The Timing of SCIF’s Liability Acceptance Did Not Affect Injured Workers’ Access to Medical Care
Our review of 30 employee and 36 inmate workers’ compensation claims from January 2015 through June 2018 showed that SCIF completed most liability decisions within required time frames. SCIF is allowed to delay liability decisions in certain circumstances, which it did in 15 of the cases we reviewed. However, these delays did not hinder the injured workers’ access to medical care. SCIF and CDCR’s facilities took the necessary actions to ensure that SCIF complied with time requirements regarding its liability decisions in most of the cases we reviewed.
SCIF Made Most Liability Decisions Within Required Time Frames
SCIF completed most liability decisions, including those that were delayed, within the time frames set by laws and regulations. SCIF must make a liability decision about each claim to establish whether the injury is work‑related and therefore whether the employer is financially responsible for treatment. State law requires SCIF to accept the claim, deny the claim, or notify the employee of a delay in the decision within 14 days of the date the employer is made aware of the injury. SCIF may delay a claim decision because it needs additional required information, such as a claim form or statement from the employee, or if SCIF cannot determine if the employer has any liability for the injury. However, if SCIF fails to reject liability within 90 days of when the injured worker files the claim, liability is presumed to be accepted, as we explain later in this section.
SCIF and the facilities took the necessary steps to comply with the 14‑day requirement to accept, deny, or delay the claim in most of the 30 employee and 36 inmate claims we reviewed, as Table 2 shows. For all of SCIF’s late decisions, ranging from one to 63 days, we noted that the facilities did not submit claim information to SCIF within the required time frames. SCIF’s agreement with state departments requires CDCR to submit initial claim information within the statutory time frame—which is five days—but CDCR’s facilities did not meet this requirement for any of the claims with late liability decisions. In five cases—one employee and four inmates—the facilities did not inform SCIF of the injury claims until the 14‑day requirement had passed, making it impossible for SCIF to comply with the 14‑day requirement. When the facilities informed SCIF of these five claims after 14 days or more had passed, SCIF made the liability decision on them as early as the same day and no later than eight days after receiving the claim information.
SCIF’s Late Liability Decisions Resulted From Untimely Notification From Facilities After They Learned of an Injury
|SCIF DECIDED LIABILITY OR DELAYED DECISION WITHIN 14 DAYS||SCIF DECIDED LIABILITY AFTER MORE THAN 14 DAYS||FOR THOSE OUTSIDE OF 14 DAYS|
|FACILITY SENT CLAIM TO SCIF WITHIN 5 DAYS (REQUIRED TIME FRAME)||FACILITY SENT CLAIM TO SCIF IN 6 TO 14 DAYS||FACILITY SENT CLAIM TO SCIF AFTER MORE THAN 14 DAYS|
|Employees||28 of 30||2||0||1||1|
|Inmates||26 of 36||10||0||6||4|
Source: Analysis of 30 employee and 36 inmate workers’ compensation claims from January 2015 through June 2018.
When making its claim determinations, SCIF’s claims adjusters obtain information about the injury by reviewing injury reports, witness statements, and other relevant documentation, and by interviewing individuals who have or may have knowledge about the injury, such as the injured worker, employer, and physicians, to evaluate whether CDCR is liable for the injury. If SCIF cannot determine whether CDCR has liability for an injury within 14 days after it learned of the injury, state law allows SCIF to delay its decision so that it can collect the necessary information. Of the 30 employee and 36 inmate cases we reviewed, SCIF delayed its liability decision in five employee and 10 inmate cases, and it subsequently made all but one of those 15 delayed decisions within the 90‑day requirement.
