Unfair FF Work Comp Denials Key Reform Measure Signed By Governor

Across the state, firefighters and other hard-working people are having Workers' Comp medical care delayed or denied because ... well, just because. 

Thanks to CPF-sponsored legislation signed by Gov. Jerry Brown -- Senate Bill 1160 -- California took a critical first step to swing the pendulum back to the injured workers.

The challenges facing injured workers was dramatized recently in a series of investigative reports from NBC Bay Area, which found dozens of San Jose Fire Fighters Local 230 members summarily denied Work Comp benefits during the “utilization review” process -- a process controlled by insurers and employers.

San Jose is not alone -- California Professional Firefighters surveyed local unions and found dozens upon dozens of cases where claims were denied out of hand, sometimes over something as trivial as an unchecked box on a form.

SB 1160 (Mendoza) would help ease the burden placed on injured workers, while ensuring timely delivery of the care needed to get these men and women back to work.

Specifically, SB 1160 institutes a 30-day treatment window in an accepted Workers’ Comp claim, so an injured worker can get the care they need (providing it conforms with medical guidelines) without being subject to “prospective” utilization review that can result in denial of care when it is most critically needed.

SB 1160 also calls for greater oversight over UR providers, requiring that they be reviewed the Division of Workers’ Compensation and accredited by an independent nonprofit organization by July 1, 2018. It also stricter penalties against those claims administrators who refuse to satisfy their legal obligation to report workers’ injuries.

As with most legislative efforts around Workers’ Compensation, SB 1160 is the product of negotiations involving stakeholders on all sides of the issue, including the California Labor Federation. It reflects a clear consensus among these stakeholders that the UR process had thrown needless roadblocks in the paths of truly injured workers. It won overwhelming bipartisan support before being signed by Gov. Brown.

"Our profession has a high risk of on-the-job injury, but firefighters didn’t get into this line of work to be sidelined -- they want to be back on the job as soon as possible," said CPF President Lou Paulson.  "We think the provisions in SB 1160 represent an important step in the ongoing effort to ensure a balanced and effective Workers’ Comp system that truly serves those for whom it was created – injured workers."