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Summary
Read the report at California State Auditor ↗
April 1998
Report 95017
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ainrofilaC
Early Intervention
Program:
Flaws Found in the 1997 Report on the
Benefits of the Early Intervention Program
The first printed copy of each California State Auditor report is free.
Additional copies are $3 each.
Printed copies of this report can be obtained by contacting:
California State Auditor
Bureau of State Audits
660 J Street, Suite 300
Sacramento, California 95814
(916)445-0255 or TDD (916)445-0255 x 248
Permission is granted to reproduce reports.
C S A
ALIFORNIA TATE UDITOR
KURT R. SJOBERG MARIANNE P. EVASHENK
STATE AUDITOR CHIEF DEPUTY STATE AUDITOR
April 8, 1998 95017
The Governor of California
President pro Tempore of the Senate
Speaker of the Assembly
State Capitol
Sacramento, California 95814
Dear Governor and Legislative Leaders:
As required by Chapter 1034, Statutes of 1994, the Bureau of State Audits presents its audit
report concerning its evaluation of the study the California Department of Corrections (CDC),
the California Youth Authority (CYA), and the Department of Mental Health, in cooperation
with the State Compensation Insurance Fund, prepared on the accomplishments of the Early
Intervention Program. Our report concludes that it would be imprudent for the Legislature or the
CDC and the CYA to rely on this study in deciding the future of the Early Intervention Programs.
This is the second time we have reviewed a study the CDC and the CYA have prepared on the
impact of early intervention. In July 1992, we also cautioned readers to be wary of the results of
a similar study. These two attempts to measure the effectiveness of early intervention have
produced inconclusive results.
Respectfully submitted,
KURT R. SJOBERG
State Auditor
BUREAU OF STATE AUDITS
660 J Street, Suite 300, Sacramento, California 95814 Telephone: (916) 445-0255 Fax: (916) 327-0019
Table of Contents
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12
Appendix
Provided by the department as text only
State of California
DEPARTMENT OF CORRECTIONS
Memorandum
Date : November 7, 1997
To : Kurt R. Sjoberg
California State Auditor
Bureau of State Audits
660 J Street, Suite 300
Sacramento, CA 95814
Subject : ASSEMBLY BILL 2163 AUDIT RESULTS
The following joint report, as mandated by Assembly Bill 2163 (Areias,
Chapter 1034), from the California Department of Corrections (CDC) and
the California Department of the Youth Authority (CYA) in conjunction
with the Department of Mental Health (DMH) is provided in response to
California Labor Code Section 3214 (Early Intervention Program; audit of
program) which requires an audit of the Early Intervention Programs of the
CDC and the CYA.
The data presented in the report has been gathered from several sources
including the State Compensation Insurance Fund (SCIF), CDC, CYA and
DMH Return-to-Work Coordinators, State Controller’s Office, and Public
Employees’ Retirement System.
If you need additional information or clarification, please
call James E. Tilton, Deputy Director, Administrative Services Division,
CDC, at 323-4185 or Timothy J. Mahoney, Assistant Director, Labor
Relations/Employee Assistance/Employee Safety Office, CYA, at 262-1447.
Gregory W. Harding
For
C. A. TERHUNE
Director
Department of Corrections
Attachments
cc: David J. Tirapelle, Director, DPA
Francisco J. Alarcon, Director, CYA
Stephen W. Mayberg, Director, DMH
Frank Floyd, Program Manager, SCIF
13
REPORT TO THE AUDITOR GENERAL
REGARDING
“THE EARLY INTERVENTION PROGRAM”
AS MANDATED BY ASSEMBLY BILL 2163
(AREIAS, CHAPTER 1034)
14
TABLE OF CONTENTS
Introduction.......................................................................................................2
Mitigating Factors
Return-to-Work Coordinator Positions......................................................2
Training....................................................................................................3
Policy Development.................................................................................3
Workers' Compensation Reform ..............................................................3
Department Background
California Department of Corrections.......................................................4
California Department of the Youth Authority............................................4
Department of Mental Health ...................................................................5
Audit Plan Description .....................................................................................6
Objectives
Objective 1. Saves money in the short and long term ...........................7
Objective 2. Improves the speed at which injured workers
receive workers’ compensation benefits............................8
Objective 3. Affects the total number of injuries reported
on the California Occupational Safety and
Health Act (Cal-Osha) Log 200. ........................................9
Objective 4. Affects the total number of injuries (claims)......................10
Objective 5. Affects the elapsed days between the date
of injury and the date benefits are provided.......................8
Objective 6. Affects the total number of disability injuries....................11
Objective 7. Reduces the total number of lost work days ....................12
Objective 8. Increases the total number of employees
returning to work from work related injuries .....................13
Objective 9. Affects the total number of vocational
rehabilitation referrals......................................................14
15
Objective 10. Is cost effective...............................................................15
Objective 11. Reduces the total number and cost of
medical-legal consultations............................................16
Objective 12. Reduces the total cost of finalized claims.......................17
Objective 13. Affects the rate of industrial disability
retirements .....................................................................18
Objective 14. Affects back-up costs for industrial injuries.....................19
Objective 15. Affects industrial disability retirement costs ....................18
Objective 16. Total number and cost of litigated claims. .......................20
Conclusions....................................................................................................21
Audit Plan Documentation/Contact Individuals ...........................................22
Appendix
Spreadsheet
Audit Plan Criteria
SCIF Computer Disc’s for each Department
16
INTRODUCTION
Labor Code (LC) Section 3214, Early Intervention; Audit of Program
mandated that the California Department of Corrections (CDC) and
the California Department of the Youth Authority (CYA) in conjunction
with employee bargaining units develop and implement an
Early Intervention (EI) program effective December 31, 1989. The EI
program includes counseling by an authorized independent Early
Intervention Counselor (EIC) and development and implementation
of Mutually-Agreed-Upon Medical (MAMPD) Panels to assist in
determining compensability of workers’ compensation claims. The
LC Section 3214 further mandates that all costs associated with the
EI program be absorbed by the participating departments.
The EI program was developed with the intention of reducing the costs
associated with the workers’ compensation system and to assist in the
need to provide timely benefits to the injured worker. Furthermore, the
EI program is intended to settle disputes regarding compensability prior
to litigation.
To measure the effectiveness of the EI program, LC Section 3214 also
mandates that an audit of the EI program be conducted, and further
outlines 15 specific objectives to measure the effectiveness of the
program.
MITIGATING FACTORS
The CDC and the CYA have implemented numerous measures to improve
the monitoring and administration of its workers' compensation
programs which encompass the components of the EI program,
reasonable accommodation, return-to-work and accident prevention
programs.
Return-to-Work Coordinator Positions
Full time Return-To-Work Coordinator (RTWC) positions have been
established at each CDC and CYA facility since 1990. These positions
are dedicated to monitoring the institutions workers' compensation
programs including coordinating the efforts of the EIC, the State
Compensation Insurance Fund (SCIF), as well as the medical and
vocational rehabilitation providers. These positions have improved the
communication between the employees, the adjusting agency and
supervisors and management personnel, and have contributed
significantly to the benefits provided to the injured employees.
17
Training
Each department has been able to develop and refine systems and
procedures to ensure that injured workers are provided appropriate
benefits in a timely manner and are returned to work as soon as
possible. Such efforts include providing training to staff, EICs, SCIF
adjusters and MAMPD physicians on their respective responsibilities
within the CDC and CYA programs and increasing communication with
the supervisors, injured workers, medical providers and vocational
rehabilitation providers to identify appropriate job modifications or
alternative positions.
Policy Development
Both the CDC and the CYA have continued development of policies and
procedures to assure compliance with the Americans with Disabilities
Act as well as continued development of Injury and Illness Prevention
Programs at each CDC and CYA facility.
