CHSWC Focuses on Steamlining Benefit Notices

Wednesday, February 23, 2011 | 0

By Peggy Sugarman
Grancell Lebovitz Stander Reubens and Thomas
 
As the California Division of Workers' Compensation completed a revision to the Medical Provider Network benefit notices and other posting requirements, the Commission on Health & Safety & Workers’ Compensation (CHSWC) is taking on the issue on an expanded level with industry representatives. Their goal is to streamline benefit notices to allow claims administrators to communicate effectively with injured workers.

I recently joined the CHSWC volunteer work team to assist with this project. The make-up of the team is inclusive, reflecting the labor-management vision of the commission. The project leader, Julianne Sum of the UC Berkeley’s Institute for Research on Labor and Employment, has worked on many other projects to create products that inform workers of their rights and benefits in an increasingly complex system.  

As part of this current effort, the CHSWC conducted a survey of injured workers to see whether online sources of information would be feasible. In this study, they found that the majority of injured workers access the Internet at least once per month, with only 16% of workers having no access. Estimating that this number is likely to lessen over time, one strategy is to focus on systematically referring injured workers to online materials, with mailed copies to be reasonably available through DWC upon request. This could allow for shorter, less complicated benefit notices that focused on the immediate claim issue with references to more detailed guidebook that is  accessible online. 
 
We are currently examining the old DWC-500 notices for some guidance. These mandatory forms were eliminated in the mid-1990s to allow claims administrators the ability to customize their communications and combine topics into one letter so long as the letter  complied with a basic list of requirements. The DWC then created standard, check-list type paragraphs that met the requirements, but
these became overwhelmingly complicated for claims administrators to effectively manage and equally complicated for injured workers to understand.
 
The CHSWC strategy includes the creation of new notices using a table format that lists the type of benefit, the specific change made to that benefit, and where to access additional information regarding that benefit including the information on rights and obligations.

As part of the project, CHSWC is proposing draft changes to various statutes to eliminate provisions that are inconsistent with the goals of effective, streamlined communication. Such changes must eventually be legislated after which the DWC administrative director would have to adopt implementing regulations as the CHSWC has no regulatory authority. But with estimated savings of $43 million annually coupled with bipartisan support, such legislation is likely to be favorably received. 
 
<i>Peggy Sugarman is training director for the Grancell Lebovitz Stander Reubens and Thomas law firm, which represents insurers and employers. This column was reprinted with the firm's permission from its quarterly newslettter.</i>