According to state law, if SCIF fails to make a determination in 90 days, liability is presumed to be accepted, but that acceptance can be reversed if evidence supporting a denial is discovered after 90 days has passed, and that evidence could not have been reasonably obtained prior to the 90 days. As such, liability should have been presumed accepted in the one case in which SCIF did not make its decision in 90 days, but SCIF denied liability two weeks later, stating in its denial letter that there was no medical evidence to support an injury. SCIF’s claims compliance director explained that it can rebut presumption of accepted liability if it is unable to ascertain a medical opinion regarding the alleged injury, which was the situation in this case. However, we disagree that SCIF had appropriate cause to deny the claim at that point, as no additional evidence had been discovered. Regardless, because the worker was an inmate, his immediate medical care was not affected by the liability decision, and upon his release from incarceration, the inmate successfully appealed SCIF’s denial of liability.
Delayed Liability Decisions Did Not Affect Access to Medical Care in the Cases Reviewed
Our review showed that the delayed or late liability decisions did not hinder injured workers’ access to medical care. For four of the five employees whose liability decisions were delayed, the employee received treatment two or more weeks before SCIF accepted liability. Two employees whose claims had not been delayed also received care before the liability decision. Many inmates whose claims we reviewed received treatment before SCIF accepted liability, regardless of whether SCIF first delayed the decision, because their treatment did not depend on SCIF’s liability decisions. In the remaining cases, injured workers either did not need subsequent treatment or SCIF had accepted liability by the time the medical provider requested approval for a treatment.
As we discuss in the Introduction, state law allows employees with work‑related injuries to obtain up to $10,000 in relevant medical care while SCIF is making its liability decision. After the employee receives an initial medical exam, all subsequent treatments using these funds are subject to review for medical necessity, a process which we describe further in the next section. Additionally, once SCIF makes a decision to accept liability, it may retroactively authorize treatment by determining that a treatment was appropriate and agreeing to pay for it. If SCIF decides to deny liability, it will not authorize any further payments for medical treatment, although the employee is not required to pay back up to $10,000 of the cost of the earlier treatment.
For inmates, the timing of SCIF’s liability decision does not affect the timing or provision of medical care because Correctional Health must provide all medical care to inmates regardless of the origin of the injury or illness. The liability decision does not affect medical care for an inmate suffering a work‑related injury unless and until the inmate is no longer incarcerated and requires further treatment. At that point, the now‑former inmate must have an accepted claim on file with SCIF to receive additional medical care through the workers’ compensation system.
Despite Different Processes and Time Requirements, Employees and Inmates Received Timely Treatment
Many of the injured workers whose cases we reviewed received immediate medical care following a work‑related injury, and SCIF and Correctional Health facilitated any further medical treatment needed for those injured workers in a timely manner. However, SCIF’s and Correctional Health’s different purposes and procedures for providing care to injured employees and inmates complicate any meaningful conclusions when comparing the provision of employee and inmate medical treatment following a work‑related injury.
Different Purposes and Processes for SCIF and Correctional Health Limit Meaningful Comparisons of Treatment for Injured Employees and Inmates
Although SCIF and Correctional Health both facilitate medical care for injured workers, each organization has distinct priorities unique to the populations they serve. SCIF makes a liability determination for each workers’ compensation claim and reviews treatment requests, which it approves only for accepted or delayed claims for work‑related injuries. SCIF does not actually provide medical care; rather, medical providers within SCIF’s network generally provide the treatments. In contrast, Correctional Health must provide to inmates a constitutionally adequate level of care, regardless of whether the injury is work‑related. Additionally, Correctional Health directly provides on‑site treatment to injured inmates, except in circumstances when outside medical care is needed. For these reasons, it is difficult to draw meaningful conclusions when comparing the provision of employee and inmate medical treatment following a work‑related injury.
SCIF and Correctional Health both authorize medical care for injured workers, but have different processes, policies, and time requirements governing the approval of treatment. As we discuss in the Introduction, if an injured employee’s workers’ compensation physician requests further treatment to address a work‑related injury, state law requires SCIF to review the request to ensure that it meets established medical standards before authorizing it. This utilization review process is based on nationally recognized standards of care, and SCIF is responsible for determining that the requested treatments align with medical treatment standards.
