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Governor Schwarzenegger Signs Workers' Compensation Legislation

Governor Arnold Schwarzenegger made the following statement upon signing workers' compensation reform legislation (SB899, Poochigian):

"Today I delivered on my promise to create real workers' compensation reform. This bill completes a process that brought together Republicans and Democrats, business and labor, and all the affected parties to produce billions of dollars in savings, protect workers, and root out fraud and waste in the system. No longer will workers' compensation be the poison of our economy. Our message to the rest of the country and the world, is that California is open for business. We are making our state once again a powerful, job-creating machine."

On April 19th, 2004, Governor Schwarzenegger signed Senate Bill 899 into law. This bill made major changes to the state’s workers’ compensation system. The law imposes a limit of 24 visits to physical therapy, along with 24 occupational therapy and 24 chiropractic visits, unless the employer authorizes more visits. This limit applies to those with a date of injury on or after January 1, 2004. Treatment must also follow the guidelines of the American College of Environmental and Occupational Medicine (ACEOM). These guidelines severely limit physical and occupational therapy, as well as chiropractic, acupuncture, and other therapies, and apply to all claims, even those filed before January 1, 2004.

Having worked within the workers’ compensation system for some time, we have a few suggestions that may help make your healing process go more smoothly.

It is important to establish a good relationship with your adjustor, if at all possible. Stay informed about the details of your claim. Know your claim number, date of injury, and the name of the carrier. Each time you talk to your adjustor, or anyone else regarding your claim, document the date, who you spoke with, and what was discussed.

If the therapy is working for you, tell your adjustor! It is vital that your adjustor knows that there has been a functional improvement resulting from your therapy. While level of pain may be your greatest concern, it is not usually that of your workers' comp carrier. Several times throughout the course of your treatment you will be asked to fill out our functional capacity evaluation, and it is important that you do so with great detail.

Due to the utilization review process, it is taking anywhere from a week to two months to authorize treatment. As you approach the end of your prescription, discuss with your treating therapist possible ways of coping with a lapse in treatment.

What are my options if I am denied treatment by Workers’ Comp?

1) If you have a lawyer, ask him or her to appeal your case. In San Jose, many denials are coming from doctors who have never seen you as a patient. Because of that, if the case goes to court, many judges are overruling and allowing for more care.

2) If you do not have a lawyer, call or better yet, write to your adjustor. Although it is not acknowledged often, your claims adjustor has the final decision about continuing care. We recently received the following notice regarding one client:
“I also wanted to pass on some information regarding changes in the CA workers’ compensation laws…the American College of Environmental and Occupational Medicine Guidelines (ACOEM) are presumed appropriate. The ACEOM book does not provide an allowance for massage, and severely limits physical therapy, acupuncture, and chiropractic care, amongst other things. In your case, because of the dramatic improvement you’ve made, we are overriding the ACOEM guidelines in order to continue…”

When you contact your adjustor, it is important to speak in terms of functional improvement, not just pain and discomfort. A typical letter to your adjustor could include the following:
State the difference between your treatment at Myofascial Therapy and any previous treatment. For example: “The treatment plan at Myofascial Therapy has gotten me further than any form of therapy I have worked with up to this point. It is a lot of work on my part, and it is worth it because of the improvements I have realized.”

List the functional and symptomatic changes that have occurred. Be as precise as possible.

Emphasize the home movement program and education you have received to continue improvement on your own and to prevent further injury. Indicate that you want to learn more before you are discharged.

Write that you feel confident that if you continue (be specific about what you want) that you will achieve your goal (for a functional life and return to work, for example).

3) Let your legislators know how the new law has affected you. To look up your local legislator, click here.