The California Constitution grants the Legislature authority to create a workers’ compensation system, which generally requires employers, including state agencies and departments, to provide employees with certain benefits, such as disability pay and medical care to cure or relieve injuries, when they sustain those injuries on the job. Employees can sustain work‑related injuries in many ways, including during a single incident; from a physically traumatic repetitive activity over time; or from repeated exposure at work, such as loss of hearing from constant loud noise. Through an agreement with the California Department of Human Resources, the State Compensation Insurance Fund (SCIF) administers the workers’ compensation claims process for many state agencies and departments, including the California Department of Corrections and Rehabilitation (CDCR). SCIF processes claims for work‑related injuries submitted to it, determines liability for those claims, and helps ensure that the medical procedures requested are appropriate to treat the workers’ injuries, among other functions. We describe SCIF’s duties more completely later in the Introduction.
If injured while performing work‑related duties, both CDCR employees and inmates on job assignments are generally eligible to receive workers’ compensation benefits.2 If SCIF denies liability for an employee’s injury because it determines that the injury was not work‑related, the injured employee can continue to receive medical care through his or her regular medical provider. Inmates are not eligible to receive disability pay while they are incarcerated, but they are not dependent on approval or payment from SCIF for medical care for their injuries the way employees are. However, once an inmate is paroled or discharged from a correctional facility (facility), the former inmate may seek workers’ compensation benefits, such as disability pay and further medical care, through SCIF for accepted work‑related injuries sustained while incarcerated that are not fully healed. At that point, the former inmate follows the same process as an employee would. Figure 1 shows the steps CDCR employees and inmates take to receive medical care for work‑related injuries.
Medical Treatment for Work‑Related Injuries for CDCR Employees and Inmates Follow Similar Processes but Are Administered Separately and Under Different Criteria
Source: State law; CDCR, Correctional Health, and SCIF policies; and staff interviews.
* This graphic shows the process for a prospective treatment request in which SCIF authorizes the treatment before it is provided. A separate process for retrospective requests allows SCIF to approve treatment after it is provided. However, a majority of the requests we reviewed were prospective.
† Utilization review and utilization management are not always required steps. For inmates, it is only necessary for “high cost, high risk, exceptional, and complex cases.” For employees, certain medical providers can bypass the review for specific procedures.
Liability for Work‑Related Injuries
SCIF administers CDCR’s workers’ compensation claims and is responsible for deciding on behalf of CDCR whether to accept liability for claims arising due to work‑related injuries sustained by employees and inmates. SCIF’s agreement with state departments requires CDCR to submit initial claim information within the five‑day statutory time frame. Further, 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. Accepting liability generally means agreeing that the injury occurred while the individual was working and was caused by the worker’s job and, therefore, that CDCR is financially responsible for the associated benefits, including medical treatment. Throughout this report we refer to this determination by SCIF as a liability decision and to instances in which SCIF accepts liability for work‑related injuries as accepted claims.
Inmates receive medical care for both work‑related and non‑work‑related injuries through California Correctional Health Care Services (Correctional Health), which is under the control of a court‑appointed federal receiver. A federal court established the receivership after issues with inmate medical care resulted in a class action lawsuit. In 2005 the federal court determined that CDCR had not ensured that its medical care system met constitutional standards. As a result, the court appointed a receiver effective April 2006 to provide leadership and executive management of CDCR’s health care delivery system. Although the federal receiver has begun delegating the responsibility for providing medical care back to CDCR’s facilities as the facilities prove they can provide a constitutionally-adequate level of care, the management of inmate medical care at the three facilities we reviewed varied. Specifically, medical care at California Rehabilitation Center and California State Prison, Solano is still under the authority of the federal receiver, and medical care at California Men’s Colony was delegated back to CDCR in May 2018.
When seeking treatment for work‑related injuries, CDCR employees generally obtain care from providers within SCIF’s medical provider network. State law allows injured employees to obtain up to $10,000 in care while SCIF is making a liability decision. These costs for initial treatment of an injury are covered by CDCR regardless of whether SCIF accepts or denies the claim. Employees with accepted claims generally continue to receive care through the SCIF medical provider network; employees whose claims are denied by SCIF, including those whose denials are upheld upon an appeal, may seek medical care through their regular medical providers. Employees with denied claims are not required to repay up to $10,000 in costs incurred for medical treatment before SCIF’s denial of liability, but SCIF will not cover the cost of further treatment for the claimed injury.
