I read Peter Rousmaniere's column on the Guzman v. Milpitas Unified School District case. He got most of it right. This case has thrown the system into a full-scale panic.
I write regarding a portion of his column, especially the statement "a permanent disability is a sign of failure in employer practices and restorative medicine." I would like to know how he feels it is a failure in employer practices ... in California, where I work, taking an injured worker back to work has no bearing at all on their permanent disability rating (whether it should be or not is another issue for another time). Permanent disability, under the California system, is compensation for the industrial injury causing a lessened ability to compete in the open labor market. When California had vocational rehabilitation, putting a worker in vocational rehabilitation and having them complete the plan was supposed to be a way to decrease permanent disability. If you had a worker with a 30 percent permanent disability, but by job retraining they could now compete in jobs they could never compete in before, this would lower the permanent disability. However, vocational rehabilitation was dismantled, so permanent disability awards remain the same.
Of course there are some benefits for taking workers back, but most employers really do not want injured workers back. Why? They are afraid of increased costs if they take the person back.
Many times, the worker doesn't want to go back. Why? Maybe they are afraid of injuring themselves again or they simply don't like their job. To simply throw this on the back of an employer is wrong.
Restorative medicine--again, Peter misses the boat here. What is restorative medicine? I have worked in the California system for 23 years. I have never heard the term used. But, what has happened in California is the overwhelming presence of alternative medicine, such as chiropractic medicine.
Most workers' comp patients at some point use chiropractors. Chiropractic, which has promoted itself as a "restorative" treatment, is the treatment of choice in many minority communities. Many times, they go for 24 visits to a chiropractor, find out that the chiropractor has not helped their pain, and then they go back into the system to find a doctor to help. By that time, they have been in pain for six months, and then the doctor says "well, if he has been in pain for six months, he needs surgery."
Then, they are out for another six months post-surgery. I know that in prior columns, Peter has championed the use of exercise to get people back to work. Well, it's not going to happen. The medical community, especially in California, won't go for it. Before using such terms as restorative medicine, he needs to define it and say what he believes it should do.
What is dangerous in the workers' comp system is to use opinions to chart a course of direction. Dealing with injured workers and employers is delicate work. Each is an individual and has different needs, motivations and desires. Until all of the players get together and come to a common conclusion as to what the system can do to get workers back to work quickly and productively, making blanket statements such as Peter's is dangerous, risky and counterproductive.
State Compensation Insurance Fund
San Jose, Calif.
August 1, 2009
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