Workers' Compensation Reform
In the last five years, the Legislature has successfully passed numerous
workers' compensation reforms that include:
• Reductions in the cost of vocational rehabilitation plans for injured
workers where the injured worker is now entitled to only one plan per
injury and the total cost of the vocational rehabilitation plan cannot
exceed $16,000.
• Injured workers claiming psychiatric injury must now prove that
actual events of employment are the predominant cause (51 percent)
of the injury.
• No compensation is due an injured worker if the injury was
substantially caused by a lawful, nondiscriminatory, good faith
personnel action.
• Specific language was added to the LC to allow civil monetary
penalties in fraudulent workers' compensation cases.
As new legislation is enacted and the workers' compensation
environment continues to evolve, the CDC and CYA will continue to
adapt its programs and policies to meet any changes.
18
DEPARTMENT BACKGROUND
California Department of Corrections
The CDC plays an important role in protecting the public by
incarcerating the most serious criminal offenders in a secure, safe and
disciplined institutional setting. The CDC provides work, academic
education, vocational training, and specialized treatment for California's
inmate population as well as parole services supervision, surveillance
and specialized services. The CDC also provides for the protection of the
public through cooperative efforts with criminal justice system agencies.
The CDC is responsible for the direct operation of 33 correctional
institutions, four parole regions and provides oversite of inmate
classification and disciplinary actions for 12 community correctional
facilities. The CDC has an annual budget of $3.8 billion with nearly
44,000 employees of which 27,000 are sworn correctional peace officers.
Each institution and parole region operates under the direction of a
warden or regional administrator who are responsible for the custody,
classification, case records, health services, education services, and
parole supervision of all inmates and parolees within the California
system.
The CDC provides a secure and controlled environment for the inmates
incarcerated within its facilities. All correctional peace officers are
required to provide security to inmates as well as direct inmates work
activities and assignments. Although not armed with weapons,
correctional peace officers may employ weapons such as handguns, rifles,
shotguns, sidehandle batons, as well as Oleoresin Capsicum (OC) to
quell disturbances.
Although correctional peace officers involved in cell extractions are
required to wear safety equipment such as protective arm pads; elbow,
shin and knee pads; protective vests; gloves; face shields; and helmets,
officers are still at risk for injury.
California Department of the Youth Authority
The CYA is charged to protect the public from criminal activity by
providing education, training and treatment services for youthful
offenders.
The CYA is responsible for the operation of 11 institutions, 4 forestry
camps, 16 parole offices and 2 residential drug treatment programs. The
CYA has an annual budget of $436,000,000 and has 5,500 employees.
Each institution and parole region operates under the direction of
superintendent or regional administrator who is responsible for the
19
custody, classification, education, health services, case records and
parole supervision of all wards and parolees within the CYA system.
Besides providing a secure and controlled environment for its youthful
offenders, the CYA program emphasizes treatment, education, and
rehabilitation. Due to the treatment oriented approach to correctional
work with potentially violent young offenders, the CYA places special
importance on an effective and comprehensive safety and return-to-work
programs including the EI program.
Department of Mental Health
The DMH is the State's mental health authority, and as such sets overall
policy for the delivery of mental health services statewide; executes and
oversees performance contracts with county mental health departments;
monitors compliance with State and federal laws, rules, and regulations;
and oversees various State-funded programs and projects consistent with
specific departmental objectives.
The DMH is also responsible for the direct operation of Atascadero,
Metropolitan, Napa and Patton State Hospitals as well as the Acute
Psychiatric Program at the California Medical Facility at Vacaville. The
DMH assures the provisions of quality inpatient treatment services for
mentally disabled Lanterman-Petris-Short (LPS) patients under contracts
with local mental health departments, judicially committed patients,
mentally disordered offenders, inmates transferred from the CDC, and
wards from the CYA. The basic goal of the State Hospital program is the
restoration of the patient's optimal level of functioning to allow
reintegration into the community.
Although the DMH was chosen as the control group for the EI study,
it is important readers of this report understand the DMH's
responsibility to provide medical and psychiatric treatment for its
State hospital patients represents a fundamental difference in
patient-employee interface when compared with the CDC and the
CYA. This difference is significant in any discussion of occupational
injury risk factors because when mentally ill patients in the State
hospitals display aggressive or assaultive behavior, DMH staff are
required to directly and humanely intervene to prevent the patients from
harming themselves or others. The emphasis on maintaining a
therapeutic environment for DMH patients exposes the patient care staff
to different injury risks than the custodial care employees at CDC and
CYA.
20
AUDIT PLAN
The CDC, CYA and DMH developed an audit plan to address the
objectives outlined in LC Section 3214 in preparation for the formal
audit by the Bureau of State Audits. The DMH served as the control
group. In the development of the plan, the CDC, CYA and DMH
identified the target group of workers' compensation claims for inclusion
in the audit. The target group consisted of all stress related workers'
compensation claims (including psychological, heart, hypertension, and
gastro-intestinal), trauma induced stress (including inmate assault and
HIV/hepatitis B exposure); those CDC and DMH claims with 30 days of
lost time; and those CYA claims with 15 or more days of lost time.
The audit period was determined to be from July 1, 1995 through
September 30, 1996 (15 months).
The DMH reported only those claims that met the above requirements
with injury dates between July 1, 1995 through September 30, 1996. The
CDC and CYA reported only those claims actually receiving EI services
with injury dates between July 1, 1995 through September 30, 1996.
When developing the Audit Plan, the CDC, CYA and DMH with the
assistance of the SCIF identified the necessary data and data sources to
determine whether the EI program satisfies the objectives outlined in
LC Section 3214.
21
Objective 1. Saves money in the short and long term.
Saves money in the short term.
Average Claim
Cost
CDC CYA DMH
$11,172 $9,882 $10,038
This table reflects a comparison of the average cost of workers'
compensation claims included in the audit for each of the participating
departments. All costs associated with each workers' compensation
claim were averaged including paid medical and paid compensation as
well as all costs associated with industrial disability leave and temporary
disability benefits. The information for this section was extracted from
the SCIF data base and personnel and payroll data bases of each
department.
It does not appear that CDC and CYA claims receiving EIC referrals
incurred a significant cost savings in the short term.
Saves money in the long term.
Objective Description of Objective CDC CYA DMH
1 Average claim cost $11,172 $9,882 $10,038
7 Average number of lost work days 42 69 78
8 Number of employees
returning to work 930/85% 144/65% 155/70%
10 Cost EIC services $394 $641 NA
11 Number of med/legal 59/100 74/100 53/100
11 Cost of med/legal $874 $614 $761
12 Number of finalized claims 81/7% 21/9% 26/11%
12 Cost of finalized claims $16,743 $12,001 $15,024
13 Rate & cost of IDR's 1% less than 1% less than 1%
16 Number of litigated claims 123/11% 1/.5% 30/14%
16 Average cost of litigated claims $11,025 $12,283 $7,094
This table reflects a comparison of Objectives 1, 7, 8, 10, 11, 12, 13, 15,
and 16. The information for this section was extracted from the SCIF
data base and personnel and payroll data bases of each department.
It does not appear that the CDC and CYA claims receiving EIC referrals
incurred a significant cost saving in the long term.
22
Objective 2. Improves the speed at which injured workers receive work-
ers’ compensation benefits.
Objective 5. Affects the elapsed days between the date of injury and the
date benefits are provided.
Number of Days Between
Date of Injury to Acceptance
CDC CYA DMH
41 days 42 days 34 days
This table reflects the average number days for a claim to be accepted by
SCIF as the result of an industrial injury. This data was extracted from
the SCIF data base for each claim included in the audit.
The data reflected in this chart does not indicate that the EI program
contributes to the speed at which injured workers receive workers'
compensation benefits nor does the EI program have any impact on the
number of days between the date of injury and the date of acceptance by
the SCIF.
23
Objective 3. Affects the total number of injuries reported on
the California Occupational Safety and Health
Act (Cal-Osha) Log 200.
