Commission on Health and Safety and Workers' Compensation
MINUTES OF MEETING
November 16, 2001
San Francisco, California
Chair John C. Wilson
Commissioners Jill A. Dulich, Tom Rankin, Kristen Schwenkmeyer, Robert B. Steinberg, and Darrel "Shorty" Thacker
Executive Officer Christine Baker
Commissioners Allen L. Davenport and Leonard C. McLeod
Call to Order / Adoption of Minutes
Chairman Wilson called the meeting to order at 10:00 am and asked for a motion on the draft August 24, 2001 CHSWC meeting minutes. Commissioner Dulich moved for approval of the minutes, Commissioner Rankin seconded and the motion passed unanimously.
Proposal: Addressing Legal Services Needs of Injured Workers
Julian Sum, JD, MS, Labor Occupational Health Program, UC Berkeley
Ms. Sum presented a proposal which would support work to engage stakeholders in the workers compensation community in active discussions regarding practical solutions to address the legal-services needs of injured workers.
Commissioner Steinberg asked about the genesis of the study. Ms. Sum stated that this proposal arose out of the other projects that she was involved in for CHSWC which found that there were significant problems faced by injured workers in learning about their rights and seeking workers compensation benefits.
Gilbert E. Stein and Todd McFarren of the California Applicants Attorneys Association (CAAA) commented on concerns regarding unrepresented workers. Mr. Stein believes that an injured workers language barrier does not interfere with an attorneys willingness to represent that worker. Mr. McPherson stated that there were problems of unrepresented workers with minor injuries and in uninsured employer cases.
Commissioner Dulich moved to approve the proposal for Evaluation of Legal Services of Injured Workers, Commissioner Thacker seconded and the motion passed unanimously.
Update and Proposal: Young Worker Health and Safety
Diane E. Bush, MPH, Labor Occupational Health Program, UC Berkeley
Since 1996, CHSWC has sponsored UC Berkeleys Labor Occupational Health Program (LOHP) to convene and staff a statewide Study Group, now known as the California Partnership for Young Worker Health and Safety. The Partnership brings together key agencies and organizations that are involved with Californias youth employment and education issues or that can otherwise play a role in educating and protecting young workers.
Ms. Bush reported that the Partnership and its activities have put California at the forefront on young workers health and safety issues. One of the key and recent accomplishments by the Partnership was the development of the California Resource Network for Young Workers Health and Safety, which provides training, educational materials, technical assistance and information and referrals to help educate and protect young workers.
The Partnership has also begun to collect data and other information to develop a pilot project targeting teens and employers in the restaurant industry. The project will test cooperative strategies identified in previous interviews with agency heads.
Ms. Bush requested an additional $10,000 to support the continued work of the Partnership. The supplemental funds will allow LOHP to continue to convene and staff regular meetings of the Partnership through June 2002 as well as carry out its projects.
Commissioner Rankin moved to grant supplemental funding of the California Partnership for Young Worker Health and Safety to assist in the Partnerships activities through June 2002. Commissioner Dulich seconded and the motion passed unanimously.
Presentation and Proposal on the Worker Injury National Survey Project (WINS)
Dr. Ben Amick, PhD, Associate Professor, School of Public Health, University of Texas Health Science Center
Dr. Amick reported on the Worker Injury National Survey (WINS), which is sponsored by the Robert Wood Johnson Foundations Workers Compensation Research Initiative. WINS is exploring the feasibility of a national information resource on issues of access to workers compensation medical care, the process of medical care and the outcomes of care.
To accomplish this, WINS has developed a version of the national survey that it is piloting in several states. The survey documents the performance of the workers compensation medical care system from the perspective of the injured worker.
Dr. Amick proposed that CHSWC consider conducting the survey of injured workers in California. Ms. Baker explained that the cost of the survey could be borne by CHSWC by means of an existing contract with RAND and that the additional funding being requested for the survey would be somewhere between $20,000 and $40,000.
Commissioner Rankin asked about the results of the survey from other states. Dr. Amick answered that Minnesota and Florida have completed the survey and that Massachusetts is currently in the process of piloting it. The State of Minnesota is currently interested in looking at the economic impact of work related injuries and patient satisfaction with medical care, while Massachusetts is interested in looking at the access to care for injured workers.
Commissioner Wilson asked if the confidentiality of the injured workers would be protected. Dr. Amick responded that he would follow the guidelines and make sure that they were met in California. After some discussion, the Commissioners considered the proposal.
Commissioner Rankin moved to approve funding for the Worker Injury National Survey pilot in California. Commissioner Thacker seconded and the motion passed unanimously.
