We interviewed a broad variety of system participants in two matched sets--in the north and in the south of the state. They included applicant and defense attorneys, treating physicians, forensic physicians (experts who specialize in providing workers' compensation evaluations), third-party claims administrators, self-insured firms, insurers, and staff of the Division of Workers' Compensation, including representatives of the Disability Evaluation Unit (DEU), the Workers' Compensation Appeals Board (WCAB), and the Industrial Medical Council--entities responsible for evaluating or processing workers' compensation claims.
Our interviews and review of prior quantitative analyses indicated that the 1989 and 1993 reforms brought about the following changes: The number of PPD claims, workers' compensation premiums, and insurer's costs have decreased; medical costs have fallen sharply; and abusive claims practices have been reduced. Views about whether specific changes improved the workers' compensation system were mixed. However, everyone we interviewed agreed that the system remains highly adversarial and litigious, that it is excessively complex--now even more so as a result of the legislative changes, that the system is increasingly impenetrable to persons who are not regulars, and that it is a costly system delivering modest benefits.
There was a general feeling across participant groups that despite reductions in the number of claims filed, the system is still overwhelmed. Many members of the insurance, employer, and attorney communities complained about continuing delays in claims processing and evaluation at the Disability Evaluation Unit and at the Workers' Compensation Appeals Board. In addition, increased system complexity has caused insurers, third-party administrators, and attorneys to substantially reduce the caseload that they can expect adjusters and attorneys to manage.
There was concern, but little agreement, about how to improve the quality of medical evaluations used as the basis for determining ratings. Insurers, employers, attorneys, and even physicians themselves admitted that many doctors submitting medical evaluations are not well prepared for this important task. Many who expressed such concern also wanted to eliminate the current "presumption of correctness" afforded to treating physicians--that is, the heavy reliance upon the disability rating derived from evaluations by treating physicians.
Both participant and stakeholder interviews revealed sharply divergent views about key features of the treatment of PPD claims, particularly the process for determining disability ratings. Employers, insurers, and some defense lawyers complained that the disability schedule, particularly its reliance on unverifiable subjective findings, produced inconsistent ratings and unnecessary litigation. On the other hand, applicant lawyers and some defense lawyers found the disability schedule and process workable, with the flexibility needed to address fairly the enormous variety of PPD claims.