In addition to its utilization review process, SCIF has established a program that facilitates treatment by allowing a select group of medical providers—which it calls passport providers—to provide certain treatments without having to first obtain individual authorization through its formal utilization review. Under this program, SCIF authorizes medical providers as passport providers if they have consistently adhered to evidence‑based treatment guidelines and have demonstrated superior outcomes. Only certain treatments are preauthorized under this program including physical therapy up to 24 visits; antibiotics for the first 30 days after injury; up to three steroid injections; and some surgery, such as an initial hernia repair. Passport providers must still obtain approval from SCIF for less common treatments. Because passport providers can provide certain treatments without waiting for SCIF’s approval, an employee can receive treatment faster. As we discuss in the next section, the 12 employees we reviewed who received their treatment through passport providers generally received their treatment faster than the employees who saw non‑passport providers and received comparable treatments that required approval through SCIF’s utilization review process.
Correctional Health has entirely different policies for the medical treatment it provides to inmates. It must provide medical treatment to inmates for all injuries, including work‑related injuries. Correctional Health’s providers, including physicians, nurse practitioners, and physician assistants, may prescribe certain treatments without needing authorization through utilization management. These treatments include selected medications and durable medical equipment, as well as X‑rays and certain imaging services. Correctional Health ensures medical necessity and authorizes treatments that are high cost, high risk, exceptional, or complex cases through its utilization management process. Of the 36 inmate work‑related injuries we reviewed, 14 cases included treatments requiring authorization through the utilization management process. The other 22 inmates we reviewed did not require authorization for their treatments. In many of these 22 cases, Correctional Health provided low‑level treatments such as basic pain medicine, ice, and splints or wraps following the work‑related injury.
Treatment provided to employees and inmates may differ in its timeliness yet still meets the requirements specific to each population. Although SCIF’s utilization review process is functionally similar to Correctional Health’s utilization management process, the time frames for authorizing treatment differ for each. For example, state law generally requires that once SCIF is in receipt of the information it needs to make its determination, it must approve, modify, or deny physicians’ requests for treatment within 72 hours for urgent cases and five business days for nonurgent cases.3 However, the utilization review requirements under state law do not address how quickly a medical provider must actually provide the approved treatment to injured employees. In contrast, Correctional Health’s procedures require approval of treatment for inmates requested through its utilization management process within two days in urgent cases and seven days in routine cases. Its policies also require that Correctional Health provide approved treatments to injured inmates within 14 days in urgent cases and 90 days in routine cases. Although Correctional Health’s procedures require treatment of inmates within these time frames, no such requirement exists for employee treatment, which complicates any conclusions drawn from a direct comparison of the provision of medical care to employees and inmates for work‑related injuries.
Medical Providers Treated Workers Promptly and SCIF and Correctional Health Authorized Requested Treatments Within Required Time Frames
The employees and inmates we reviewed received necessary care through established and medical industry‑approved processes within reasonable time frames, and we did not identify notable, systemic negative effects or areas for the processes to become more efficient. Specifically, many of the employee and inmate workers’ compensation claim files we reviewed showed that the injured worker received immediate initial medical care following a work‑related injury. For example, of the 30 employees we reviewed with work‑related injuries, two obtained treatment before informing CDCR of their injuries, 23 received medical care within one day of informing CDCR of their injuries, and four others obtained care within a week of informing CDCR. The remaining employee filed a claim for a cumulative injury—an injury caused by repeated events or repeated exposures at work, such as a wrist injury from repetitively performing the same motion or a loss of hearing because of constant loud noise—and obtained care 17 days after reporting the injury to CDCR. For inmates, of the 36 work‑related injuries we reviewed, the inmates received medical care on the same day as the injury in 29 cases. For the remaining seven cases, one inmate obtained medical care the next day, two suffered relatively minor injuries that did not require immediate medical care, and four did not request medical care until one or more days after the injury.