Update: Permanent Disability Study and Presentation on Upper Extremities
Robert T. Reville, PhD, RAND Institute for Civil Justice
Dr. Reville first reported on the status of several reports related to the Commissions permanent disability projects, which evaluate the way that California workers are compensated for permanent disability incurred on the job. The original permanent disability study wage loss study completed in 1997 which looked at wage loss sustained by injured workers at insured firms, has been expanded to include analyses of wage loss sustained by permanently disabled employees of self-insured employers and analyses of the impact of local economic conditions on wage loss and return to work. The "Permanent Partial Disability at Self-Insured Firms" report was published in 2001 and the "Impact of Local Economic Conditions on Wage Loss" is currently in the process of being printed. Mr. Reville also stated that the drafts of the "Return to Work" report and "Earnings Losses and Permanent Disability in Five States" would be available in January 2002 and December 2001, respectively.
Mr. Reville then presented preliminary results of the permanent disability rating study "Comparing Severity of Impairment for Different Permanent Upper Extremity Musculoskeletal Injuries". Some of the main preliminary findings indicate that Californias disability ratings poorly predict severity of labor market outcomes across body parts impaired and that injuries resulting in severe range of motion permanent impairment have significantly worse outcomes. Mr. Reville emphasized that the findings were preliminary and that the draft of the rating study would be available in May 2002.
Update: Study of Presumption of Correctness of Treating Physician Reports
Frank Neuhauser, Survey Research Center, UC Berkeley
Before 1993, whenever a medical issue arose in a workers compensation case, many medical reports were involved in the resolution. In addition to the reports of the treating physician, the applicant and the defendant were each entitled to procure a medical-legal evaluation and report, in each appropriate medical specialty. In the 1993 reforms, the role of treating physician in evaluating disability was increased in the workers' compensation process. They were required by legislation to report on all medical issues necessary to determine eligibility for compensation. In addition, whenever another medical evaluation is obtained, the findings of the treating physician are presumed to be correct. This gives a much greater weight to the findings of the treating physician. The statute was originally interpreted to cover medical-legal issues, but in 1996 a series of cases and in particular Minnear (1996) interpreted the statute to cover medical treatment and increased the requirements for rebutting the presumption.
CHSWC contracted with the University of California for a project to evaluate the role of the treating physician, the quality of treating physician reports, and the cost-benefit of the presumption of correctness of treating physician reports. The study found that the primary treating physician reports compare poorly with reports completed by a Qualified Medical Examiners (QME), even when the treating physician was a QME and that there was no evidence to demonstrate reductions in medical-legal costs resulting from the presumption.
In May 2000, the Legislature requested that CHSWC update its study report on the presumption of correction for treating physician reports. The workers compensation community raised a number of concerns about the presumption. Mr. Neuhauser reported on the preliminary findings of the updated report. Some of the key findings of the updated report showed that presumption with employee control of the doctor leads to higher medical costs and longer treatment. A draft report of the updated study is expected in December 2001.
Survey of States Occupational Safety and Health Approaches - Discussion of Best
Frank Neuhauser, Survey Research Center, UC Berkeley
Mr. Neuhauser reported on the work that the CHSWC is doing in the area of loss control with the International Association of Industrial Accident Boards and Commissions (IAIABC). The first step of the study involved a survey of the targeted safety efforts in the fifty US states and the Canadian provinces.
Mr. Neuhauser presented the results of the survey describing the various types of targeting and intervention undertaken by each state and province. Mr. Neuhauser commented that states have states use different approaches for targeting OSHA inspections such as using the OSHA Data Initiative and BLS Survey and Targeting Specific Industries. The survey found that many states do not have regulation of loss control services for the public sector.
Mr. Neuhauser indicated that the draft report will specify how to incorporate incentives to create demand for loss control services, address cooperation of labor and management committees and describe what would make a good integrated approach on a health and safety program for states to follow. The draft of the results from the survey part of the report should be completed within two weeks.
Commissioner Rankin suggested that CHSWC look more closely at the issue of increasing medical costs in the workers compensation system. He requested that Ms. Baker bring back some ideas on how CHSWC could approach this issue at the next meeting, scheduled for December 14, 2001 in San Francisco.
Commissioner Dulich moved to adjourn the meeting, Commissioner Rankin seconded and the meeting was adjourned at 12:20 pm.
Approved: Respectfully submitted,
SIGNATURE ON FILE DEC. 14, 2001 SIGNATURE ON FILE DEC. 14, 2001
John C. Wilson, Chair Date Christine Baker, Executive Officer
For Question relating to this minutes, please contact the Commission
on Health and Safety and Workers' Compensation.
455 Golden Gate Avenue, 10th Floor
San Francisco, CA 94102
(415) 703-4220 Fax: (415) 703-4234 Email: Chswc@dir.ca.gov Contact: Christine Baker