Title: Senior Staff Counsel, State of California Department of Insurance
Resume: Prior to joining the Department of Insurance, Citko was a shareholder with the Sacramento law firm of Cuneo, Black, Ward & Missler, practicing workers’ comp insurance defense and subrogation. He is a former Certified Workers’ Compensation Law Specialist, State Bar of California Board of Legal Specialization. He previously worked for a national insurance company in various claims positions, including management of claims personnel and handling complex claim matters.
Schools: Citko earned degrees from the University of California, Davis and University of the Pacific, McGeorge School of Law.
Awards: State Bar of California and State Bar of Nevada

Citko is a staple at workers’ comp rate hearings and provides valuable input to the ratemaking process. His legal insight and expertise are an important part of the insurance commissioner’s rate decisions. Citko attended the University of California, Davis and McGeorge School of Law, University of the Pacific.

What are the top three regulatory challenges facing the workers’ comp system?  
Predictability, affordability, and protection of injured workers. Predictability – what are the costs going to be, the affordability is what employers are going to have to pay.

Are we headed for a hard market, and if so, when will it come? How long should we expect it to last? What are the repercussions?  
Too difficult to predict what’s going to happen in the market, too many factors in the economy.

It’s no longer a question of if but when we enter a hard market, so what is in the future of State Compensation Insurance Fund? Will its market share climb back to historic levels? Do you think that further reforms are needed for the governance of State Fund, for example, does it make sense to have Senate confirmation for board members?  
Same as it’s always been. It’s been through a dramatic change as a result of decade ago insolvencies. The large increase in the market it insured. It’s back to its normal market level, just has to deal with the rapid change. Overall, it’s where it’s basically has been.

Are medical provider networks a help or a hindrance? How should they be improved?  
I think they can be a help. Anytime you can deliver medical in an efficient and cost-effective way, it helps everyone – the employer, the injured worker. The devil is in the details. There are some good models out there. There are some that can be done better. Everyone is still figuring it out, overall it is a benefit to the system. One thing at the department, that we’d like to know, is the metrics (the commissioner’s asked) – how effective are they in cost/delivery of medical benefits. That’s where we need information, where we need data.

How should utilization review be improved?  
The same thing applies. We need better measurements of how effective it is. One question that’s come up here (DOI) is how often is UR utilized, and how often is the cost authorized? How are they determining how effective it is, and when to make the choice to use UR or not. UR should be used in the exceptional case, but in our WC system has turned it around to use it in every case. That’s the biggest problem.

What needs to be done to improve return-to-work?  
Not sure. It’s a collaborative effort between employers and the injured worker. There have been good efforts made. Insurers and employers should both concentrate on that as the final goal.

What do you see, other than medical, as the next big cost driver?  
Permanent disability, it’s going to depend on the outcome of current cases that are out there.

Where do you see applicant attorneys focusing litigation in the future?  
They’ve been focusing on PD and that’s where they’ll continue to focus. There are a number of cases at the court of appeals on PD and that’s where they’ll be focusing. There are some unanswered questions on that right now.

Now that the federal health care bill has become law what impact, if any, do you see on workers’ comp, and what are your concerns?  
At this point I don’t see much of an impact on worker’s comp.