The impact of Senate Bill 335 (SB335), a law seeking to cut the time allotted for the investigation of workers’ comp claims in half (from 90 days to 45 days), has been questioned in a recent report by the California Workers’ Compensation Institute (CWCI). Workers’ compensation investigations involve complicated procedures that require the involvement of an extended network of people – claims administrators, doctors, attorneys, employers, and employee-claimants. It requires an ample amount of time to ensure good coordination in the process as well as having to consider what kinds of injuries are being investigated and many other details pertinent to each and every claim.

The way an investigation works is that claims adjusters must first be informed of any workplace injury claim by any representative of the company or employee involved, which is considered “day 1” of the period of investigation and delivery of medical benefits. It counts as the first of the current 90-day limit given to adjusters to reach a decision regarding a claim’s compensability. Data collected by the CWCI during the study indicated that 97% of all claims reported to adjusters had reached a decision regarding compensability within the current 90-day limit, a 12% difference when compared to the 85% claims decided within 45 days.

CWCI concluded that SB335’s 45-day cap on investigation may make it difficult for claims adjusters to mount a coordinated investigation with all parties involved and that it may create undesired financial results. It might also reduce a claimant’s access to medical benefits while causing more denials due to the time it might take to find a qualified medical evaluator (QME), the lack of on-hand documentation, or any other problem that might be cause for litigation in court and/or increased expenses relative to the investigative procedure. In other words, should SB335 pass into law, there is a chance that it may negate all the positive progress recently made by California’s Workers’ Compensation system in controlling expenses, medical inflation, and avoiding litigation.

Visit TukkoMed regularly to stay briefed on topics related to California’s Workers’ Compensation system – and if you are a QME in need of assistance with HIPAA-compliant reporting, then look no further. Contact us today and discover a better way to get your job done.

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