This objective was not evaluated. The EI program is not an injury
prevention program and does not impact the total number of injuries
reported on the Cal-Osha Log 200.
24
Objective 4. Affects the total number of injuries (claims).
Total Number of Claims
Between
July 1, 1995 through September 30, 1996
CDC CYA DMH
1,096 222 220
This table reflects the total number of claims meeting the EI referral
criteria reported during the identified audit period for each department.
This information is presented for statistical purposes only as EI is not
an injury prevention program and does not impact the total number of
injuries or claims.
25
Objective 6. Affects the total number of disability injuries.
Total Number of Disability Injuries
CDC CYA DMH
466 claims 136 claims 122 claims
42.50% 61% 81%
This table reflects the number and percentage of claims included in the
audit that were determined to be actual disability claims. Disability
claims are defined as those claims that exceed three days of lost time.
This information is presented for statistical purposes only as the EI
program is not an injury prevention program and does not impact
whether an injury is disabling.
26
Objective 7. Reduces the total number of lost work days.
Reduces Number of Lost Work Days
CDC CYA DMH
42 69 77
This table reflects the average number of lost work days for each
department. The data presented was extracted from the SCIF data based
on information complied from the Data Collection Sheets and
subsequent SCIF printout.
This data indicates that that CDC and CYA employees have earlier
return to work dates from their industrial injuries than those of the
DMH. This may be directly attributed to the nature of the overall DMH
mission and subsequent clientele. The DMH provides care for and
houses mentally ill patients who can be much more violent than the
wards and/or inmates housed within CDC and CYA facilities. Therefore,
the injuries suffered by DMH employees are typically more severe and
more often the result of a violent act.
The data presented in this objective indicates that the EI program may
have an impact on the early return-to-work of injured CDC and CYA
employees. Both the CDC and CYA have identified light duty policies
that facilitate the early return-to-work of injured employee's to positions
that meet their identified work restrictions. The CDC and CYA also have
dedicated RTWC's in each institution and parole region which also
directly impacts an employee's early return to work.
27
Objective 8. Increases the total number of employees returning to
work from work related injuries.
Number of Employees Returning to Work
CDC CYA DMH
Number of employees
returning to work 930 144 155
Percentage of employees
returning to work 85% 65% 70%
This table reflects the number and percentage of employees who returned
to work. The data presented was extracted from the SCIF data based on
information compiled from the Data Collection Sheets and subsequent
SCIF printout.
The CDC and the DMH both returned a greater percentage of employees
to work than the CYA.
The data presented is inconclusive as to whether the EI program has a
direct impact on the number of employee's returning to work.
28
Objective 9. Affects the total number of Vocational Rehabilitation
referrals.
Number of Vocational Rehabilitation Referrals
CDC CYA DMH
Number of QIW
employees 33 22 16
Percentage of QIW
employees 3% 10% 7%
This table reflects the number of audit claims for each department that
received vocational rehabilitation referrals. The data presented was
extracted from the SCIF data based on information compiled from the
Data Collection Sheets and subsequent SCIF printout.
The EI program does not affect the finalization of workers' compensation
claims nor does it affect early return-to-work of employees.
The data presented is inconclusive as to whether the EI program has a
direct impact on the number of vocational rehabilitation referrals.
29
Objective 10. Is cost effective.
Cost of EI Services
CDC CYA DMH
EIC $337,928 $93,814 NA
Services
EIC Services $94,373 $48,690 NA
@ RTW Meetings
Total EI costs $432,301 $142,504 NA
Average EIC $308 $424 NA
cost per claim (EIC
services only)
Average EIC cost per $394 $641 NA
claim (EIC services
and EIC services at RTW
Meetings)
This table reflects the costs of services provided by EIC's for individual
claim service, the cost of their services for attendance at return-to-work
meetings and the average cost for an EI referral for the identified audit
claims. The data presented was extracted from the SCIF data based on
information compiled from the Data Collection Sheets and subsequent
SCIF printout.
All costs associated with EI referrals are in addition to costs for IDL,
workers' compensation, and medical-legal costs, therefore increasing the
overall cost of a claim for workers' compensation benefits. There is no
indication that EIC services are assisting the CDC and CYA in reducing
the overall costs of workers' compensation claims.
This information is presented for statistical purposes only. Cost
effectiveness is evaluated under Objective 1.
30
Objective 11. Reduces the total number and cost of medical-legal
consultations.
Reduces Number and Cost of Med-Legal Consults
CDC CYA DMH
Number of consults 59 74 53
per 100 claims
Average cost of $874 $614 $761
consultations
This table reflects the number of medical-legal consultations per
100 claims referred to the EI program and the average cost of medical-
legal consultations for each department. The data presented was
extracted from the SCIF data based on information compiled from the
Data Collection Sheets and subsequent SCIF printout.
Although the CDC and the DMH claims generated less medical
consultation evaluations than the CYA, the CYA and DMH consultation
costs were both lower than the CDC's. This may be attributed to what
type of injuries that were evaluated. The costs would also be impacted by
the location of the medical provider and the cost of living in those areas.
Additionally, the SCIF data reflects that many of the claims had more
than one medical-legal consultation with many claims having two or
more medical-legal consultations. Workers' compensation claims that
address more than one body part typically require that a medical
consultation be conducted for each affected body part.
The data presented is inconclusive as to whether the EI program has any
impact on the reduction of the number and costs of medical-legal
consultations.
31
Objective 12. Reduces the total cost of finalized claims.
Total Cost of Finalized Claims
CDC CYA DMH
Number of finalized 81 21 26
claims
Percentage of claims 7% 9% 11%
finalized claims
Average cost of $16,743 $12,001 $15,024
finalized claims
This table reflects the number and average cost of finalized claims for
each department. The data presented was extracted from the SCIF data
based on information compiled from the Data Collection Sheets and
subsequent SCIF printout.
The CYA's lower average finalized claims cost is a possible indicator of EI
program effectiveness, although this was not reflected in the CDC
finalized claim costs. Objective 11 also indicates that the average cost of
a medical-legal consultation for the CYA is lower than both the CDC and
the DMH. This Objective also shows that the CYA conducts more
medical-legal consultations than the CDC and DMH but at a lower cost
per consultation.
The data presented is inconclusive as to whether the EI program reduces
the total cost of finalized claims for CDC or DMH.
32
Objective 13. Affects the rate of industrial disability retirements.
Objective 15. Affects industrial disability retirement costs.
Industrial Disability Retirements
CDC CYA DMH
16/1% 5/ < 1% 1/ < 1%
This table reflects the percentage of industrial disability retirements for
the audit claims for each department. The data presented was extracted
from the SCIF data based on information compiled from the Data
Collection Sheets and subsequent SCIF printout.
Generally, industrial disability retirement authorizations take from
90 days to one year for processing depending on how long it takes to
gather the necessary medical reports, job descriptions, and other
information. The law mandates that the California Public Employees'
Retirement System (CalPers) make a determination within 90 days of the
receipt of all required information. Additionally, it may be necessary for
CalPers to schedule an independent medical evaluation (IME), especially
when the there are conflicting medical reports that relate to the
industrial injury, thus prolonging the processing period.
The data presented is inconclusive as to whether the EI program has any
impact on the rate or costs of industrial disability retirements authorized
by CalPers for the CDC or the CYA.
33
Objective 14. Affects backup costs for industrial injuries.
Average Backup Costs Per Claim
(IDL X 2)
CDC CYA DMH
$6,951 $11,060 $7,800
This table reflects the average backup costs for each claim in the audit
for all departments. The data presented was extracted from the SCIF
data based on information compiled from the Data Collection Sheets and
subsequent SCIF printout, and from payroll history obtained from the
Office of State Controller.
