Workers Comp Zone


The LA Times  published a July 2018 investigation on California workers’ comp (see the link at the bottom of this post). The piece runs under the headline “Workers claim injuries all over their bodies for big payouts-but continue their active lives.”

It’s an interesting article. The writers seem to be fusing three stories. One is the general increase in cumulative trauma claims to multiple body parts. Another is the frequency of such claims filed by cops and firefighters in Southern California. Third, it is a story of some workers who allegedly scammed the system.

The Times claims to have done a data analysis of millions of workers’ compensation cases spanning nearly three decades. This goes back before the creation of the WCIS so it is not clear what data base the authors used in their analysis or the methodology they applied.

In any event, the article notes that whereas many years ago claims tended to be for only a single body part, many claims now are for multiple body parts. However, the article’s chart shows that these multi-body part claims  peaked around 2012.

The authors may be right that these claims initially increased as a reaction to the 2004 Schwarzenegger reforms. But I would suggest it may also be due to increasing understanding that the body mechanics and duties of public safety workers is linked to development of certain orthopedic conditions, hearing loss due to firing range noise, blood pressure and other internal problems due to inherent occupational stress and the like.

The fact that multiple body parts are sometimes alleged does not necessarily mean that the claims are illegitimate. Multiple body part allegations may also be on a compensable consequence theory, something not discussed in the article.

Of course I am aware that many employers and insurers may argue that some of this is “junk science” or claims driven by lawyers who are intent on filing “skin and contents” cases to see what will stick. This was a theme at last week’s CCWC annual Disneyland conference, with some speakers arguing for stricter adherence to “evidence -based causation.”

Of course, as the LA times article notes, these claims have potential significant consequences for municipal budgets. The article notes that thousands of claims have been filed by cops and fire who are eligible for “Los Angeles’ controversial Deferred Retirement Option Plan-or DROP, as it’s known-which allows veteran cops and firefighters to collect their salaries and pensions simultaneously for the last five years of their careers.” Most municipalities do not have this sort of plan, so the incentives may be higher in LA, of course.

In some past articles The Times has been focusing on abuses in this LA program.

Those alleged abuses are a big part of this article. For example, there’s the fire captain who had a cumulative claim involving 13  body parts and who collected DROP but was noted scuba diving in the Galapagos “with hammerhead sharks”. Apparently he had a kidney cancer claim, presumed industrial under the California law, but other body parts were added in. He was able to scuba dive but we don’t know the extent of his physical difficulties .

The LA Times article offers other examples of claims that certainly “look bad” in the sense of workers padding injuries or lacking motivation to work. But as I noted above, the article seems to fuse three themes, and some examples of bad behavior by a few does not rise to an effective indictment of these claims generally. There are occasional problems with workers who are not truthful after sustaining specific injuries, too. There is no evidence that fraud is more common with cumulative claims.

Limiting cumulative trauma claims is high on the wish list for many in the employer and insurer community. Despite their interest in doing a legislative fix this year, it does not appear that it is likely this legislative session.

In this blog I have sometimes expressed concern that the LA basin is an “outlier” in workers’ comp practice. If nothing else, the LA Times article will keep public attention on the issues surrounding these c/t claims.

Here is the link to the LA Times article:

Julius Young