Fact Checking

By: Mark Webb
Mark Webb
Mark Webb

As noted in the last edition of this publication, the latest existential threat to California’s workers’ compensation system is Assembly Bill 1465 co-authored by Assembly Majority Leader Eloise Reyes (D-San Bernardino) and Assembly Appropriates Committee Chair Lorena Gonzalez (D- San Diego). AB 1465 establishes a California Medical Provider Network (CAMPN) operated by the Division of Workers’ Compensation (DWC). Initially, the CAMPN will have every physician currently participating in an MPN also be in the CAMPN.

The point of this exercise is not immediately apparent from the language of the bill. The intent of the authors and sponsors – the California Applicant Attorneys Association (CAAA) and the California Professional Firefighters Association – is set forth in what is known as a Fact Sheet prepared by the authors and distributed to legislative staff and Members. The Fact Sheet makes it clearer what concerns the authors and sponsors have, but still leaves us largely in the dark as to how a CAMPN is going to address those concerns.

Specifically, the Fact Sheet states, “…there are 2,457 approved Medical Provider Networks in California. With so many MPNs in place, it can be challenging for injured workers to know whether they are covered by an MPN and if so, which MPN applies to their claim.”

“With so many MPNs in place, it can be challenging for injured workers to know whether they are covered by an MPN and if so, which MPN applies to their claim.” – California Professional Firefighters Association Fact Sheet

For most employees, there is one employer. Even if there is more than one employer, I will bet that no worker in California gets a paycheck – and MPN notices – from 2,457 employers. If someone does, I would really like to meet them.

Regulations of the DWC state that when an injured worker reports an injury the employer is required to provide a complete MPN notice. The requirements of that notice are considerable, and give the injured worker all the information necessary to obtain prompt treatment. While it may be daunting to understand all the contents of this notice deemed essential by the DWC acting in parens patriae for injured workers, it isn’t “challenging”.

And there’s more – when a new employee is hired, DWC regulations require the employer to provide a variety of notices, including a description about Medical Provider Networks (“MPN”) which includes that the employer may be using an MPN, what a MPN is, the predesignation exemption from the MPN, when an employee must begin to use a physician from the MPN, and how to request information about using an MPN.

The same notice is required to be posted at the place of employment per Labor Code Section 3550. This would seem to be pertinent for employees who have been deemed essential and have worked at a physical location throughout the pandemic.

The Fact Sheet also states, “Under current law, California’s Workers’ Compensation system is among the slowest in the nation to provide medical treatment for bona fide workplace injuries.”


 Profound Misrepresentations

Well, not really. The supporters cite two studies, one by the Workers’ Compensation Research Institute (WCRI) and one by the Workers’ Compensation Insurance Rating Bureau (WCIRB) to support their conclusion. That is a profound misrepresentation of the works by these two entities. The WCRI study shows access to emergency care and evaluation and management services is in line with other states.

But this “fact” representation is particularly egregious given the WCIRB study was designed to address the delay accessing treatment caused by the COVID-19 pandemic. Yes, there are access issues to certain medical procedures during a pandemic. How does creating a government supported MPN change that?

The year 2021 must not be remembered as the year workers’ compensation reforms were unwound. The Legislature recently passed, and Governor Newsom signed, a $7.6 billion relief package for individuals and businesses ravaged by COVID-19. No part of that money should be spent to subsidize a cynical effort to return the workers’ compensation system to the excesses of the late 1990s and early 2000s – excesses that helped cause the recall of Governor Gray Davis. Whatever AB 1465 is intended to do, it won’t help workers or their employers. As such, it needs to be rejected as soon as possible.

Note: The opinions expressed herein may or may not be those of Workers’ Comp Executive. Mark Webb is a former Arizona insurance regulator, insurance company chief compliance officer, and is an expert in corporate governance, risk and compliance. He is the owner of Prop 23 Advisors.