Payments from RTW Fund Increase in June

"...his assessment on the $120 million fund is deteriorating quickly since July, when he called it an 'unadulterated failure.' Just because checks are going out doesn't mean the program is a success." Alan Gurvey

The California Department of Industrial Relations paid more than $1 million to injured workers from the Return-to-Work Supplement Program in June alone, about 50% more than it did during the first seven weeks after the program went live in April.

And while department officials say they're happy with how the program is working and have received feedback from injured workers who are also satisfied, applicants' attorneys say they still have some concerns with how the $120 million fund created by Senate Bill 863 is operating. The lawyers say they're worried that not all workers who might be eligible are applying for and receiving payments.

As of June 30, the department had reviewed 506 of the applications it received, DIR spokeswoman Erika Monterroza said Wednesday. It issued $5,000 checks to 433 workers and determined 73 were not eligible, either because the person was injured before 2013 or the application was incomplete or a duplicate.

Monterroza said the numbers she provided are different than what was reported in the department's assessment of the 2012 reforms published July 22 because the report estimated that 46 of the 54 applications pending review would be eligible for payments. Monterroza said 45 of the pending applications turned out to be eligible.

By the end of June, DIR had paid $2.165 million to injured workers through the program created by SB 863.

The department started accepting applications through its online portal on April 13. By the end of May, it received 233 applications and determined 173 workers were eligible for payments and 37 were not.

This means the DIR mailed checks totaling $1.3 million to 260 injured workers in June alone, compared to the $865,000 it sent to 173 workers in the first seven weeks after the program's launch.

DIR Director Christine Baker, speaking July 23 at the California Coalition on Workers' Compensation 13th annual Conference, Legislative and Educational Forum, said injured workers expressed gratitude with the department's quick turnaround time in reviewing applications and mailing checks. 

"We're receiving letters from workers amazed that they were able to get their checks so quickly," she said.

In one of the letters, sent by email June 5, an injured worker reported receiving notice that her application was approved on May 30. Three days later, on June 2, the injured worker received the $5,000 check.

Monterroza, who provided a copy of the email to WorkCompCentral, said the department is satisfied with how the program is operating and is particularly happy about the quick turnaround in sending checks to injured workers.

The department's rules require it to review all applications and make eligibility determinations within 60 days and to mail checks within 25 days of deciding a worker is entitled to payment. While the DIR reform assessment doesn't report the turnaround time for reviewing the applications and processing payments, the numbers suggest the agency is cutting checks faster than the rules require.

Workers might be happy with the quick turnaround, but the attorneys who represent them said there's still room for improvement.

Diane Worley, director of policy implementation for the California Applicants' Attorneys Association, said there is nothing on the home page of the DIR website informing workers about the fund or how to apply for payments. To get to the Return-to-Work Supplemental Program page on the DIR website, a person has to click on the drop-down tab labeled "Director's Office" to find the link. 

"It took me some time to find this information, so I can only imagine that most injured workers who don't know what they're looking for aren't able to access any information about the availability of funds from the program," she said. 

Worley also said some injured workers are having a hard time getting the Supplemental Job Displacement Benefit voucher from their employers. 

An injured worker is eligible for the $6,000 voucher if the at-injury employer does not offer an accommodating job within 60 days of the treating physician saying the worker is permanent and stationary and will have some amount of permanent disability.

Under rules approved by the Office of Administrative Law on April 6, an injured worker most actually receive the voucher to be eligible for payments from the $120 million fund. 

Because receipt of the voucher is a prerequisite to applying for payments from the Return-to-Work Program, Worley said CAAA is concerned difficulty obtaining the voucher could create an obstacle preventing workers from seeking benefits to which they are entitled.

Worley said she is pleased to see that the number of applications increased in June. But she also said she was worried that, according to the numbers reported in the DIR's assessment of SB 863 shows 14.5% – 66 out of 454 applications – were deemed ineligible.

"We understand that some of these ineligible applications are for injuries before Jan. 1, 2013, but some are described as incomplete or duplicates," she said. "We would like to see more specific descriptions as to why applications are being denied as incomplete or duplicates and whether the injured worker is being given any assistance from the Return-to-Work Unit on how to correct these errors."

Alan Gurvey, managing partner of applicants' firm Rowen, Gurvey & Win, said his assessment on the $120 million fund is deteriorating quickly since July, when he called it an "unadulterated failure." Just because checks are going out doesn't mean the program is a success, he said.

Gurvey on Wednesday said he's particularly concerned about catastrophically injured workers who need medical treatment, home health care and transportation more than they need $5,000. 

"My clients, for the most part, honestly don't care about this $5,000, although I am sure they won't turn it aside," he said. "They care about their futures, their families and their dignity."

For workers having problems finding a network provider to treat them and get them back to work or who have treatment denied through utilization review and independent medical review, a $5,000 check is not very satisfying, he said.

"For every one injured worker who thanks the administration for a quick check for $5,000 – even though they aren't really sure why they got it – there are tens of thousands of injured workers emailing their attorneys with very explosive and negative commentary about not receiving treatment, not receiving compensation and, above all, not receiving respect," Gurvey said.

Puablished by WorkCompCentral on 06/30/2015, authored by Greg Jones