In my experience, many beginning workers’ compensation lawyers are unfamiliar with the state administrative system which is charged with operating the workers’ compensation program as a whole. Thus, in teaching workers’ compensation, I always review in detail the responsibilities of workers’ compensation agencies in their oversight and regulatory functions.
This aspect of workers’ compensation is treated nicely in the Little, Eaton & Smith workers’ compensation textbook (first sections of Chapter 10), and it is also the subject of Professor Duff’s book, similarly at Chapter 10.
A neglected subject (including by myself) in this area is the role of agency medical directors. I was thus pleased that the managed care expert and blogger Joe Paduda has published the edifying article, “Where are the Medical Directors?,” in the new issue (July 2016) of the IAIABC periodical Perspectives. See www.IAIABC.org. As to Mr. Paduda’s blog, see http://www.joepaduda.com/.
Paduda wonders out loud why more legislatures do not create, in their state workers’ compensation agencies, a strong medical director. By his count, only seven states do so. The familiar example is Colorado, where Dr. Karen Mueller is well-known for having been a leader in developing medical treatment guidelines for her state’s system. However, Paduda also identifies Washington and Ohio (both, notably, fund jurisdictions), as major states that have influential medical directors. In both states, for example, these officials have developed opioid use guidelines.
In Paduda’s view, the rapidly-changing medical treatment world calls for effective agencies to have this type of leadership. He asserts, specifically, that state agencies with medical directors are better equipped and positioned to address challenging medical issues that develop, including the opioid abuse crisis and other over-utilization of medications.
The idea of a medical director is unfamiliar in Pennsylvania (my state) – our Act has never provided for such a position. Thus, Pennsylvania is a jurisdiction where Paduda’s rhetorical query applies with full force. It is notable that the Pennsylvania agency, like many in the nation, has always been on the passive side in terms of regulatory policy. More room (I am thinking), presumably exists for this sort of pro-activity in fund states, where administration and oversight of the law is comprehensively managed by state government.
What, precisely, are the responsibilities of such officials? Paduda explains that medical directors set policy, provide guidance and input into agency decision-making, review medical treatment, participate in guideline assessment, educate legislators, testify with regard to proposed legislation, and develop recommendations for new medical conditions and treatment. He points out a problem with not having such a position: agencies are, as a result, dependent upon special local interests, like medical societies, for the development of policy and promulgation of regulations.