In our review of employee and inmate treatment requests submitted after they had received initial medical care, both SCIF and Correctional Health authorized requests within the required time frames in nearly every case. Specifically, in the 30 employee cases we reviewed, SCIF authorized all requests for further treatment within the time frames that the law requires. Similarly, in 13 of 14 inmate cases in which the inmate’s physician requested authorization for treatment, the facility processed the request within the required period, as Table 3 shows. In the remaining inmate case, the facility approved the treatment request two days late. However, because Correctional Health provided the requested treatment to the inmate within 21 days of the approval of treatment—well within Correctional Health’s 90‑day time frame for routine treatments—the inmate was not negatively affected or harmed by the late approval of the requested treatment.
SCIF and Correctional Health Generally Processed Requests for Treatment Authorization Within the Required Time Frames
|AUTHORIZATION PRACTICE||CALIFORNIA MEN’S COLONY||CALIFORNIA REHABILITATION CENTER||CALIFORNIA STATE PRISON, SOLANO||TOTALS|
|Number of employees requiring authorization of treatment for a work-related injury||6 of 10||4 of 10||2 of 10||12 of 30|
|How many treatment authorizations did SCIF process within the required time frame?*||6 of 6||4 of 4||2 of 2||12 of 12|
|Number of inmates requiring authorization of treatment for a work-related injury||6 of 12||5 of 10||3 of 14||14 of 36|
|How many treatment authorizations did Correctional Health process within the required time frame?†||6 of 6||5 of 5||2 of 3||13 of 14|
Source: Review of workers’ compensation claims and medical records, state law, and Correctional Health’s policies.= Generally complied.
* State law generally requires SCIF to approve or deny treatment authorizations within 72 hours for urgent cases and five business days for nonurgent cases once SCIF is in receipt of the information it needs to make a determination.
† Correctional Health policy requires different time frames for processing urgent and routine inmate treatment authorizations—two days for urgent treatment and seven days for routine treatment.
The number of days between the date of a worker’s injury and the date of treatment varied greatly, although this metric does not always provide an accurate measurement of treatment timeliness. For example, our testing showed that 17 injured workers did not immediately report their work‑related injuries, which delayed how quickly a physician could recommend treatment. In fact, in three cases, the workers did not report their injuries for more than three months, leading to a longer time between the date of injury and the date treatment was provided. For example, one employee’s date of injury was more than five months before the employee informed CDCR of the injury; therefore, the employee did not receive treatment for several months.4 For several inmate cases, Correctional Health physicians initially provided treatments that did not require authorization but then resorted to high‑level or high‑cost treatments requiring authorization. For example, in one inmate case, Correctional Health did not recommend a treatment requiring authorization until more than 100 days after the inmate’s date of injury because the inmate’s physician initially ordered a low‑level treatment. However, Correctional Health still provided the inmate with consistent medical care during the period leading up to the eventual authorization. For these reasons, we believe the time between the date a medical professional recommends treatment and the date the injured worker receives that treatment provides a more meaningful measurement of treatment timeliness.
Following authorization of a requested treatment for a workers’ compensation injury, employees generally received recommended treatments for their work‑related injuries in a timely manner. State law regarding utilization review does not address how quickly injured employees must be treated. SCIF’s claims compliance director stated that it is incumbent on the injured worker and medical provider to schedule an appointment for treatment following SCIF’s approval of the treatment request. Despite the utilization review process lacking a requirement for how quickly medical providers should provide authorized treatments, for the 15 employee treatment requests we reviewed, employees received the approved treatment between four and 42 days after authorization.