The workers' compensation claims included in the audit include various
different classifications from the three departments, although the
majority of the claims were for the classifications of Correctional Officer,
Youth Counselor and Psychiatric Technician.
Salary Rates
CDC CYA DMH
Classification Correctional Youth Psychiatric
Officer Counselor Technician
Maximum
salary rate $3,825 $4,210 $2,985
The backup costs were calculated at the maximum salary rate for each of
the aforementioned classifications. As noted in the second chart, there
is a significant difference in the salary rates of the three primary
classifications. The backup costs for the CYA although higher than the
CDC and the DMH, is a result of the higher salary rate.
Other data reflected in Objectives 7 and 8 indicates that the CYA
employees stay off work for longer periods of time, therefore creating
larger backup costs. Employees for the CDC return to work from
industrial injuries sooner creating less costly backup costs.
The data present is inconclusive as to whether the EI program affects the
backup costs of industrial injuries.
34
Objective 16. Total number and cost of litigated claims.
Number and Cost of Litigated Claims
CDC CYA DMH
Number of litigated 123 1 30
claims
Percentage of 11% .5% 14%
litigated claims
Average litigated $11,025 $12,283 $7,094
claim cost
This table reflects the number and cost of the litigated claims included in
the audit for all departments. The data presented was extracted from the
SCIF data based on information compiled from the Data Collection
Sheets and subsequent SCIF printouts and from payroll history obtained
from the State Controller's Office.
The CDC and the DMH litigation rates are comparable at 11 percent and
14 percent, respectively, and the average cost of a litigated claim is
significantly lower than that of the CYA. The data for the CYA reflects
only one litigated claim making any comparison of rate of litigation and
litigation costs difficult.
The data presented is inconclusive as to whether the EI program impacts
the cost or number of litigated and finalized claims for CDC or DMH.
However, it is possible that the EI program may have been a factor in
CYA's lower litigation rate.
35
CONCLUSION
Since the inception of the EI program in 1989, the CDC and the
CYA have conducted two audits to determine whether the program
accomplishes the original legislative intent of reducing the overall cost of
workers' compensation claims, assuring timely delivery of benefits due an
injured worker, and settling disputes regarding claims for benefits
without litigation. The conclusions derived from this audit, as well as
the results presented in the previous audit, show it is extremely difficult
to determine the effectiveness of one component of a multi-faceted
program.
The CDC and the CYA have worked diligently to implement and develop
aggressive and effective workers' compensation, return-to-work and light
duty programs. These programs, along with the significant changes to
the Workers' Compensation Laws of California in 1995, have a
tremendous mitigating impact and make it extremely difficult, if not
impossible, to confer merit where data cannot support a finding.
The data represented in this report reflects inconclusively or negatively in
all areas with the exception of a reduction in the total number of lost
work days. However, again, mitigating factors play a role.
To that end, based on the data presented, the conclusions of this audit
cannot support a finding that the EI program accomplishes the original
legislative intent.
36
AB 2163 AUDIT PLAN
DOCUMENTATION
DOCUMENT/DATA DOCUMENT LOCATION CONTACT PERSON TELEPHONE NUMBER
SCIF Data Collection
Sheets SCIF Rich Beaton (9l6) 567-7567
Original SCIF 3067's SCIF Rich Beaton (916) 567-7567
Department Data
Collection Form CDC Carol Jurcak (9l6) 322-1428
Department Data
Collection Form CYA Bob Hayes (9l6) 262-1452
DMH Work Entry Tracking
System DMH Jerry Beaman (916) 654-2527
Master Spreadsheets and
Computer Files SCIF Rich Beaton (916) 567-7567
MIRS Reports CDC Carol Jurcak (916) 322-1428
MIRS Reports CYA Bob Hayes (916) 262-1452
MIRS Reports DMH Jerry Beaman (916) 654-2527
Cal-OSHA Log 200 CDC Carol Jurcak (916) 322-1375
Cal-OSHA Log 200 CYA Bob Hayes (916) 262-1452
Cal-OSHA Log 200 DMH Jerry Beaman (916) 654-2527
37
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AB 2163
AUDIT PLAN
39
TABLE OF CONTENTS
Page
AB 2163 Audit Plan Timeline.................................................................... 1
AB 2163 Audit Plan Criteria...................................................................... 2
AB 2163 Audit Plan Implementation
Objective Number 1........................................................................... 3
Objective Number 2 and 5................................................................. 5
Objective Number 3........................................................................... 7
Objective Number 4........................................................................... 8
Objective Number 6........................................................................... 9
Objective Number 7........................................................................... 10
Objective Number 8........................................................................... 11
Objective Number 9........................................................................... 12
Objective Number 10......................................................................... 13
Objective Number 11......................................................................... 14
Objective Number 12......................................................................... 16
Objective Number 13......................................................................... 17
Objective Number 14......................................................................... 18
Objective Number 15......................................................................... 19
Objective Number 16......................................................................... 20
AB 2163 Audit Plan Documentation ......................................................... 21
AB 2163 Audit Plan Definitions ................................................................ 24
40
AB 2163 AUDIT PLAN
TIMELINE
Audit Plan Implementation 07/01/95
Audit Plan Data Collection 07/01/95 - 09/30/96
Data Collection Checkpoint 10/01/95
Data Collection Checkpoint 01/01/96
Data Collection Checkpoint 03/01/96
Data Collection Checkpoint 07/01/96
Audit Plan Data Compilation 10/1/96 - 12/31/96
SCIF Data to Departments 01/01/97
Audit Plan Data Calculations 01/01/97 - 03/31/97
DMH Data to CDC/CYA 03/31/97
Audit Plan Data Analysis and Report Preparation 04/01/97 - 06/30/97
Audit Plan Reports to BSA 07/01/97
BSA Report to Legislature 12/31/97
41
AB 2163 AUDIT PLAN
CRITERIA
Type of Claim (When Filed)
o Stress
- Psyche
- Heart
- Hypertension
- Gastro-Intestinal
o Trauma-Induced Stress
- Inmate Assault (Violence Related/Altercation)
- HIV/Hepatitis 8 Exposure
o 30 Days Lost Time (CDC and DMH)
o 15 Days Lost Time (CYA)
Target Group
Department of Mental Health
o Only those claims which meet the above-mentioned “Type of Claim” with
date of injury between 07/01/95 and 09/30/96.
California Department of Corrections/California Youth Authority
o Only those claims receiving Early Intervention Services with date of injury
between 07/01/95 and 09/30/96.
42
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 1: Saves money in the long and short term.
Audit Plan Data Collection/Compilation
Responsibility - SCIF
Data - Employee Name/Claim Number/Total Number of Claims Included in
Audit/Total Number of Accepted Claims Included in Audit/Total Cost Per
Claim/ Total Cost of Claims Included in Audit/Total Cost of Accepted
Claims Included in Audit
Method - “SCIF Computer Run-Cost of Claim”
Data Collection Timeline - 07/01/95 - 09/30/96
Data Compilation Timeline- 10/01/96- 12/31/96
Audit Plan Data Calculations
Responsibility - CDC, CYA and DMH
Timeline - 01/01/97 - 03/31/97
Calculations -
o Using the “SCIF Computer Run-Cost of Claim”, an average cost per claim
will be identified for CDC, CYA and DMH.
o The summary data will be documented and identified as “Objective Num-
ber 1, Calculations”.
Audit Plan Data Analysis and Report Preparation´
Responsibility - CDC and CYA
Timeline - 04/01/97 - 06/30/97
Result:
o Using “Objective Number 1, Calculations”, the average cost per claim
for CDC and CYA will be compared to the average cost per clai´m for DMH.
o Based on this comparison, it will be determined whether or not EI
saves money in the short term.
43
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 1 continued
Audit Plan Data Analysis and Report Preparation continued
o Using the results of Objectives Number 1 (short-term), 7, 8, 10, 11, 12, 13,
15, and 16, an analysis will be made and conclusions reached regarding
whether or not EI saves money.
o Based on these conclusions, it will be determined whether or not EI
saves money in the long term.
