Posted on 07/25/2004 1:04:23 PM PDT by NormsRevenge
SACRAMENTO (AP) - Jesse Ceniceros was at the top of his profession as a mechanic for Lockheed when he was injured on the job and fell into California's workers' compensation maze.
Now, out of work, hobbled by pain and in need of hip replacements, he may lose tens of thousands of dollars in benefits because of a key part of the sweeping changes in the 91-year-old system that were pushed through the Legislature earlier this year by Gov. Arnold Schwarzenegger.
Other workers who suffer serious work-related injuries could face the same problem if courts decide the new law requires doctors to pin part of the blame for work-connected disabilities on arthritis, osteoporosis or other age-related conditions, even when the worker shows no symptoms.
Body weight and whether a woman had given birth could also affect how much in benefits injured workers receive under the new law, critics say. Earlier this year, a doctor concluded that 2 percent of a hotel maid's abdominal problem was caused by moving a bed and 98 percent by the fact she was overweight and had three children.
"It could affect anybody," says Ceniceros, 49, who worked for 19 years for the aircraft manufacturer.
The new law, part of a two-year effort by lawmakers to rein-in skyrocketing workers' comp insurance rates, has also delayed or reopened many workers' cases, in large part because of new treatment guidelines that have brought a flood of rejection notices from insurers, critics say.
"Every day we're getting 15 of these rejections or more," says Helen Seagull, a paralegal at a law office in Pomona. "The client calls me and asks me what can I do? Nothing. We can't do a thing. We're just at a standstill, hoping that these utilization coordinators and doctors will approve it."
At the same time the changes in law haven't made a huge dent in the cost of the workers' compensation insurance that most employers are required to buy.
Workers' comp insurance rates have dropped an average 10.38 percent since the changes were enacted last fall and this spring, according to the Department of Insurance. From 2000 to 2003, rates jumped an average 149 percent, the department said. Some employers complained of increases as high as 300 percent.
"I think this is going to go down as one of the biggest insurance company rip-offs of all time," says Sen. Richard Alarcon, D-Van Nuys, a leading critic of the legislation and an advocate for state regulation of workers' comp rates.
But the legislation's supporters say it's too early to tell what the full impact of the new law will be because much of it hasn't taken effect yet.
"I think companies are cutting rates as much as they are able to, given that we haven't seen all the savings from these reforms yet," says Nicole Mahrt, a spokeswoman for the American Insurance Association. "I think carriers are reducing rates based on faith."
Sen. Chuck Poochigian, the Fresno Republican who was the lead author of the legislation, says he expects the law to produce great improvements and more rate reductions. It's too early to consider rate controls, he adds.
"When all is said and done and we are a year or two down the road and say it's still a crisis and rates have not come down adequately, obviously we are going to look for further ways to bring about a system that isn't harmful to enterprise," he says. "But that assumes facts not in evidence."
Ceniceros says lawmakers shouldn't wait that long to rework what they did this year, and he wants to talk to Schwarzenegger to give him a real-world view of the effect of the legislation.
"I don't know that he realizes with this gung-ho attitude what he has done to injured workers," Ceniceros said.
Ceniceros' problems started in March 1999 when his left knee popped as he climbed into an electric cart while working as a hydraulic and development mechanic at the Lockheed Martin plant in Palmdale.
Knee surgery failed to alleviate his pain and favoring the left leg led to problems with his right knee, hips and back, Ceniceros says.
Now he has trouble standing or sitting for long periods of time, has difficulty sleeping and takes pain pills 24 hours a day.
In May, citing the change in law signed by Schwarzenegger three weeks earlier, a physician selected by attorneys for Lockheed and Ceniceros blamed half his hip problems on arthritis, although the doctor said the workplace injury accelerated the condition.
Among other things, the new law requires physicians to determine the percentage of a worker's permanent disability that is caused by work and the percentage that can be attributed to other factors.
Mark Gerlach, a consultant for the California Applicant Attorneys Association, a group of lawyers who represent injured workers, says employers are arguing that process should be extended to take in medical conditions that haven't shown any symptoms.
That could affect almost anyone over a certain age who suffers a major workplace injury, he says.
"Everybody over the age of 25 has some arthritic conditions in their back," Gerlach said. "It's just a natural result of aging.
"What employers are trying to say now is that this disability is not caused by just lifting the heavy supplies at work but was partially caused by this arthritic condition, even though (the worker) never had any pain, never had any symptoms."
The previous interpretation, which the applicant attorneys contend is still in effect, was that the work-related injury was the sole cause of the disability if the employee had no symptoms of a disabling medical condition, Gerlach said.
Ceniceros says he had no indication he had arthritis before he was injured, although he had diabetes.
"I played pingpong daily at work," he says. "I was always a person who loved athletics, loved doing things. Now my life has just come to a standstill. I can't do anything like that."
Ceniceros' injuries are considered permanent because medical treatment is not likely to result in quick, substantial improvement, said his attorney, Scott Rubel.
If the doctor's opinion stands, it could cost Ceniceros about $70,000 to $80,000 in permanent disability pay plus pension benefits that could total another $20,000, Rubel said.
Willie Washington, a lobbyist for the California Manufacturers & Technology Association, agrees the new evaluation process is a "big departure from what we have been doing" but says it's not fair to force employers to pay for conditions that are a natural part of aging.
"The point here is we will pay for the (work-related) injury but we're not willing to pay for the arthritis you have, unless they can show specially that work itself contributed to the arthritic condition," he said.
But Tom Rankin, former president of the California Labor Federation, says that approach undermines the no-fault premise of workers' compensation.
"You're not taking the worker as you find them, which is the way it's always worked," he said.
The dispute is likely to end up in the courts or back before the Legislature, he added.
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On the Net: Read the law, SB899, at www.senate.ca.gov
Sorry, too bad. If you were in construction and you hurt yourself and partly it was because you were out of shape, TOUGH. Go learn a new trade.
I don't think that's a very healthy reaction. Some people do get injured and they need to be taken care of. My reaction to this report is that every plan has problems and this person is choosing to accentuate them, rather than the overall effectiveness of this plan. These problems will be ironed out or the plan will once again be addressed.
For those who are legitimately hurt and now are cast off or put off,, some system.
That's what I meant. Every case has to be judged on it's own merit. Right now, it's not. I think this is at the very least, a good start.
How did you jump to that conclusion from this article? It's like welfare, those who really need it, I'm 100% sure will get it. THose who don't, or can be helped someway else, not necessarily throught the Government, won't. You can't make cuts without someone getting hurt. We of all people know this. But it must be done.
Sorry, but as an investigator of Worker's Comp fraud cases, this is just too much Boo-Hooing.
All you have to do is make a claim. The Insurance Company's(There are only two or three now in the State that will write WC insurance)money IMMEDIATELY starts going out.
If you are an employer, your WC premium is almost the same as the salary you pay your employee.
Many of the Claimants are here in the U.S illegally, but that does not make a difference. They go to Depositions and admit--under oath--that they have used at least one other name, and just "made up" their Social Security Number.
The INS and SSN Administrations ARE NOT INTERESTED.
To claim STRESS,all you have to do is allege that someone or conditions at work cased it.
Thank you Hildy. I appreciate your response. I agree that it's a good start. I also agree with many others that this was too little of a start. The Arizona plan would have been much better.
No letup in Trial Lawyer actions at this rate...
And Hildy, I did use the word "legitimately" in my response.
I want fakers and minimally injured to be the most affected, not those who are truly in need and qualified for care and remuneration.
The last thing we need is more lawyers involved.
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