In 12 of the 30 cases we reviewed, employees received treatment through passport providers between zero and 34 days after the medical provider recommended treatment. As Figure 2 shows, for comparable treatments, such as physical therapy, passport providers generally delivered treatment faster on average than medical providers who required preauthorization through utilization review. SCIF’s claims compliance director explained that passport providers have demonstrated to SCIF that they have an established process for efficiently and effectively treating workers’ compensation injuries, including providing medically necessary treatment while minimizing costs and the amount of time a claim is open. She also explained that because passport providers have demonstrated that they effectively review treatments for necessity, SCIF’s utilization review is unnecessary for low‑level treatments. However, she stated that not all medical providers in SCIF’s network have demonstrated that they meet the above requirements; therefore, they are not all passport providers. As a result, there are not enough passport providers for all employees to take advantage of this program. Additionally, although passport providers generally treated injured employees more quickly than employees who received comparable treatments through utilization review, in one case the injured employee waited 34 days after a treatment recommendation before receiving the recommended treatment, demonstrating that passport providers did not always provide a quicker path to treatment. SCIF’s claims compliance director stated that the amount of time it takes for an injured worker to receive treatment is usually contingent on scheduling limitations of the medical provider and injured worker.
Employees Receive Comparable Medical Care Faster With Passport Providers
Source: Analysis of selected workers’ compensation claims.
In nearly every inmate case we reviewed, Correctional Health provided authorized treatment for work‑related injuries within the required time frame. Correctional Health’s policy requires medical care within 14 days for approved urgent treatments and within 90 days for approved routine treatments. Its policy also mandates that Correctional Health personnel ensure that emergency treatment occurs immediately. Of the 13 inmate cases we reviewed in which the inmate received a treatment requiring authorization, Correctional Health provided treatment for 12 inmates within the required time frames. In the remaining case, CDCR transferred the inmate to a different facility after Correctional Health had approved the requested routine treatment, and the inmate received the treatment 23 days later than the 90‑day mandated time frame. The available documentation is unclear as to whether the transfer directly caused the treatment delay. Correctional Health’s health care transfer policy requires that a facility summarize an inmate’s medical information—including current treatments—and send it to the receiving facility’s medical personnel when an inmate transfers between facilities. In this case, Correctional Health personnel followed the policy and indicated that the inmate had approved treatment pending, yet the inmate did not receive treatment until medical personnel at the receiving facility filed and approved a new treatment request. However, with the exception of this case, Correctional Health complied with its policies for providing timely treatment to inmates, as Table 3 demonstrates.
Many Factors Affect the Recovery Time of Injured Workers
Our review of 30 employee and 36 inmate cases showed that employees generally recovered more slowly than inmates. However, the time it takes for injured workers to recover can vary greatly, even among those with comparable injuries. Variables such as the severity of the injury and the worker’s health history affect recovery time, or an injured worker with an existing medical condition may naturally take longer to recover from an injury. As a result, although SCIF generally had documentation of the date of an employee’s release from care, the variables affecting recovery limited the ability to draw meaningful conclusions from summarized data that are based solely on when a worker was released from care. Further complicating the analysis, Correctional Health’s documentation of an inmate’s release from care date for a work‑related injury was inconsistent.5 Therefore, we reviewed individual case files instead of drawing conclusions from the summarized data.
A Variety of Factors Affect an Injured Worker’s Recovery Time
As Figure 3 shows, when we measured recovery times from the date a worker first received medical care for a work‑related injury, CDCR employees tended to recover more slowly than inmates.
Employees’ Injuries Resulted in Longer Recovery Times Than Inmates’ Injuries
Source: Analysis of 30 employee and 36 inmate workers’ compensation claims from January 2015 through June 2018.
The difference in recovery times we observed may be, in part, a result of the different types of work‑related injuries that employees and inmates sustain. According to a study published in the Journal of Safety Research, Vol. 43, No. 3, July 2012, correctional officers in particular are exposed to unique workplace hazards. The U.S. Department of Labor’s Bureau of Labor Statistics reports that the incidence rate of correctional officers suffering nonfatal occupational injuries and illnesses in 2017 was three times greater than the national average for all occupations. Further, 36 percent of such injuries were caused either intentionally or unintentionally by another person. Ten of the 30 employee workers’ compensation claims we reviewed resulted from altercations with inmates, during which the employees sustained injuries such as strains, sprains, and bruises to the knees, shoulders, and lower back. The return‑to‑work coordinators at one facility stated that, based on their facility’s claims, inmate work‑related injuries tended to be less severe than employee injuries. Two supervisors of inmate work programs also said that the inmate injuries they had observed were generally not severe.
