Title: Director of Workers' Compensation, Southern California Edison
Resume: Muir has worked for Bekins Company, Carter Hawley Hale Stores, Inc., HealthNet, and currently serves as director of workers’ compensation for Southern California Edison.
Schools: She attended UCLA.
Boards: California Self-Insurers' Security Fund, National Council of Self-Insurers, California Self-Insurers' Association
Certifications: Certified Claims Administrator
Favorite Book: Pillars of the Earth by Ken Follett
Favorite Quote: George Bernard Shaw: “The power of accurate observation is often called cynicism by those who don’t have it.”
Influential people: Muir has “a whole group of people” who have been influential to her. From her early years in workers’ comp, she cites Art Fitzgerald at UniCal; John Sullivan with Mobil Oil; and Joe Markey, who was the executive director of the California Self-Insurers Association, as influences. In contemporary times, she cites Bill Zachry from Safeway, Sean McNally from Grimmway Farms, and Jill Dulich from Marriott.

Muir is a recognized presence in the workers’ comp community, bringing a wealth of knowledge from her numerous years at Southern California Edison. As the workers’ comp director for a self-insured utility, she’s lent her expertise on cost containment and utilization review at seminars and conferences. She also recognizes the importance of getting benefits to injured workers timely by employing a commonsense approach to UR. She’s been an active board member of the California Self-Insurers' Security Fund for a number of years, speaking on behalf of the board and speaking to the effects of a struggling economy and benefits increases on employers.

What are the top three issues in California workers’ comp today?  
As the issues are right now, number one is the amount of litigation we have, primarily with medical liens. There are two emerging issues that are probably weightier: we’re going to have 38 new legislators in Sacramento in January, which is always a problem in workers’ comp. You have to educate the new lawmakers about workers’ comp. We’ll also have a new governor. Obviously, we don’t know who that will be, but that is always sort of a threat to the employers’ side of workers’ comp—new legislators, a new governor, and not knowing what the new governor will want to do with workers’ comp.

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?  
I can’t say much, but I think my concern is that if we’re headed for a hard market, it represents a deteriorating potential for businesses to start, stay, or expand in California.

Are medical provider networks a help or a hindrance? How should they be improved?  
They’re definitely a help. Southern California Edison has the first employer-contracted network in California. We’re really seeing medical provider network regulation that makes maintaining a network or building a network more difficult. The regulation right now is really focused on those entities that have medical provider networks and need to improve, but the regulation impacts everybody, no matter how well you’re running your network. It becomes difficult to have one. We think medical provider networks are a help. They’re helpful to us because we have a strong network of credentialed providers that serve employees in most of our operating territory.

How should utilization review be improved?  
The best improvement would be to keep the Workers’ Comp Appeals Board judges from second-guessing utilization review. We need to have a system where medical decisions are made by medical clinicians, not judges. I think that it will improve the care that patients receive and it keeps judges out of a realm that they don’t have an expertise in.

What needs to be done to improve return-to-work?  
That’s been beat to death. The state has tried everything to improve return-to-work. We’re probably as good as we’re going to get. It’s difficult for small employers and more probable for large employers who have the ability to place employees in different jobs. They’re doing that. There are enough laws in place to make them do that. Everybody could probably do a better job, but I don’t think more laws and incentives will do.

What do you see, other than medical, as the next big cost driver?  
Litigation in general. There’s a lot of litigation that’s going to be popping up over the interpretation of AMA guidelines, which gets into the Almaraz/Guzman cases. That will continue to be a thorny problem and I don’t think we’re over that yet.

Is it realistic to deal for more cost-cutting reforms in exchange for increasing PD benefits?  
Yeah, I think so. It can take many forms; there are still a lot of problems in the system, like liens. I think that there are some great things we can do with permanent disability to streamline it and make the benefits better for injured workers. I look at permanent disability and when an employee is able to return-to-work, an advance payment is not necessary. We often make payments we can’t recoup. This is not really increasing permanent disability; it’s making it more efficient. For those folks who aren’t working, I’m very much in favor of paying the permanent disability advance at the temporary disability rate. Because they’re not working, it’s more advantageous to them. Those are some of the things we can work on with permanent disability that are win-win for employers as well as employees.

Where do you see applicant attorneys focusing litigation in the future?  
On permanent disability, because that’s how they make their money. As long as they’re paid a piece of the permanent disability award, their focus is going to be on increasing permanent disability awards.

Now that the federal health care bill has become law, what impact, if any, do you see that having on workers’ compensation and do you have any concerns?  
It’s hard to tell. There haven’t been enough analytics to the bill to know. My best guess would be that there could be some balance between cost and some advantages. The positive could be that increasing health care coverage, there’s probably a fair number of workers’ comp claims that are filed that represent the only way the patient can access health care at affordable prices. What may be the balance to that may be that the changes in the Medicare reimbursement rate may impact the state. We’re relying on Medicare for developing some of the rates that we have for medical providers and hospitals. Depending on what happens with those reimburse rates, it could have a direct impact on workers’ comp costs.

What is the effect of more than $1 billion in payroll being absorbed by the self-insured groups?  
There is probably an impact on the insurance industry: that’s rates and revenue they don’t have access to. These are typically employers who are too small to be self-insured on their own. The impact of the groups so far has been a little bit of concern to self-insured employers. Not all of them are solvent, which creates a problem for the members within the self-insured group and self-insured employers as a whole. When they fall, they will land on the shoulders of the Self-Insurers’ Security Fund.

If you’re self-insured, are you seeing more or fewer claims in a recession?  
We’re seeing about the same number of claims. Typically in a recession, unless there are layoffs, the claims remain stable or decline somewhat. We haven’t noticed an increase because of the recession. We’re seeing a slight uptick in the number of claims actually due to a larger exposure base; we have more employees so we have more claims.

Is a recession more or less likely to drive an employer toward self-insurance?  
Less likely, I would say. The qualifier for self-insurance has to do with financial viability and credit viability; so many employers are being negatively impacted by the recession and may not qualify for self-insurance. I also think that large and medium companies facing uncertainty would rather have the certainty of their insurance bill, rather than having the uncertainty of self-insurance. We don’t see a lot of people coming into self-insurance in recessionary times.

What needs to be done to keep California SIGs from suffering the same fate as New York’s trusts?  
I think the regulations need to be retooled. I think that the regulator has to pay close attention to what’s happening within the groups, whether they are actually pricing product to members on the basis of exposure rather than pricing based on retention of employers within the group. The problems we have seen in the past, the problems they saw in New York and even a few in California, happen when the administrator is low-balling costs to keep the group happy. They’re actually putting them at great risk by not charging enough. We’ve seen that they can become insolvent. When you do the forensics, it’s because they undercharged their members.