Los Angeles contesting workers’ comp claims more vigorously

Los Angeles is concerned about workers' compensation costs to the city.

Workers' compensation provides a valuable benefit for workers who are injured on the job. Instead of resorting to a lawsuit, injured workers can obtain much-needed money through workers' compensation benefits, a form of insurance, which does not require the worker to prove anyone was at fault. Unfortunately, workers' compensation can also be a complex area of state law. And in the fight to keep costs and fraudulent claims down, the process can leave some injured workers without their due benefits.

Los Angeles is conducting its own fight to keep workers' comp costs down. According to two audits released on July 1, 2014 by City Controller Ron Galperin, city workers in Los Angeles file workers' compensation claims in greater numbers than other California cities. This has led to calls by the controller and others to more strenuously contest workers' compensation claims in order to reduce costs.

Last year, city workers in L.A. filed 17 claims for every 100 workers, the audits show. In San Francisco, by comparison, 11 of every 100 workers filed workers' comp claims.

According to the letter accompanying the audits, Galperin wrote that his findings "raise questions of whether the City and its administration are doing the best possible job of containing workers' compensation costs." In plain terms, "containing costs" means denying more workers' compensation claims or lowering the cost of medical treatment.

New legislation in effect

In September of 2012, California passed legislation that attempted to reduce workers' comp costs for employers and insurers. Among other provisions, the law included instituting independent medical reviews for treatment and billing issues. The law also created fee schedules for home health care and other workers' comp services.

Whether the legislation has achieved its goal is still up for debate. Insurers began using independent medical reviews in July 2013.

The independent medical reviews allow 50 days for physicians to resolve disputes about the need for certain medical care, rather than having it resolved by workers' compensation judges. Under the system, insurers pay a little over $500 to have a physician work on a disputed case. In June, there were nearly 20,000 independent medical review requests in California, about five times the number expected when the legislation passed.

Workers' comp can be a contentious process

When it works correctly, workers' compensation can provide a means for injured workers to pay for basic living expenses while they recover. However, an injured worker must be sure to timely file a thorough and accurate claim in order to have the best chance of receiving benefits.

Injured workers in California should contact an experienced workers' compensation attorney to discuss their workers' compensation claim.

Keywords: workers' comp, work injury, Los Angeles