44
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 2: Improves the speed at which injured workers
receive workers’ compensation benefits.
OBJECTIVE NUMBER 5: Affects the elapsed days between the date of
inJury and the date benefits are pro´rided.
Audit Plan Data Collection/Compilation
Responsibility- SCIF
Data - Employee Name/Claim Number/Total Number of Accepted Claims
Included in Audit/Total Number of Elapsed Days from DOI to Date Claim
Accepted per Claim/Total Number of Elapsed Days from DOI to Date Claim
Accepted for all Claims Included in Audit
Method - SCIF Spread Sheet
Data Collection Timeline - 07/01/95 - 09/30/96
DateCompilationTimeline- 10/01/96- 12/31/96
Audit Plan Data Calculations
Responsibility - CDC, CYA and DMH
Timeline - 01/01/97 - 03/31/97
Calculations -
o Using the SCIF Spread Sheet, an average number of elapsed days from
date of injury to date claim accepted will be identifled for CDC, CYA
and DMH.
o The summa´y data will be documented and identified as “Objective
Number 2 and Objective Number 5, Calculations”.
Audit Plan Data Analysis and Report Preparation
Responsibility - CDC and CYA Timelines - 04/01/97 - 06/30/97
Results -
o Using “Objective Number 2 and Objective Number 5, Calculations”, the
average number of elapsed days from date of injury to date claim accepted
for CDC and CYA will be compared to the average elapsed days from date
of injury to date claim accepted for DMH.
45
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 2 AND OBJECTIVE NUMBER 5 continued
Audit Plan Data Analysis and Report Preparation continued
o Based on this comparison, it will be determined whether or not El
improves the speed at which injured workers receive workers’
compensation benefits and/or affects the elapsed days between the
date of injury and the date benefits are provided.
46
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 3: Affects the Total Number of Injuries
Reported on the Cal-OSHA Log 200.
Objective Number 3 will not be evaluated. EI is not an injury prevention
program and does not impact the total number of injuries reported on the
Cal-OSHA Log 200.
47
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 4: Affects the Total Number of Injuries (Claims).
Audit Plan Data Collection/Compilation
Responsibility- SCIF
Data - Employee Name/Claim Number/Total Number of Claims Included in
Audit/Total Number of Claims Filed between 07/01/95 and 09/30/96
Method - “SCIF Computer Run-Cost of Claim”
Data Collection Timeline - 07/01/95 - 09/30/96
Data Compilation Timeline - 10/01/96 - 12/31/96
Audit Plan Data Calculations
Responsibility - CDC, CYA and DMH
Timeline - 01/01/97 - 03/31/97
Calculations -
o Using the “SCIF Computer Run-Cost of Claim”, a total number of
claims included in audit and flied between 07/01/95 and 09/30/96
will be identified for CDC, CYA and DMH.
o The summary data will be documented and identified as “Objective
Number 4, Calculations”.
Audit Plan Data Analysis and Report Preparation
Responsibility - CDC and CYA Timeline - 04/01/97 - 06/30/97
Results -
o “Objective Number 4, Calculations” will be presented as Statistical
Information Only. EI is not an injury prevention program and does
not impact the total number of injuries/claims.
48
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 6: Affects the Total Number of Disability
Injuries.
Audit Plan Data Collection/Compilation
Responsibility- SCIF
Data - Employee Name/Claim Number/Total Number of Disability Injuries
(Claims which exceed 3 Days Lost Time)/Total Number of Claims Included
in Audit
Method - “SCIF Computer Run-Disability Injuries”
Data Collection Timeline - 07/01/95 - 09/30/96
Data Compilation Timeline- 10/01/96- 12/31/96
Audit Plan Data Calculations
Responsibility - CDC. CYA and DMH Timeline - 01/01/97 - 03/31/97
Calculations -
o Using the “SCIF Computer Run-Disability Injuries”, a percentage of dis-
ability injuries will be identified for CDC, CYA and DMH.
o The summary data will be documented and identified as “Objective
Number 6. Calculations”.
Audit Plan Data Analysis and Report Preparation´
Responsibility - CDC and CYA
Timeline - 04/01/97 - 06/30/97
Results -
o “Objective Number 6, Calculations” will be presented as Statistical Infor-
mation Only. EI is not an injury prevention program’ and does not impact
whether an injury is disabling.
49
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 7: Reduces the Total Number of Lost Work Days.
Audit Plan Data Collection/Compilation
Responsibility- SCIF
Data - Employee Name/Claim Number/Total Number of Verified Lost Work
Days from 3290/TD Data/Reason Lost Work Days Ended per Claim/Total
Number of Verified Lost Work Days of all Claims Included in Audit/ Total
Number of Claims Included in Audit
Method - SCIF Spread Sheet
Data Collection Timeline - 07/01/95 - 09/30/96
Data Compilation Timeline - 10/01/96 - 12/31/96
Audit Plan Data Calculations
Responsibility - CDC, CYA and DMH
Timeline - 01/01/97 - 03/31/97
Calculations -
o Using the SCIF Spread Sheet, an average number of lost work days for
CDC, CYA and DMH will be identified.
o The summary data will be documented and identified as “Objective
Number 7, Calculations”.
Audit Plan Data Analysis and Report Preparation
Responsibility - CDC and CYA
Timeline - 04/01/97 - 06/30/97
Results -
o Using “Objective Number 7, Calculations”, the average number of lost
work days for CDC and CYA will be compared to the average number of
lost work days for DMH.
o Based on this comparison, it will be determined whether or not Early
Intervention reduces the total number of lost work days.
50
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 8: Increases the Total Number of Employees Re-
turning to Work from Work-Related Injuries.
Audit Plan Data Collection/Compilation
Responsibility - CDC, CYA and DMH; SCIF
Data - Employee Name/Employment Status/Total Number of Accepted
Claims Included in Audit/Total Number of Employees Returning to
Work/Total Number of Claims Included in Audit/Total Number of Accepted
Claims with Return to Work
Method - Department Data Collection Form; “SCIF-Cost of Claim”
Data Collection Timeline - 07/1/95 - 09/30/96
Data Compilation Timeline- 10/01/96- 12./31/96
Audit Plan Data Calculations
Responsibility - CDC. CYA and DMH
Timeline - 01/01/´97 - 03/31/97
Calculations -
o Using the Department Data Collection Form and “SCIF Computer
Run-Cost of Claim”, a percentage of employees returning to work will
be identified for CDC, CYA and DMH.
o The summary data will be documented and identified as “Objective #8,
Calculations”.
Audit Plan Data Analysis and Report Preparation
Responsibility - CDC and CYA
Timeline - 04/01/97 - 06/30/97
Results -
o Using “Objective Number 8, Calculations”, the percentage of
employees returning to work for CDC and CYA will be compared to the
percentage of employees returning to work for DMH.
o Based on this comparison, it will be determined whether or not EI
increases the total number of employees retu´ning to work from work-
related injuries.
51
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 9: Affects the Total Number of Vocational
Rehabilitation Referrals.
Audit Plan Data Collection/Compilation
Responsibility - SCIF
Data - Employee Name/Claim Number/Total Number of Claims Receiving
Outside Vocational Rehabilitation Services/Total Number of Claims Included in
Audit
Method - “SCIF Computer Run-V. R. Referrals”
Data Collection Timeline - 07/01/95 - 09/30/96
Data Compilation Timeline - 10/01/96 - 12/31/96
Audit Plan Data Calculations
Responsibility - CDC, CYA and DMH
Timeline - 01/01/97 - 03/31/97
Calculations -
o Using the “SCIF Computer Run-V. R. Referrals”, a percentage of V. R. referrals
will be identified for CDC, CYA and DMH.
O The summary data will be documented and identified as “Objective Number 9,
Calculations”.