Authorization for Treatment
State law generally requires medical treatment for work‑related injuries to incorporate nationally recognized standards of care. State law specifically requires the adoption of a medical treatment schedule that incorporates the American College of Occupational and Environmental Medicine’s Practice Guidelines or other nationally recognized evidence‑based medical treatment guidelines. SCIF or its contractor is responsible for determining whether medical treatment requested by medical providers for employees with accepted claims aligns with these guidelines. Similarly, Correctional Health determines the appropriateness of all medical treatment of inmates regardless of whether an injury is work‑related. Either Correctional Health or SCIF can deny treatment that it determines to be medically unnecessary.
Correctional Health refers to its process of making these determinations as utilization management; SCIF refers to its process as utilization review. However, Correctional Health’s approval for specific treatments is necessary only for treatments that are high cost, high risk, or exceptional and complex. Correctional Health indicates that its providers may prescribe certain treatments—such as X‑rays, certain imaging services, and selected medication—without going through utilization management. Similarly, SCIF has preauthorized certain routine and noncomplex treatments when performed by specific, preapproved providers without requiring the utilization review process. Therefore, some workers’ compensation treatments may be preauthorized, whereas others must first be reviewed by SCIF or Correctional Health.
Returning to Work
For both employees and inmates, the treating medical provider must decide whether the injured worker can return to full duty; return to work with physical restrictions, such as no lifting or running; or be medically placed off work following a work‑related injury. In the event the medical provider clears the injured worker to return to work with restrictions, the employer—in this case the facility—assesses the extent to which the injured worker can perform the job duties of his or her position without compromising the safety and security of the facility. If the facility determines that the restrictions prevent the injured worker from performing his or her duties, it places the injured worker off work.
CDCR’s Employee and Inmate Workforce
CDCR has a wide range of employees, such as correctional officers, administrative staff, and maintenance workers. As Table 1 shows, each of the three facilities we reviewed employed about 1,000 staff as of June 2018 and had roughly 360 accepted workers’ compensation claims for employees from January 2015 through June 2018. These claims included injuries ranging from those typical of office or medical settings, such as carpal tunnel syndrome or strained backs from lifting medical equipment, to those sustained by correctional officers, such as injuries from inmate assaults.
Accepted Workers’ Compensation Claims By Facility Reviewed
As of June 2018
|CALIFORNIA MEN’S COLONY||CALIFORNIA REHABILITATION CENTER||CALIFORNIA STATE PRISON, SOLANO||TOTALS|
January 2015 through June 2018
|Facility Inmate Population||3,911||2,420||3,993||10,324|
January 2015 through June 2018
Source: CDCR’s unaudited data from its Computerized Statistics (COMPSTAT) system, SCIF reports of accepted claims, and facilities’ lists.
CDCR housed 129,000 inmates as of June 2018. According to CDCR, it employed 60,000 of those inmates in jobs, such as working in the kitchen or carpentry shop or performing yard work on facility grounds. The California Prison Industry Authority (CalPIA), which operates manufacturing and agricultural industries with the intent to provide inmates with work skills and to reduce recidivism, employed an additional 5,000 inmates. As Table 1 shows, each of the three facilities we reviewed employed between 1,700 and 3,300 inmates as of June 2018 and had between 49 and 79 accepted workers’ compensation claims for inmates from January 2015 through June 2018. Further, according to SCIF, as of June 2018, it had provided compensation or medical benefits to 952 former inmates who suffered work injuries at facilities statewide from January 2015 through June 2018. SCIF’s database does not specify where former inmates who receive workers’ compensation benefits were housed during incarceration; therefore, SCIF could not identify how many of the 952 former inmates were injured at the three facilities we reviewed.
2 Throughout this report, we refer to injured employees and inmates collectively as injured workers. Go back to text