Californian’s Lose Millions in Workers Compensation Benefits

Newswise — A new study completed by the Occupational Therapy Association of California (OTAC), and the American Occupational Therapy Association (AOTA), estimates that workers who were injured on the job and submitted claims under California’s new workers compensation law (SB 228) were deprived of $56 million in occupational therapy services in the first six months of 2004, caused by a striking increase in the number of denied or delayed treatments.

The study surveyed 150 occupational therapy practices in California, and compared key data from January 1- June 30 for the years 2003 and 2004. Key findings pointed to fewer treatments, more denied claims, and longer waiting times for treatment, more than twice as long in 2004, due to new medical review requirements designed to streamline the process:

* The number of occupational therapy treatments completed from January
2004 – June 2004 dropped 35% from last year.

* The number of denied claims for OT increased dramatically to 14,979 in
2004, compared to 1030 in 2003.

* The average waiting time for a claim to be approved jumped to 15.43
days in 2004, compared with 6.02 days in 2003.

“This data is troubling because what it really means is injured workers are getting fewer services," said Frederick P. Somers, Executive Director of the American Occupational Therapy Association. “It will have an impact on productivity – people won’t get back to work; and it will impact personal income – the burden of paying for rehabilitation therapies will be transferred to injured individuals and families. If people don’t regain full function, over the long term, long term disability costs are going to skyrocket.”

Given these startling figures, AOTA is working with California therapists and policy makers to assure that utilization guidelines are appropriate, implemented fairly, and processed efficiently.

Occupational therapy is a proven, recognized therapy that enables people to overcome injuries and other disabilities to be productive members of the workforce. Occupational therapists use work-related activities in the assessment, treatment, and management of individuals whose ability to work has been impaired by physical, emotional, or developmental illness or injury. Work rehabilitation provides a transition between acute care and return to work by addressing the issues of safety, physical tolerance, work behavior, and functional ability.

The American Occupational Therapy Association is the nationally recognized professional association of more than 35,000 occupational therapists, occupational therapy assistants, and students of occupational therapy. These practitioners serve people with physical illnesses and injuries, congenital and chronic conditions, and mental and developmental disabilities, helping them regain, develop, and build skills essential to restoring or maintaining independent function, health and well-being, and social participation. For more information, please visit http://www.aota.org.