Audit Plan Data Analysis and Report Preparation
Responsibility - CDC and CYA
Timeline - 04/01/97 - 06/30/97
Results -
o Using “Objective Number 9, Calculations”, the percentage of V. R.
referrals for CDC and CYA will be compared to the percentage of V. R
referrals for DMH.
o Based on this comparison, it will be determined whether or not EI
affects the level of vocational rehabilitation referrals.
52
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 10: Is Cost Effective.
Audit Plan Data Collection/Compilation
Responsibility - SCIF
Data - Employee Name/Claim Number/Total El Counselor Costs Per
Claim/Total EI Counselor Costs/Total EI Counselor Costs at RTW
Meetings/Total Number of Claims Included in Audit
Method - “SCIF Computer Run-EIC Costs”
Data Collection Timeline - 07/01/95 - 09/30/96
Data Compilation Timeline- 10/01/96- 12/31/96
Audit Plan Data Calculations
Responsibility - CDC and CYA
Timeline - 1/01/97 - 03/31/97
Calculations -
o Using the “SCIF Computer Run-EIC Costs”, an average cost of EIC
Services per claim; a total cost of EIC Services; and a total cost of EIC
Services at RTW Meetings will be identified for CDC and CYA.
o The summary data will be documented and identified as “Objective
Number 10, Calculations”
Audit Plan Data Analysis and Report Preparation
Responsibility - CDC and CYA
Timeline - 04/01/97 - 06/30/97
Results -
o “Objective Number 10, Calculations” data will identify the specific
cost of EI Counselor services and will be presented as Statistical
Information Only. No analysis will be conducted to determine cost
effectiveness. These costs are included in the overall cost of a claim
and cost effectiveness is being evaluated under Objective Number 1.
53
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 11: Reduces the Total Number and Cost of
Medical-Legal Consultations.
Audit Plan Data Collection/Compilation
Responsibility- SCIF
Data - Employee Name/Claim Number/Total Number of Medical-Legal
Evaluations per Claim/Total Number of Medical-Legal Evaluations for all
Claims Included in Audit/ Total Cost of Medical-Legal Evaluations per
Claim/Total Cost of Medical-Legal Evaluations for all Claims Included in
Audit/Total Number of Claims Included in Audit
Method - SCIF Spread Sheet and “SCIF Computer Run-Medical-Legal
Evaluations”
Data Collection Timeline - 07/01/95 - 09/30/96
Data Compilation Timeline - 10/01/96- 12/31/96
Audit Plan Data Calculations
Responsibility - CDC. CYA and DMH
Timeline - 01/01/97-03/31/97
Calculations -
o Using the SCIF Spread Sheet, an average number of medical-legal
evaluations will be identified for CDC, CYA and DMH.
o Using the “SCIF Computer Run-Medical-Legal Evaluations”, an
average cost of medical-legal evaluations will be identified for CDC,
CYA and DMH.
o The summary data will be documented and identified as “Objective
Number 11, Calculations”.
54
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 11 continued: Reduces the Total Number and Cost
of Medical-Legal Consultations.
Audit Plan Data Analysis and Report Preparation
Responsibility - CDC and CYA
Timeline - 04/01/97 - 06/30/97
Results -
o Using “Objective Number 11, Calculations”, the average number and
average cost of medical-legal evaluations for CDC and CYA will be
compared to the average number and average cost of medical-legal
evaluations for DMH.
o Based on this comparison. It will be determined whether or not El
reduces the number and cost of medical-legal evaluations.
55
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 12: Reduces the Total Cost of Finalized Claims.
Audit Plan Data Collection/Compilation
Responsibility´´- SCIF
Data - Employee Name/Claim Number/Claim Finalization Status/Total
Cost Per Finalized (Closed or Settled) Claim/Total Cost of Finalized Claims
Included in Audit/Total Number of Finalized Claims Included in Audit/Total
Number of Claims Included in Audit
Method - “SCIF Computer Run-Finalized Claims”
Data Collection Timeline - 07/01/95 -09/30/96
Data Compilation Timeline - 10/01/96 - 12/31/96
Audit Plan Data Calculations
Responsibility - CDC, CYA and DMH
Timeline - 01/01/97-03/31/97
Calculations -
o Using the “SCIF Computer Run-Finalized Claims”, an average cost of
finalized claim will be identified for CDC. CYA and DMH.
o The summary data will be documented and identified as “Objective Num-
ber 12, Calculations”.
Audit Plan Data Analysis and Report Preparation´
Responsibility - CDC and CYA
Timeline - 04/01/97 - 06/30/97
Results -
o Using “Objective Number 12, Calculations”, the average cost of
finalized claim for CDC and CYA will be compared to the average cost
of finalized claim for DMH.
o Based on this comparison, it will be determined whether or not EI
reduces the total cost of finalized claims.
56
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 13: Affects the rate of Industrial Disability
Retirements.
Audit Plan Data Collection/Compilation
Responsibility - CDC. CYA, and DMH; SCIF
Data - Employee Name/Total Number of Claims Included in Audit/Employment
Status/Total Number of Industrial Disability Retirements
Method - Department Data Collection Form; “SCIF-Cost of Claims”
Data Collection Timeline - 07/01/95 - 09/30/96
Data Compilation Timeline - 10/01/96 - 12/31/96
Audit Plan Data Calculations
Responsibility - CDC, CYA and DMH
Timeline - 01/01/97 - 03/31/97 Calculations -
o Using the Department Data Collection Form and “SCIF Computer
Run-Cost of Claims”, a percentage of industrial disability retirements
will be identified for CDC, CYA and DMH.
o The summary data will be documented and identified as “Objective
Number 13, Calculations”.
Audit Plan Data Analysis and Report Preparation
Responsibility - CDC and CYA
Timeline - 04/01/97 - 06/30/97
Results -
o Using “Objective Number 13, Calculations”, the percentage of
industrial disability retirements for CDC and CYA will be compared to
the percentage of industrial disability retirements for DMH.
o Based on this comparison, it will be determined whether or not EI
affects the rate of industrial disability retirements.
57
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 14: Affects Baclc-up Costs (IDL x 2) for Industrial
Injuries.
Audit Plan Data Collection/Compilation
Responsibility - CDC, CYA and DMH; SCIF
Data - Employee Name/Total Number of Claims Included in Audit/Total
Number of Accepted Claims Included in Audit/Total Cost of IDL per
Claim/Total Cost of IDL for all Accepted Claims
Method - Department Data Collection Form; “SCIF-Cost of Claim”
Data Collection Timeline - 07/01/95 - 09/30/96
Data Compilation Timeline - 10/01/96 - 12/31/96
Audit Plan Data Calculations
Responsibility - CDC. CYA and DMH
Timeline - 01/01/97 - 03/31/97
Calculations -
o Using the Department Data Collection Form and “SCIF Computer
Run-Cost of Claims”, an average back-up cost will be identified for
CDC, CYA and DMH.
o The summary data will be documented and identified as “Objective
Number 14, Calculations”.
Audit Plan Data Analysis and Report Preparation
Responsibility - CDC and CYA
Timeline - 04/01/97 - 06/30/97
Results -
o Using “Objective Number 14, Calculations”, the average back-up cost
for CDC and CYA will be compared to the average back-up cost for
DMH.
o Based on this comparison, it will be determined whether or not EI
affects back-up costs for industrial injuries.
58
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 15: Affects Industrial Disability Retirement Costs.
