The California state agency responsible for making sure workers get treatment after injuries on the job is ignoring conditions that delay care and impair quality in the system, according to an audit published Tuesday.

When injured workers have disputes with their employers over things such as whether work caused their injuries, the extent of their injuries and the treatment required, they can request a review from a doctor through the Division of Workers’ Compensation, which is part of Department of Industrial Relations.

Many workers who have requested reviews in recent years have met with months-long delays, according to Auditor Elaine Howle’s report.

Too few physicians are doing the reviews, according to the audit. While requests for the reviews rose by 37 percent from 2013 through 2018, the number of available doctors dropped by 12 percent, according to the audit.

When workers request reviews of their cases, they are offered a panel of three physicians. Often, none of those physicians are available within 60 days. In that case, workers or insurers can request a new panel to try to speed things up.

The auditor found the number of those delay-related requests rose sharply from 2013 through 2018. The number of replacement panels requested due to 60-day delays rose to about 19,000 in fiscal year 2017-2018, up from 4,600 in 2013-2014, according to the audit.

More than half the time, no one from that second panel is available within two more months, according to the audit.

The auditors’ review raised concerns that workers could be prolonging treatment while they wait to figure out how it will be paid for, to the detriment of both employees and employers.

The Division of Workers’ Compensation hasn’t taken the most obvious step to increase the supply of doctors — increasing their pay, according to the audit.

While the division has increased what it pays for doctors to treat the patients, it hasn’t increased the pay for the reviews since 2006, according to the audit. Doctors have been paid $625 for the reviews since then, a figure that if adjusted for inflation would come out to $812, according to the audit.

The division “should not continue to ignore the indicators of its dwindling supply of (doctors),” the audit states.

George Parisotto, the division’s administrative director, said in a written response to the audit that the department isn’t ignoring the decrease in doctors in the system.

Parisotto said independent studies have suggested the problem lies in the distribution of doctors in the system, not their number. He said many are never assigned to the panels of reviewing doctors. He said the division would look at ways to improve the panel selection process.

He also cited a general physician shortage, saying supply overall is diminishing.

Driving doctors out

In some cases, the division may be driving doctors out of the system, according to the audit. Auditors identified a pattern: when an insurer accuses a reviewing doctor of overbilling, the division often denies the doctor’s reappointment in the system rather than launching a typical administrative review.

Then the doctor, known as a qualified medical examiner or QME, is put in a position to try to settle the overbilling claims before receiving a fair hearing, auditors found.

“We believe the alleged violations remain allegations until later in the disciplinary process,” the auditors wrote.

Parisotto, denied that assessment, saying the division follows standard disciplinary procedures.

No quality reviews

The audit also found the division rarely reviews the doctors’ reports.

An associate medical director told auditors that when he did review a selection of the reports from 2015 and 2016, he found 85 percent of them were “substandard in one or more ways,” according to the audit.

But the division never did anything about it, and the associate medical director stopped reviewing the reports, according to the audit.

“Ultimately, to meet its legal obligation, we believe (the division) has a responsibility to use existing resources or seek additional resources to help ensure the quality and timeliness of (doctors’) reports, which injured workers and their employers rely on to resolve disputes,” auditors wrote.

The audit suggests the Legislature should set up a process requiring the division to review its pay for the medical examaners every two years and make other changes to the way the panels are set up to improve the supply of doctors.

“This investigation finds serious shortcomings at (the division) that harm employers, injured workers, and the (medical examiners), the physicians charged with determining whether injured workers are eligible for benefits,” Gabor Vari, CEO of California Medical Evaluators, said in a statement. “As the audit recommends, the Legislature must step in, provide oversight, and pass legislation to hold the (division) accountable and make sure there are enough (medical examiner) physicians to meet workers’ needs.”

This story was originally published November 19, 2019 at 1:10 PM.