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Byline: JILL STEWART Capitol Punishment

THE message of ``Jurassic Park'' was that if you mix one highly complex system of DNA with another, you will create an utterly unpredictable and potentially tragic hybrid otherwise known as a monster.

If only Jeff Goldblum's character had been present during the dead of night on April 15, issuing such pearls of wisdom when the California Legislature put the final touches on its 75-page, epic workers' compensation reform.

I truly want to report that this sweeping law will hack one-third off horrific medical, salary, legal and indemnity costs, forcing a big drop next year in insurance premiums that cripple everybody from nonprofits to cafes to factories.

But this well-intended reform may become a monster from which we all want to flee.

Among other things, SB 899 is filled with ambiguities that offer rich veins for lawyers to mine. Moreover, the law is clearly biased against small proprietors, who can't afford experts to protect them from liabilities of up to $10,000 per injury. And a new definition of ``cure and relieve'' could produce never-closing claims by people who insist they've not been ``relieved.''

Experts agree that billions may be saved - but not without a lot of vigilance by California businesses. Among other things, they say:

--A new rule that workers who claim an injury must use a health network selected by employers is so full of holes it could morph from a cost-saving device into a costly universal health care program. Says Dr. Jennifer Christian, an occupational medicine expert, ``All an employee now has to do is say they have an injury in order to get the care immediately'' and they can spend $10,000 before a claim is even approved.

Preventing these and other troubles rests largely on regulations to be written by the state Division of Workers Compensation, whose record in writing effective regulations is hardly encouraging.

--There's no guarantee that noncredible doctors who promote unneeded treatments will be kept out of the networks. The law expects busy employers themselves to learn if unqualified doctors are in a network. Says Dale O'Brien, of workers' compensation consultant ClearComp, ``You have to make sure you have credible orthopedists, credible neurosurgeons.''

--The law is vague on how to meld the complex old and new rules. Until now, a worker could get a ``permanent'' disability rating of, say, 30 percent on a body part, then return to court again and again claiming a new disability rating on the same body part to win more money. California finally copies states where the human body equals 100 percent and each part equals a fraction of that. Period.

In judicially liberal California, consultant David De Paolo of WorkComp Central estimates, 95 percent of workers seeking permanent disability settlements will get them. But how will courts compute the math to meld lax pre-existing awards to the tougher measurement?

--To return injured employees to work (California has the nation's worst return-to-work rate), employers must make work sites or duties easier on the injured worker's body - or face penalties. Expect major lawsuits over vague wording regarding the pricey 15 percent penalties. Also, the ``return to work'' provision reimburses employers up to $2,500 for work site modifications. But Allan Leno, a workers' comp consultant to businesses, says the reimbursement isn't even mandated.

Don't get me wrong. Big savings could materialize, but it won't be quick or easy. Christian points to ``landmark, strengthening changes'' that copy states in which an injured worker's treatment is decided ``using evidence-based principles'' instead of the wildly differing views of doctors.

Rob Bekken, a lawyer representing employers who are preparing to sue workers' comp insurers, says SB 899 ``will end the doctor-shopping.''

Another plus is that disability reports must now rely on objective American Medical Association standards to assess injury. Huge savings could result. Vince Sollitto, spokesman for Schwarzenegger, calls this ``probably the single biggest reform in the package.''

Perhaps the governor can use his sheer force of will to make sure the leeches and middlemen who ply the ambiguities and loopholes will somehow get shut out.

But it's equally possible that, in a couple of years, we'll be discussing a way to cage the monster the legislature created on April 15, 2004, while the rest of us were sleeping.
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Title Annotation:Viewpoint
Publication:Daily News (Los Angeles, CA)
Date:May 2, 2004

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