Audit Highlights . . .
Our audit to determine the timeliness of workers’ compensation claims approval and the provision of medical treatment for CDCR employees and inmates following work‑related injuries revealed the following:
- » SCIF and CDCR authorized requested medical treatments within required time frames, and any late claims or liability decisions did not affect injured workers’ access to medical care.
- » Many CDCR employees and inmates we reviewed received immediate initial medical care following a work-related injury.
- » Employees were generally released from care more slowly than inmates, although this difference may be due to the types and severity of injuries in these groups.
- » We did not identify any notable, systemic negative effects or areas for the processes to become more efficient.
Results in Brief
California’s workers’ compensation system generally requires employers, such as the State’s correctional facilities (facility), to provide for medical care for injuries that workers sustain on the job. The facilities of the California Department of Corrections and Rehabilitation (CDCR) and the California Prison Industry Authority (CalPIA) both employ inmates, and those inmates are entitled to file claims for injuries sustained while working. CDCR provides inmates jobs at the facilities, such as working in the kitchen or performing yard work, while CalPIA operates manufacturing and agricultural industries intended to provide inmates with work skills and reduce recidivism. Although state law allows inmates to file workers’ compensation claims for work‑related injuries sustained while they are incarcerated, it prohibits them from receiving certain workers’ compensation benefits, such as disability payments, until they are released from prison.
Our review of workers’ compensation cases found that many employees and inmates received immediate initial medical care following a work‑related injury. Although the objectives for this audit asked that we compare the timeliness of treatment for CDCR employees and inmates for work‑related injuries, different purposes and procedures for providing care to injured employees and inmates complicate any meaningful conclusions when making this comparison. Variability in the severity of the injuries and in the overall health of the injured workers further complicates a direct comparison of the timeliness of medical care for employees and inmates. Those differences aside, the employees and inmates we reviewed received the 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. Therefore, we do not make any recommendations.
The State Compensation Insurance Fund (SCIF), which administers CDCR’s workers’ compensation claims, decides whether an injury is work‑related and if it should therefore accept liability for a submitted claim. In this report, we refer to SCIF’s determination of whether the injury leading to a claim was work‑related as a liability decision and to instances in which SCIF accepts liability for claims for work‑related injuries as accepted claims. With the exception of limited initial medical treatment, employees will receive workers’ compensation benefits only if the claim is accepted. Although SCIF also makes liability decisions for inmates, their injuries are treated as needed by California Correctional Health Care Services (Correctional Health), which provides care to California’s prison inmate population at all CDCR facilities statewide regardless of whether the injury is work‑related.
Our review also found that SCIF and Correctional Health promptly facilitated any necessary medical treatment beyond an initial exam, although the means by which they did so differed. Specifically, even though SCIF must review most proposed treatments for injured employees and decide whether the treatment is medically necessary, Correctional Health only uses its formal process to review inmate treatments for medical necessity when the proposed treatment is high cost, high risk, exceptional, or complex; in other cases, Correctional Health’s providers prescribe necessary treatments without going through a review process. Correctional Health’s policy establishes required time frames for the provision of medical treatment to inmates, which we found that it generally met. Although state law does not address how quickly a medical provider must provide treatment to an injured employee after SCIF approves the treatment, we found that medical providers similarly provided treatments to employees in a timely manner.
Employees were generally released from care more slowly than inmates, although this difference may be due to the types and severity of injuries in these groups. Physicians determine when an injured worker is ready to be released from care, but this date does not always coincide with the date that an injured worker returns to work. SCIF noted that many variables can affect the recovery process, such as injury type, injury severity, and employee characteristics; these variables also limit our ability to draw meaningful conclusions from summarized data based on the release‑from‑care dates. In addition, Correctional Health generally does not determine the release‑from‑care date for inmates because inmates continue to receive care regardless of whether the injury is work‑related.
Just more than half of CDCR employees we reviewed returned to work within 30 days, while 78 percent of inmates reviewed returned within 30 days, and many of those within 10 days after their first medical visit. The longer time for employees to return to work, compared to inmates, may be due to the facilities’ inability to accommodate physical work restrictions for employees in certain job roles.1 Further, CDCR policy limits facilities from accommodating work restrictions that would affect the safety and security of the facility. For example, the facilities were generally unable to accommodate physical work restrictions for correctional officers who oversee the security of the facility.
Because this report is informational in nature and does not contain recommendations, we did not request responses to the draft report.
1 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