1, 1994 implementation of most of the reforms, DWC had less than six months to complete the regulatory process on numerous sets of regulations which, among other things, gave shape to the new Health Care Organization (HCO) program, the radically changed shape and delivery of vocational rehabilitation, the new responsibilities of treating physicians, and the revised disability evaluation process. Fee schedules were adopted for medical treatment and medical-legal evaluations, as well as for the services of rehabilitation counselors and interpreters. Twelve sets of reform related regulations were adopted in just the initial months following the enactment of reform. Over 200 new positions were authorized to implement the reform, triggering a massive effort to recruit, test, hire, and train new DWC staff. In addition, all staff were trained on the new law and regulations. We also provided training for the workers' compensation community.

DWC faced enormous challenges, attempting to implement the 1993 reforms while simultaneously dealing with some very serious pre-reform issues, chiefly the backlogs of medical provider liens and summary ratings. I am pleased to be able to say, however, that we are now well on our way to eliminating both the lien and summary rating backlogs, as well as completing the implementation tasks assigned to DWC.

We have two special Lien Units making progress in eliminating the lien backlog, as well as a new policy to prevent this backlog from recurring. We still have a backlog of about 140,000 liens, but we expect to be able to deal with all these liens over the next 18-24 months.

The backlog of summary ratings should be cleared even quicker, hopefully by the end of this calendar year. We filled every available rater position as quickly as possible -- an increase in capacity of about 25% -- and these new raters are now completing their training. This new capacity, coupled with the success of our strategy of promoting settlements based on self-ratings, should eliminate the remaining backlog of about 12,000 cases by the end of the year.

Most of the DWC tasks necessary to implement the 1993 reforms have also been completed. There are a few remaining implementation tasks -- most significantly, completion of the revisions to the Permanent Disability Rating Schedule, the inpatient hospital fee schedule, the utilization review regulations, and the workers' compensation information system. We are working diligently on the remaining tasks and will be completing them as quickly as responsibly possible.

I look forward to the day, in the not too distant future, when DWC will be able to focus primarily on normal maintenance and minor course correction, rather than being forced to managed the kind of upheaval required by the legislation enacted over the last several years. I am beginning to believe that day may be just around the corner.