Posted by T. Urtle on March 16, 1999 at 21:46:47:
In Reply to: SB 220 eliminates DCBS oversight posted by Del on March 11, 1999 at 22:08:11:
I appreciate your concern regarding the lack of oversight, however, I don't believe SB 220 merits concern on this issue. The evaluations unit does not provide oversight of claims closed by insurance companies. In fact, a vast majority of workers' compensation claims are already closed by the insurer. The only time the insurer refers a claim to evaluations for closure is when they want the opportunity to appeal the closure since they are not allowed to appeal their own closure. Also, a claim may be referred to evaluations if the attending physician has provided contradictory information and the insurer would prefer to have evaluations close the claim, thus, avoiding an unnecessary penalty.
It is my understanding that the evaluation unit is producing so few closures that they cannot justify the cost of maintaining this unit.
As far as I know, no one is proposing a major change to the reconsideration process so injured workers would still have the right to request review of the closures produced my the insurance carriers. This includes the right to a medical arbiters exam if the attending physician's description of the impairment was inadequate or incomplete. The reconsideration process has always been and continues to be DCBS's tool to evaluate the carrier's closures and keep them from unfairly or inadequately applying the law in relation to the rating of impairment. In fact, an insurer can be penalized for failing to rate impairment properly.
Also, the oversight of insurer produced closures lies in the hands of auditors employed by the Dept. of Consumer and Business Services. Your attention would be better spent insuring adequate funding of an equitable auditing system instead of viewing SB 220 as a mountain instead of the molehill that it really is. Wouldn't you prefer that your tax dollars be spent on a system that provides true oversight and not to fund a unit that is producing very little meaningful work?
I support your move to increase funding for the Ombudsman and would encourage anyone with questions to call them.
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