Further, because of the many ways that injuries and individuals differ from one another, the time it takes for injured workers to recover can vary greatly. Even when two workers suffer a similar injury, recovery time can vary drastically depending on the severity of the injury. For example, when two CDCR employees each sustained knee injuries, one was released from care three days after the injury, and the other took almost a year before being released from care. Even though both employees initially showed some knee swelling and reduced mobility, and were provided a brace, the first employee improved after a few days, while the second employee continued to experience pain and eventually underwent surgery.
An injured worker’s physical condition, health history, and compliance with treatment instructions can also affect the speed of recovery. A worker with an existing medical condition may naturally take longer to recover from an injury. For example, one inmate worker we reviewed who was injured in a fall also had past cardiac problems. His doctor noted that it was unclear if some symptoms were the result of his work‑related injury, complicating the determination of when the injury had healed. Other health factors and individuals’ decisions subsequent to the injury can also affect how quickly the worker recovers. For example, another inmate who injured his arm did not always comply with his medical provider’s instructions to wear a sling or brace, and his records show that he consistently refused steroid injections that may have helped alleviate his pain. Because medical advice is intended to facilitate recovery, the inmate’s noncompliance with medical orders likely delayed his healing. As with the other factors, it is difficult to establish exactly how detrimental these actions may have been to the recovery process in each case.
The Date of an Injured Worker’s Release From Care Does Not Offer a Comprehensive Picture of Recovery
Although SCIF’s claims compliance director indicated that the date of maximum medical improvement (maximum improvement) is the closest approximation for measuring an injured worker’s release‑from‑care date, this date does not offer a comprehensive picture of an individual worker’s recovery.6 We used the date of maximum improvement to measure release from care because it indicates that a worker’s condition has stabilized or is not expected to get substantially better or worse within a year with or without medical treatment, but that milestone does not always mean the worker has fully recovered or requires no further treatment. For example, a physician concluded that one employee we reviewed had reached maximum improvement after recovering from surgery, but the physician still expected that the employee would need further medication and may benefit from future physical therapy to manage certain persisting symptoms. Similarly, maximum improvement does not always coincide with the date that an injured worker returns to work: an injured worker may return to work before, at the same time as, or after reaching maximum improvement, depending on the job and the limitations of the injury.
According to its claims manual, SCIF can rely on the determination of maximum improvement from the injured worker’s physician to close workers’ compensation claims and to identify whether future care is necessary. Therefore, we generally found that the date of maximum improvement was included in workers’ compensation physical documents that we reviewed. However, according to its claims compliance director, SCIF does not consistently record this date as a data point in its database. SCIF’s claims compliance director explained that there are too many other factors that can affect the recovery process, such as injury type, injury severity, and employee characteristics, to enable any meaningful conclusions to be drawn from maximum improvement dates. She also added that summarized data based on maximum improvement dates could be easily misinterpreted. Additionally, the maximum improvement date can be determined retroactively, as in one case we reviewed in which the physician determined that the maximum improvement date was four months earlier than his examination date. SCIF’s claims compliance director confirmed that a physician may determine that the employee reached maximum improvement at an earlier date based on the physician’s medical opinion, evaluation, and review of the medical records. Maximum improvement is also not always documented before a claim is closed. In one case we reviewed, SCIF administratively closed a claim because the employee was no longer receiving regular care for the work‑related injury. SCIF notified the employee and the employee’s medical provider that documentation of ongoing medical care would keep the case open, but did not receive a response.
