Evaluating the Reforms of the Medical-Legal Process Using the WCIRB Permanent Disability Survey


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:

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