Audit Plan Data Collection/Compilation
Responsibility - Refer to Objective Number 13
Data - Refer to Objective Number 13 Method - Refer to Objective Number 13
Data Collection Timeline - 07/01/95 - 09/30/96
Data Compilation Timeline - 10/01/96 - 12/31/96
Audit Plan Data Calculations
Responsibility - CDC. CYA and DMH
Timeline - O 1/01/97 - 03/31/97
Calculations -
o Refer to Objective Number 13
o Refer to Objective Number 13
Audit Plan Data Analysis and Report Preparation
Responsibility - CDC and CYA
Tirneline - 04/01/97 - 06/30/97
Results -
o Using “Objective Number 13, Audit Plan Data Analysis”, an analysis
of the correlation between the rate of industrial disability retirements
and industrial disability´ retirement costs will be made.
o Based on this analysis, it will be determined whether or not EI affects
industrial disability retirement costs.
59
AB 2163 AUDIT PLAN
IMPLEMENTATION
OBJECTIVE NUMBER 16: Total Number and Cost of Litigated Claims.
Audit Plan Data Collection/Compilation
Responsibility - SCIF
Data - Employee Name/Claim Number/Total Number of Litigated
Claims/Total Number of Claims Included in Audit/Total Cost per Litigated
Claim/Total Cost of Litigated Claims Included in Audit/Total Cost of all
Claims Included in Audit
Method - “SCIF Computer Run-Litigated Claims”
Data Collection Timeline - 07/01/95 - 09/30/96
Data Compilation Timeline- 10/01/96- 12/31/96
Audit Plan Data Calculations
Responsibility - CDC. CYA and DMH Timeline - 01/01/97-03/31/97
Calculations -
o Using the “SCIF Computer Run-Litigated Claims”, a percentage of
litigated claims and an average cost of litigated claims will be
identified for CDC, CYA and DMH.
o The summary data will be documented and identified as “Objective
Number 16, Calculations”.
Audit Plan Data Analysis and Report Preparation
Responsibility - CDC and CYA
Timeline - 04/01/97-06/30/97
Results -
o Using “Objective Number 16, Calculations”, the percentage of litigated
claims and average cost of litigated claims for CDC and CYA will be
compared to the percentage of litigated claims and average cost of
litigated claims for DMH.
o Based on this comparison, it will be determined whether or not EI
affects the total number and cost of litigated claims.
60
AB 2163 AUDIT PLAN
IMPLEMENTATION
SCIF DOCUMENTATION
SCIF Computer Run-Cost of Claim
- Employee Name
- Claim Number
- Total Number of Claims Included in Audit
- Total Cost Per Claim (Developed from Pay Histo´y Data)
- Total Cost of Claims - Total Number of Accepted Claims Included in Audit
- Total Number of All Claims Filed between 07/01/95 and 09/30/96
- Total Cost of Accepted Claims Included in Audit
SCIF Computer Run-Disability Injuries
- Employee Name
- Claim Number
- Total Number of Disability Injuries
- Total Number of Claims Included in Audit
SCIF Computer Run-Vocational Rehabilitation Referrals
- Employee Name
- Claim Number
- Total Number of Claims Receiving Outside V.R. Services
- Total Number of Claims Included in Audit
SCIF Computer Run-EIC Costs
- Employee Name
- Claim Number
- Total EIC Costs per Claim
- Total EIC Costs
- Total EIC Costs at RTW Meetings
- Total Number of Claims Included in Audit
SCIF Computer Run-Medical-Legal Evaluations
- Employee Name
- Claim Number
- Total Number of Medical-Legal Evaluations per Claim
- Total Number of Medical-Legal Evaluations
- Total Cost of Medical
- Legal Evaluations per Claim
- Total Cost of Medical
- Legal Evaluations
- Total Number of Claims Included in Audit
61
AB 2163 AUDIT PLAN
DOCUMENTATION
SCIF DOCUMENTATION continued
SCIF Computer Run-Finalized Claims
- Employee Name
- Claim Number
- Claim Finalization Status
- Total Cost per Finalized Claim
- Total Cost of Finalized Claims
- Total Number of Finalized Claims
- Total Number of Claims Included in Audit
SCIF Computer Run-Litigated Claims
- Employee Name
- Claim Number
- Total Number of Litigated Claims
- Total Number of Claims Included in Audit
- Total Cost per Litigated Claim
- Total Cost of Litigated Claims
- Total Cost of Claims Included in Audit
SCIF Spread Sheet (Developed from SCIF Data Collection Form)
- Total Number of Elapsed Days from DOI to Date Claim Accepted per
Claim
- Total Number of Elapsed Days from DOI to Date Claim Accepted for All
Claims Included in Audit
- Total Number of Verified Lost Work Days per Claim
- Total Number of Verified Lost Work Days of All Claims Included in Audit
- Reason Lost Work Days Ended per Claim
- Total Number of Medical-Legal Evaluations per Claim
- Total Number of Medical-Legal Evaluations
- Claim Number
- Employee Name
- Total Number of Claims Included in Audit
- Total Number of Accepted Claims Included in Audit
62
AB 2163 AUDIT PLAN
DOCUMENTATION
CDC, CYA and DMH DOCUMENTATION
Department Data Collection Form
- Employee Name
- Employment Status
- Total Number of Employees in Survey
- Total Number of Employees Returning to Work
- Total Number of Industrial Disability Retirements
- Total Cost of IDL per Claim
- Total Cost of IDL for All Accepted Claims
Department AB 2163 Monthly Report to SCIF
- Institution
- Report Period
- Employee Name
- Date of Injury
- Type of Injury
- Date of Referral
63
AB 2163 AUDIT PLAN
DEFINITIONS
Acronyms
C&R - Compromise and Release
CDC - California Department of Corrections
CYA - California Youth Authority
DMH - Department of Mental Health
DOI - Date of Injury
EI - Early Intervention
EIC - Early Intervention Counselor
F.M. - Future Medical
IDL - Industrial Disability Leave
MIRS - Management Information Reporting System
P.D. - Permanent Disability
QIW - Qualified Injured Worker
RTW- Return-to-Work
SCIF - State Compensation Insurance Fund
SCO - State Controllers Office
STIP - Stipulation
TD - Temporary Disability
VR - Vocational Rehabilitation
3290 - Temporary Disability Verification of State Employee
Definitions
Back-Up Costs - Industrial Disability Leave X 2
Disability Injury - Claim Exceeding 3 Days Lost Time
Employee Returning to Work - Status When Data is Collected
Finalized Claim - Closed Claim, Settled Claim (P.D. or F.M. Award)
Claim Status - Open, Closed, Finalized, Litigated
Employment Status - RTW, MLOA, Disability Retirement, Civil Service
Retirement, Resigned
64
State of California
DEPARTMENT OF CORRECTIONS
Memorandum
Date : April 3, 1998
To : Kurt R. Sjoberg
State Auditor
California State Auditor
600 J Street, Suite 300
Sacramento, CA 95814
Subject: EARLY INTERVENTION PROGRAM
Thank you for the opportunity to review the draft report submitted by the California State Auditor
regarding the Early Intervention Program: ÒFlaws Found in the 1997 Report on the Benefits of the Early
Intervention Program.Ó After reviewing the report, the California Department Corrections (CDC) agrees
with the overall content of the report.
Staff from the CDC, the California Department of the Youth Authority (CYA) and the State
Compensation Insurance Fund met with staff from the California State Auditor, Bureau of State
Audits (BSA) on Tuesday, March 31, 1998 to discuss the draft report. The Departments requested that
some minor editorial changes be made to the report. These included a typographical error in the last
paragraph on Page 3 of the Introduction; changes on Page 2 of the Analysis that include a rewording of
*
the CDCÕs ability to lock down a facility; rewording of the description of the CYAÕs mission to reflect a
more program and rehabilitation orientation versus solely custodial in nature; and a change of wording
in the last paragraph from inappropriately to mistakenly.
We agree that the study conducted by the CDC was flawed primarily because the audit criteria and
objectives were established by legislation without the input of the participating Departments. Based on
the audit objectives outlined in the legislation, the four Departments and BSA created an audit plan and
diligently collected the information specified. Because of the flawed audit criteria and objectives, the
study resulted in distorted and inconclusive comparisons. This impacted the overall conclusions
reached by the auditors. The CDC continues to believe that a combined effort by departmental staff
that includes the Early Intervention Program favorably influences the outcome of workers’
compensation claims, with no one particular factor having a predominate influence.
