San Jose Ends Rocky Relationship with Company Handling Injured Firefighters’ Workers’ Comp Claims - NBC Bay Area
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San Jose Ends Rocky Relationship with Company Handling Injured Firefighters’ Workers’ Comp Claims

The move comes after an NBC Bay Area Investigation prompted auditors from the state’s Department of Industrial Relations to take a closer look at the company

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    NEWSLETTERS

    Injured on the job but denied care. That’s the reality for dozens of firefighters in San Jose. The Investigative Unit first uncovered this summer that the City had to step in when the company handling injury claims denied medical treatment. Tuesday, the City selected a new contractor to handle workers’ comp for injured firefighters. The decision to move in a different direction comes just as the State wrapped up an audit of how injury claims are handled by the city – action prompted by NBC Bay Area’s investigation. Liz Wagner reports in a story that first aired on November 29, 2016. (Published Wednesday, Nov. 30, 2016)

    In the wake of a state audit and an NBC Bay Area investigation, San Jose City Councilmembers voted unanimously Tuesday to select a new contractor to handle workers’ compensation claims for many city employees, including injured firefighters.

    The vote signaled the end of the rocky relationship between the city and Athens Administrators, the company that’s been handling those cases since late 2013.

    An NBC Bay Area investigation found nearly 70 firefighters have filed complaints with the city since late 2014 alleging they were denied the medical care that was promised to them after being injured on the job. The City stepped in and reversed 95 percent of those decisions after finding Athens had improperly denied care. But since then, city officials say they’ve had to reverse even more denials.

    “I can honestly say things were better, but there were instances where we did have to intervene,” said Joe Angelo, Director of Human Resources for the City. “We had hoped that would have not been necessary.”

    While the State reported late Monday that auditors “did not find a pattern or practice of denial” in medical treatment, city officials still decided it was time to move on, selecting a company called InterCare to take over Athens’ duties in January.

    “InterCare put forward a compelling argument and one that provided us a chance to revisit who we currently had,” Angelo said. “And as a result of a rigorous review process, InterCare emerged as the best [Third Party Administrator] for us.”

    Athens submitted a proposal in hopes the City would renew its contract, but they were not selected. Athens did not return several phone calls requesting comment, but told NBC Bay Area in an interview this summer that it makes decisions about medical care for injured workers based on the guidelines approved by the state. The company also pointed out it scored 99.4 percent on a separate routine audit recently conducted by the state.

    But San Jose firefighters insist Athens was failing their injured comrades and applauded the city’s decision to drop the company.

    “Athens had become really bad the last year,” said Ray Storms, vice president of the Association of Retired San Jose Police Officers and Firefighters.

    Storms said he gets calls every week from injured firefighters feeling frustrated because they can’t get the medical care they need. After repeated delays and denials, Storms said many of those firefighters gave up trying to get help.

    “Out of sight, out of mind,” Storms said. “That’s how these guys out there felt. They were dropped off; they were no longer cared about. A lot of people give up and go their own way.”

    Storms said he has no idea how InterCare will perform in their new role, but he hopes the city will hold them to a high standard. A lot of injured firefighters will be depending on them.

    “These people that are retired, that are injured,” Storms said. “They’re hurting.”

    Explore the links below for the rest of NBC Bay Area's investigation into the California Workers' Compensation System.

    Part 1: Dozens of Injured San Jose Firefighters Denied Workers' Comp Treatment

    Part 2: Workers' Comp Drags Out Medical Care, Injured Workers and their Doctors say

    Part 3: Injured Workers Face Stacked Deck During Workers' Comp Appeals Process, Critics Say

    Part 4: Workers' Comp Fraud Costs the System Billions, But Some Doctors Say They're Being Unfairly Targeted

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