Carve-Outs in Workers Compensation

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Is a Carve-out in your future George K ingston Senior Consultant Bickmore Risk Services. Carve-Outs in Workers Compensation. History of Carve-outs. California law inspired by Bechtel carve-out in Massachusetts SB 983 enacted 1993 Construction only - PowerPoint PPT Presentation

Text of Carve-Outs in Workers Compensation

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Carve-Outs in Workers CompensationIs a Carve-out in your future

George KingstonSenior ConsultantBickmore Risk Services

California law inspired by Bechtel carve-out in MassachusettsSB 983 enacted 1993 Construction onlySB 853 enacted 1994 Narrowed the definition of in the business of construction2004 LC 3201.7 enacted1999 there there were 12 carve-outs operating

History of Carve-outs

Carve-Outs in CaliforniaCurrently about 23 approved 5201.5 carve-outsCurrently 2 approved 3201.7 carve-outs

3201.5 vs. 3201.73201.5 Construction The Department of Industrial Relations and the courts of this state shall recognize as valid and binding any provision in a collective bargaining agreement between a private employer or groups of employers engaged in construction, construction maintenance, or activities limited to rock, sand, gravel, cement and asphalt operations, heavy-duty mechanics, surveying, and construction inspection and a union that is the recognized or certified exclusive bargaining representative that establishes any of the following:

3201.7 All other employers Except as provided in subdivision (b), the Department of Industrial Relations and the courts of this state shall recognizeas valid and binding any labor-management agreement that meets all of the following requirements: (1) The labor-management agreement has been negotiated separate and apart from any collective bargaining agreement covering affected employees. (2) The labor-management agreement is restricted to the establishment of the terms and conditions necessary to implement this section. (3) The labor-management agreement has been negotiated in accordance with the authorization of the administrative director pursuant to subdivision (d), between an employer or groups of employers and a union that is the recognized or certified exclusive bargaining representative that establishes any of the following:

Features of Carve-Outs 3201.53201.7ADRADRExclusive medical providersExclusive medical providersExclusive list of QMEsExclusive list of QMEsJLM Safety CommitteeJLM Safety CommitteeReturn to work programReturn to work programVR ProgramVR ProgramCoordination with Group BenefitsCoordinate with Group BenefitsDrug TestingDrug TestingIncentive ProgramsIncentive programsRestriction of Attorneys

What is a Carve-OutRemove a WC program from the State mandated WC systemImprove Benefit DeliveryLimit litigation Controls Medical TreatmentResolve disputes QuicklyControl medical treatmentImprove Safety Efforts

What is a Carve-Out1. Remove from State Mandated SystemAlternative dispute ResolutionState WC Judges do not jurisdiction over claimsArbitrators replace WC JudgesSubstitute private PD raters for state ratersSubstitute private VR vendors for state VREliminate State QME process

What is a Carve-Out2. Improve Benefit DeliveryControl mediator and arbitrator response timeControl Examining physician response time

What is a Carve-Out3. Limit LitigationRestrict attorney involvementLimit medical legal examinationsPrompt benefit deliveryReduced conflictReduced need for defense attorneys

What is a Carve-Out4. Control Medical CostLimit physicians that can treatLimit Physicians that can act as a QME or IMELimit changes in Treating PhysicianLimit over treatment over utilization

What is A Carve-out5. Resolve Disputes QuicklyAlternative Dispute resolutionOmbudsmanMediatorJoint Labor Management CommitteeUse private raters rehab vendors Eliminate long waits associates with WC JudgesIncentivize Quick response form mediators, arbitrators and others

What is A Carve-Out6. Control Medical TreatmentEstablish exclusive medical provider panelEstablish exclusive examiner PanelsLimit changes in treating phuysicianLimit examining physiciansLimit second opinions

What is A Carve-Out7. Improve Safety EffortsRequired Safety StaffingRequired Minimum Safety StandardsDrug TestingSafety Inspection ProgramIncident and Near Miss ReportingManagement Reports

What a Carve-out IsntMethod to reduce employee benefit Method to avoid WC obligationProven method to reduce WC costs

Alternative Dispute Resolution1. Ombudsman Gate KeeperFirst level of dispute resolution2. Mediator3. Arbitration replaces WC JudgeAppeal from decision of MediatorSame rules as hearing before a WC Judge.4. WCABFull court in San Francisco5. State Court of Appeals

Possible Carve-Out ComponentsReturn to work incentivesMandatory return to work Increased indemnity benefitsFinancial incentives to physiciansDrug testingSafety programs

LACCD Carve-out23 signatory construction unions2000 EmployersLimits employee to one change of PTPLimits employee to one second opinionLimits physicians to MPN and group panelAttorney involvement barred until arbitrationNo control of PTPEstablished a JLMCEstablished Alternative Dispute Resolution

City of Los AngelesCovers service and engineers union membersEstablishes an ADR with OmbudsmanThere are no other features to this Carve-Out

City of Long BeachPeace Officers and FirefightersList of specialists for IMECity MPN for treatmentIME has sole discretion to select specialist for review of caseIME decision is final without appealNo other featuresNo ADR

What to considerAnalyze current WC programRecognize weaknesses and problemsDetermine what feature of carve-out will resolve problem areasEstablish benchmarks for comparisonEstablish expectationsAvoid anecdotal performance measurementsBe suspicious of unsupported claims