Asking doctors — instead of courts — to resolve disputed medical claims could save millions of dollars for Florida’s workers’ compensation system, Florida TaxWatch said Tuesday.
The nonpartisan government watchdog proposed emulating California’s independent medical review (IMR) process, which steers such disputes to “appropriately qualified, independent medical professionals” rather than compensation judges or trial courts.
The system could reduce the time needed to resolve such disputes from an average of 231 days to about 30, judging by California’s experience, TaxWatch said in an analysis.
Additionally, it could reduce litigation costs by $22.6 million and attorney fees — which during the 2016-17 fiscal year surpassed $439 million.
The state could scale back or even get rid of its Office of the Judges of Compensation Claims and its 31 administrative judges, now budgeted at $13.3 million per year. And, in California, the system produced reductions in opioid prescriptions and doses.
“Florida TaxWatch thinks IMR is worthy of consideration by the Legislature as a way to keep down Florida’s rising workers’ compensation costs,” the study concludes.
“Workers’ compensation is a critical safety net to protect Florida businesses and families,” TaxWatch President and CEO Dominic Calabro said in a written statement.
“If the state policymakers want to continue to grow Florida’s economy, it is imperative that the Legislature take the IMR process into consideration.”
Workers’ compensation premiums have been declining in Florida, following a 14.5 percent increase in 2016. Still, business and insurance interests, and the state Office of Insurance Regulation fret that Florida Supreme Court rulings liberalizing benefits and access to attorneys bode ill in the long term.
According to TaxWatch, the system was the brainchild of Maximus Federal Services Inc., which handles Medicare appeals and other insurance services and which administers the system for California.
Any disputed claim goes to an “expert physician reviewer,” who has 30 days to render a decision. During 2016, these doctors upheld treatment denials 91.6 percent of the time. In 2017, the rate was 91.2 percent and, during the first half of 2018, it was 90.1 percent.
Some 30 percent of the reviewed cases during 2016 involved opioid prescriptions, and the doctors approved access to these drugs only 9.5 percent of the time.
“In addition, treatment providers who consistently prescribe opioids contrary to the established best practices governing the use of opioids run a greater risk of identification as a result of IMR,” the TaxWatch analysis says.