SACRAMENTO — Injured workers in California are being denied needed medical care and frustrated doctors are threatening to stop treating victims of on-the-job accidents, an influential physicians' group contends in a new report on the recent overhaul of the state's workers' compensation system.
Two years of changes in the $23-billion-a-year program have substantially delivered on a promise to cut workers' comp insurance premiums for employers that endured rate hikes of as much as 300% between 2000 and 2003.
But insurers, armed with new powers to determine the level of treatment doctors prescribe, are interfering with the goal of healing injured workers and returning them to their jobs, according to the report released Monday by the California Medical Assn., which represents about one-third of the state's 90,000 physicians and based its findings on a survey of about 250 workers' comp doctors.
At a time when insurance companies are reaping big profits because of a drop in claims, the study says that they are underpaying or delaying claims payments to physicians and other healthcare providers.
Of the doctors surveyed, 63% said they expected to cut back on how many workers' comp patients they treat or get out of the business altogether.
"Doctors treating injured workers are locked in a system that is hostile to physicians and often harmful to the patients they serve," said Dr. Jack Lewin, the CMA's chief executive.
Doctors who participated in the study cited a slow and bureaucratic treatment-review process as the biggest obstacle. They said patients were being denied medical care ranging from $20 canes to more extensive procedures for chronic back ailments and psychiatric therapy.
"People get depressed when they can't use a limb, can't get comfortable and can't get sleep," said Dr. W. Joel Paule, a Ventura physical medicine and rehabilitation specialist. Paule said some of his patients had become suicidal, but couldn't get approval for emergency psychiatric care.
"Doctors are already leaving the system and will continue to do so," Paule said.
The association, which concedes that changes were needed to reduce fraud in the workers' comp system and cut employers' premiums, asked the state Division of Workers' Compensation to increase auditing and punish insurers and self-insuring companies with stiff penalties for denying or delaying care.