In terms of providing medical care, Correctional Health does not have a business need to determine an inmate’s maximum improvement date for work‑related injuries while an inmate is incarcerated because, by law, it must treat all inmate injuries and illnesses. Inmates were receiving care but Correctional Health documented inmates’ recovery less consistently than was done for injured employees. Although some medical records we reviewed included notations that the inmate’s injury was fully healed, in others a lack of further records about a specific injury was the only indication treatment was completed. These inconsistencies limited a meaningful comparison about recovery times between the two populations; therefore, we did not evaluate or reach a conclusion on whether a maximum improvement date for inmates established by Correctional Health would be beneficial to SCIF for claims administration and potential future care.
Differences in Work Restrictions Caused Some Employees to Return to Work More Slowly Than Inmates
Our review of 30 employee and 36 inmate work‑related injuries found that employees generally returned to work more slowly than inmates. The timing of injured workers’ return to work can depend on their ability to perform their job duties. Factors involved in the ability to return to work include the employer’s ability to accommodate work restrictions for certain types of employees, such as correctional officers, and state law related to modified work assignments.7
Just more than half of the CDCR employees in the cases we reviewed returned to work within 30 days of their first medical visit, although some took more than 250 days. However, the majority of inmates we reviewed returned to work within 30 days and many of those in one to 10 days after their first medical visit. As we discuss in the Introduction, the return‑to‑work dates for both employees and inmates depend on the treating medical provider’s diagnosis and whether the employer can accommodate any prescribed work restrictions. Specifically, the treating medical provider must assess the injured worker’s condition to determine whether the worker can return to work immediately and perform full duties; can return to work immediately with physical restrictions (modified duty), such as no lifting or running; or cannot return to work immediately. If the medical provider clears the injured worker to return to work with restrictions, the employer must assess whether the worker can perform his or her job duties with the work restrictions and if not, in the cases of employees, whether it can offer a temporary job that would accommodate the work restrictions. When an employer is unable to accommodate an injured worker’s prescribed work restrictions, the employer places the injured worker off work.
Although many employees and inmates we reviewed returned to work within a week of their first medical visits, for those who did not, the degree to which workers could perform their job duties with the prescribed work restrictions affected how quickly they returned to work. As Figure 4 shows, employees generally took longer to return to work than inmates. A key reason for the difference in return‑to‑work time was because facilities often determined that the employees could not perform their job duties with the prescribed work restrictions.
Employees Were Generally Off Work Longer Than Inmates Following Work‑Related Injuries
Source: Analysis of 30 employee and 36 inmate workers’ compensation claims from January 2015 through June 2018.
* Two of the 30 employees reviewed are excluded because they took disability retirement rather than returning to work.
In addition to the differences in the amounts of time it takes employees and inmates to return to work, in our review of 30 employee injuries, we found that the employees’ paths to recovery were sometimes less clear‑cut. Although some employees directly recovered from their injuries and returned to their regular duties, Figure 5 shows five employees we reviewed whose work status changed multiple times between full duty, modified duty, and off work during the course of their recoveries, and none of these five employees was able to work while cleared for modified duty because the facilities could not accommodate their work restrictions.
Five Employees Whose Cases Took More Than 150 Days to Resolve Often Shifted Between Full, Modified, and Off Work
Source: Analysis of employee workers’ compensation claims.
In one example of an employee whose work status changed multiple times, a medical provider cleared an employee—employee 4 in Figure 5—to return to work after one month of recovery from a work‑related injury. One month after the employee returned to work, the provider again placed the employee off work for nearly two months because of ongoing pain, then cleared the employee for four months of modified duty. However, the facility could not accommodate the modified duty work restrictions and so the employee remained off work for these four months. The provider ultimately requested surgery because the employee’s ongoing treatment was not providing sufficient pain relief. After surgery, the provider placed the employee off work for one month before clearing the employee to work on modified duty for an additional two months. However, the employee remained off work for these two months because the employer could not accommodate the modified duty work restrictions.