The cooperation and guidance provided by your audit staff during the audit period was very helpful to
departmental staff. Please extend our appreciation to your staff for their efforts.
Should you have any questions regarding the CDC’s Early Intervention Program, please feel free to
contact Cora Monson, Assistant Deputy Director, Office of Environmental, Health and Safety
Management, at 322-1375.
C.A. Terhune
C. A. TERHUNE
Director
Department of Corrections
65
*California State Auditor(cid:146)s comments on this response are on page 69.
This page left blank for reproduction purposes only
66
STATE OF CALIFORNIA—YOUTH AND ADULT CORRECTIONAL AGENCY PETE WILSON, GOVERNOR
DEPARTMENT OF THE YOUTH AUTHORITY
4241 Williamsbourgh Drive
Sacramento, California 95823
Telephone (916) 262-1447 TDD: (916) 262-2913
California Relay Service (800) 735-2922
Web Site: www.cya.ca.gov
April 2, 1998
Kurt R. Sjoberg
State Auditor
Bureau of State Audits
660 J Street, Suite 300
Sacramento, CA 95818
VIA: Thomas M. Maddock
Acting Agency Secretary
Youth and Adult Correctional Agency
Subject: Response to “Early Intervention Program: Flaws Found in the 1997 Report on the
Benefits of the Early Intervention Program”
Dear Mr. Sjoberg :
Thank you for the opportunity to review this Bureau of State Audits Draft Report. The Youth Authority
generally agrees with its conclusions. The flawed audit criteria established by the original legislation, report-
ing errors from departmental field offices and departmental calculation errors all impacted the final conclu-
sions. However, we believe that departmental errors were made irrelevant due to the flawed audit design.
AB 2163 mandated a comparison between unlike entities and the isolation of a factor that could not really be
isolated. It is intrinsically difficult to compare entities as unlike each other as CDC, YA, and DMH because of
their different missions, different clientele and widely divergent policies and procedures for managing their
inmates. Additionally, workers’ compensation expenses as outlined in AB 2163 are dependent on a variety
of factors, including the efforts and skills of local and departmental Return to Work Coordinators, the SCIF
adjusters, the quality of legal representation, departmental policies, and legislative changes. All of these
may influence the costs of the various elements outlined in AB 2163 as much or more than Early Interven-
tion efforts. It is impossible to attribute increased or decreased workers’ compensation costs to any single
factor such as Early Intervention.
On March 31, 1998, staff from the Departments involved in this study met with Bureau of State Audits staff
to discuss the draft report. While agreeing with the overall conclusions, we disagreed with some of the
details. For example, the draft report likens CDC and YA custodial practices in contrast to the therapeutic
environment provided by DMH when discussing client/employee interaction. However, the Youth Authority
program is more than custodial. Our population is younger, more inclined to act out, and most of the Youth
Authority wards are housed in open dormitories rather than lockdown units. Additionally, our institutional
employees are not armed. All of these factors would make our workers’ compensation exposure different *
than CDC. This and other issues were discussed with BSA staff and editorial changes were recommended.
67
*California State Auditor(cid:146)s comments on this response are on page 69.
Kurt R. Sjoberg
April 2, 1998
Page 2
We agree with the Bureau of State Audits that it would be imprudent to rely on this report to decide the future
of the Early Intervention Programs.
We would like to thank your staff for the cooperation and input provided by them during this audit process.
If there are any questions regarding this response or any other aspect of this audit, please feel free to
contact Tim Mahoney, Assistant Director for Labor Relations, Employee Assistance, and Safety, or his staff
at (916) 262-1451
Sincerely,
Francisco J. Alarcon
Director
68
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This page left blank for reproduction purposes only
70
STATE OF CALIFORNIA—HEALTH AND WELFARE AGENCY PETE WILSON, GOVERNOR
DEPARTMENT OF MENTAL HEALTH
1600 - 9TH STREET
SACRAMENTO, CA 95814
(916) 654-2309
April 2, 1998
Mr. Kurt R. Sjoberg,
California State Auditor
Bureau of State Audits
660 J Street, Suite 300
Sacramento, CA 95814
Dear Mr. Sjoberg:
Thank you for the opportunity to review the draft of the Bureau of State Audit’s
(BSA) assessment of the Legislative Report on the Early Intervention Program re-
quired by Chapter 1034, Statutes of 1994. The Department of Mental Health (DMH)
was pleased to be able to participate as a control group in the study of the Early
Intervention Program.
Our only comment relates to the assessment element to determine if the Early Inter-
vention Program “Increases the total number of employees returning to work from work-
related injuries.” At the bottom of page 5 and top of page 6, BSA concludes there is a
“...possibility that the Early Intervention Program contributes to the increased number of
employees returning to work from work-related injuries” at the California Department of
Corrections (CDC) and the California Youth Authority (CYA) when compared to DMH.
The study measured the percentage of injured employees returning to work during the 15
month data collection period. We believe our
level-of-care staff generally have a greater exposure to serious physical injuries due to
their direct, hands-on, therapeutic treatment of seriously mentally ill patients than do
Correctional Officers and Youth Counselors. Therefore, the recovery time from these
serious physical injuries in many cases exceeds 15 months. The DMH return-to-work rate
could equal or exceed that of CDC or CYA if the comparison were made over a longer
period of time. Thus, we believe the measure of this element is not conclusive.
If you need additional information regarding this issue, please contact Jerry Beaman
of my staff at 654-2527.
Sincerely,
STEPHEN W. MAYBERG, Ph.D.
Director
71
This page left blank for reproduction purposes only
72
STATE COMPENSATION INSURANCE FUND
State Contract Services
2450 Venture Oaks Way, Suite 500
Sacramento, CA 95833-3291
(916)567-7500 Fax (916) 567-7511
Mailing Address: P.O. Box 659011 • Sacramento, CA 95865-9011
March 30, 1998
Kurt R. Sjoberg, State Auditor
Bureau of State Audits
660 J Street, Suite 300
Sacramento, CA 95814
Dear Mr. Sjoberg
This is the State Compensation Insurance Fund’s response to your report entitled “Early Intervention
Program: Flaws Found In the 1997 Report on the Benefits of the Early Intervention Program”.
The State Fund is the third party administrator for the uninsured state agencies’ workers’ compensation
programs. The State Fund provides claims adjusting and legal services to all three departments involved
in this study.
The State Fund was responsible for collecting some of the raw data used in the study. The data collected
was entered on EXCEL spreadsheets and forwarded to the departments. The Fund did not attempt to
interpret the data or draw any conclusions.
The methods used to collect data are as follows:
1. Each department sent lists of claims that they felt met the audit criteria.
2. SCIF entered a code on the computer claim record for those cases.
3. At the end of the audit period, Data collection worksheets were sent to
the claims adjusters who were handling the “EI” coded cases.
4. The data collection worksheets were returned to the SCIF Sacramento
office where they were entered on EXCEL spreadsheets.
5. The completed worksheets were forwarded to the departments.
During the entire audit period, representatives of all three departments, SCIF and the Bureau of State
Audits met to be sure that deadlines were being met and acceptable methods were being used to collect
data. The State Fund feels that the data collected reasonably reflects the information that was available
to the adjusters at the single point in time that the worksheets were completed.
Sincerely
Rich Beaton
Claims Manager
cc: K. Bollier, F. Floyd
73
cc: Members of the Legislature
Office of the Lieutenant Governor
Attorney General
State Controller
Legislative Analyst
Assembly Office of Research
Senate Office of Research
Assembly Majority/Minority Consultants
Senate Majority/Minority Consultants
Capitol Press Corps
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