Evaluating the Reforms of the Medical-Legal Process Using the WCIRB
Permanent Disability Survey
Footnotes
Report Body
1 By 40 months after the beginning of the accident year, approximately 96
percent of all medical-legal exams have been conducted.
2 Accident year data through 1993 was supplied by Larry Law of the
Workers' Compensation Insurance Rating Bureau.
3. An alternative to projecting the number of exams at a future date is
to assess the number of medical legal reports using only claims resolved at comparable
points in accident year maturity. On these claims, we know virtually all of the reports
that will be done. However, the average number of exams on resolved claims varies
depending on time to resolution and this variation is unstable over accident years.
| exams/resolved claims |
1989 |
1990 |
1991 |
1992 |
1993 |
1994 |
1995 |
| 40 months |
2.16 |
2.50 |
2.01 |
1.90 |
1.46 |
n/a |
n/a |
| all available |
2.21 (64 mo) |
2.53 (64 mo) |
2.04 (64 mo) |
1.95 (52 mo) |
1.56 (40+mo) |
1.18 (28 mo) |
.61 (16 mo) |
4 See Appendix 1 for Medical-Legal Fee Schedule changes over time.
5 The Commission recommended in the previous report taht the WCIRB Survey
be modified to include information to identify when reports were conducted by treating
physicians and by QMEs drawn from panels generated by the IMC
6 This legislation added the language in L.C. 3208.3 that the
"intent of the Legislature in enacting this section is to establish a new and higher
threshold of compensibility for psychiatric injuries."
7 For this analysis, we have redefined the variables in the following
manner:
- Voluntary Settlements (here called "True Voluntary") include all cases
where a compromise and release agreement, a stipulated settlement, or voluntary payment is
indicated as a method of resolution and the only dispute mechanisms listed are
"settled with attorney" or "none of the above."
- Judicial settlements include all cases where the dispute resolution method was
"Findings and Award," "Take Nothing," or "Dismissal." These
cases were considered the most expensive and burdensome for the state's resources.
- Other settlements are those using the several dispute resolution mechanisms, but
not resulting in a formal decision.
Appendix 1
1 The impact of these alternative resolution methods has been
inconsistent. While over a third of cases in the sample had had a mandatory settlement
conference scheduled, arbitration, voluntary or mandatory, occurred in less than 1 percent
of claims.
2 See: Pacific Law Journal, vol. 215, 75-6. Also, LeVesque v. Workmen's
Compensation Appeals Bd., 1 Cal.3d 627. Note: the preponderance of evidence standard was
extended to all workers' compensation issues. Leg.H 1993 ch.r, effective April 3, 1993.
L.C. 3202.5
3 See: Pacific Law Journal, vol. 23, 806-7
4 See: Pacific Law Journal, vol. 25, 863-4
5 Some observers contend that these restrictions on post-termination
stress claims are easily circumvented and are unlikely to be a reason for the decline in
psychiatric claims.
6 See: Pacifice Law Journal, vol. 21, April 1990