Unlike employees, for the cases we reviewed, inmates’ work status did not change multiple times between off‑duty, modified duty, and full duty following work‑related injuries; rather, all of the inmates returned to work immediately, were briefly cleared to work on modified duty before returning to full duty, or were medically restricted from working before returning to full duty.
State law and CDCR policy also limit CDCR employees’ opportunities to work on modified duty. Specifically, state law limits the time CDCR’s employees may spend on a light‑duty assignment with medical restrictions to no more than 60 days in a six‑month period. Further, state law requires that CDCR place these employees in a vacant position within that employee’s bargaining unit or allow such employees to continue working in their current position and temporarily waive some aspects of the job. For example, prison facilities cannot assign an injured correctional officer to work in an administrative services unit or a nursing unit while cleared for modified duty because those positions are under different bargaining unit agreements. Although medical providers often cleared employees in the cases we reviewed to return to work with restrictions following work‑related injuries, 18 employees we reviewed spent a total of 257 weeks not working, as Figure 6 shows. Further, as we discuss in the Introduction, CDCR’s policy limits accommodation of work restrictions, specifying that facilities cannot accommodate restrictions that would affect the safety and security of the facility operations. The three facilities we reviewed generally could not accommodate work restrictions that limited correctional officers’ abilities to walk, run, or lift because of the physical nature of ensuring inmate security. When work restrictions did not affect the security of the facility, the employer did accommodate the employees and they returned to work immediately in the cases we reviewed. For example, one facility was able to accommodate a work restriction for an administrative employee who was required to take a five‑minute break for every 30 minutes of typing, and that employee returned to work immediately.
Although Cleared for Modified Duty, Many Employees Spent Most of This Time Not Working Because Facilities Could Not Accommodate Work Restrictions
Source: Analysis of 30 employee workers’ compensation claims.
In contrast, most of the inmates we reviewed returned to work fairly quickly after their work‑related injuries. Medical providers cleared 21 of the 36 inmates we reviewed to work within seven days after their first medical appointment, and cleared 12 of these inmates within one day because their injuries did not prevent the inmates from performing their job duties. For example, three inmates who sustained minor contusions, such as a hit to the head while working in the laundry facility or from having equipment fall on them in the kitchen or workshop, returned to work within one day of their first medical appointments. Although four of the 36 inmates we reviewed took more than 300 days to return to work, their time to return to work was not representative of the majority of inmate cases we reviewed. However, Correctional Health’s medical providers also restricted inmates’ ability to work when the injury would affect their ability to perform their job duties. For example, Correctional Health placed an inmate off work for five days as a result of an injury sustained while operating industrial machinery because he was unable to operate the machinery.
We conducted this audit under the authority vested in the California State Auditor by Government Code 8543 et seq. and according to generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives specified in the Scope and Methodology section of the report. We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives.
ELAINE M. HOWLE, CPA
California State Auditor
Date: July 11, 2019
3 An urgent case is one in which the injured employee faces an imminent and serious threat to his or her health. Go back to text
4 When the employee filed the claim form, the employee self‑identified the date of the injury as being more than five months earlier. According to a return‑to‑work coordinator, in the case of cumulative injuries, employees have discretion in self‑identifying the date of injury. Go back to text
5 In terms of providing medical care, Correctional Health does not have a business need to determine or document an inmate’s release from care date because, by law, it must treat all injuries and illness as long as the inmate is incarcerated. Go back to text
6 We defined an injured worker’s recovery time as the difference between the date of the first medical exam and the date of maximum medical improvement—the point at which a physician reports that an injured worker’s condition has stabilized, or is not expected to get either substantially better or worse within a year, with or without additional treatment. Go back to text
7 For purposes of this report, accommodation of work restrictions is not synonymous with the reasonable accommodation requirements of the Americans with Disabilities Act. Go back to text