Appeals Board Issues Significant Panel Decision in Kim v. B.C.D. Tofu House, Inc.; Cypress Insurance Company

In the significant panel decision in Eun Jae Kim v. B.C.D. Tofu House, Inc.; Cypress Insurance Company, (ADJ9086333) dated Feb. 7, 2014, the Appeals Board held that without regard to Court Administrator Rule 10252, which limits expedited hearings to specific issues in accepted claims, an expedited hearing may be requested and conducted under Labor Code §5502(b)(2) and Administrative Director Rule 9767.6(c) to determine whether the employee must treat in the employer’s medical provider network during the 90-day delay period, under Labor Code §5402(b), that the employer has to investigate and determine whether to accept or reject the claim.

The WCJ in this case is Peter H. Hink of the Los Angeles District Office.

DWC Releases 2013 Medical Access Study

The California Division of Workers’ Compensation (DWC) has released its 2013 study on injured worker access to medical care. The study’s objectives are to determine whether injured workers have adequate access to care and healthcare-related products, and to recommend methods to support continued access.

Data from the study came from two sources: a survey of workers injured in 2011 and 2012, and medical claims submitted to the Workers’ Compensation Information System (WCIS) from 2007 through 2011. The study concludes that that most workers have nearby access to providers and are satisfied with their medical care.

New data in this year’s report concerns medical claims submitted to WCIS, which uses electronic data to collect comprehensive information from claims administrators. The WCIS medical claims data indicates that the number of injured workers who obtain care from specialists rather than general practitioners is increasing, while the overall number of providers treating injured workers has not changed.

DWC notes in a press release that studies conducted in 2006 and 2008 focused solely on survey data. Although survey methods differed among the three surveys, the findings for each survey were similar: 85 percent of the injured workers noted they were satisfied or very satisfied with their care.

Among the the 2013 survey’s other notable findings regarding injured workers:

  • 85 percent visited a health care provider within three days of their injury
  • 53 percent received care from a general practitioner
  • 32 percent saw a specialist
  • 50 percent saw a physical or occupational therapist
  • They reported receiving care through a medical provider network (MPN) 85 percent of the time
  • 35 percent spent between eight days to one month and another 35 percent spent over one month under the care of a physician or healthcare provider
  • 11 percent indicated that they were represented by attorneys

DWC is required to complete annual studies of access under Labor Code §5307.2. Prepared by Berkeley Research Group, this study marks DWC’s first effort to review medical claims data in order to gauge injured workers’ access issues.