Following a rare win for injured workers this past legislative session, a Hawaii lawmaker is pushing for more reforms to the state’s workers’ compensation system, in an effort that has support from diverse stakeholders.

As chairman of the House Labor and Government Operations Committee, Rep. Scot Matayoshi is leading a working group including doctors and insurers. The stakeholders say Matayoshi, a public school teacher-turned-attorney, has proven skilled at brokering changes to the system designed to help people hurt on the job.

“Scot’s doing a good job, and I’m not just blowing smoke,” said Dr. Scott Miscovich, president and chief executive of Premier Medical Group.

“I think in broad terms, Scot understands how many different players are coming from different positions in the state,” said Miscovich, a member of the working group and a workers’ comp doctor who has long pushed for reforms. “He is really bringing people together, and having people find consensus, which is challenging.”

The head of Hawaii’s largest insurance trade group agrees.

“Scot has done a really remarkable job of keeping the group focused to find common ground,” said Alison Ueoka, president of the Hawaii Insurers Council, who also serves on the group. Other working group members include lawyers on both sides of the issue.

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This past session, Matayoshi proposed and helped push through a measure that gives workers with serious back and spine injuries access to magnetic resonance imaging tests within the first 60 days after an injury, and before a formal treatment plan is created. The idea is to streamline diagnosis and treatment so workers can get back to work quickly.

The measure had wide support, from both the insurers and the Work Injury Medical Association of Hawaii, which represents workers’ comp doctors.

Among the supporters was Dr. Frank Izuta, a Honolulu doctor who treats workers’ comp patients.

“Expediting the ability to obtain a specialist’s opinion will enable the appropriate, diagnosis-specific treatment to be implemented soon after an injury,” he said in testimony. “This will result in a more rapid recovery, improve functional outcomes, diminish the level of impairment and enable the injured employee to return to work with minimal delay.”

System Is Based On A ‘Grand Bargain’

The idea of getting people back to work with minimal delay is central to Hawaii’s workers’ comp system, which is established by statute — and the result of a major legal reform known as “ the Grand Bargain.” The basic trade-off is that employers must compensate workers sidelined by on-the-job injuries and pay for their medical care; in exchange, workers generally can’t sue their employers for work-related injuries.

In practice, the system often falls short. Stories abound of insurers withholding or delaying payment for treatments, while employers often claim the system is open to abuse by malingering patients who game the system to get extended paid vacations.

Insurers often call in their own so-called independent medical examiners to second-guess doctors. And, although the whole system is designed to avoid litigation and speed treatments, matters can end up disputed anyway in quasi-judicial proceedings before the director of the Department of Labor and Industrial Relations.

Meanwhile, doctors hoping to avoid such disputes, as well as the paperwork and bureaucracy workers’ comp claims trigger, often opt out of treating on-the-job injuries altogether.

The dynamics make reforming the system difficult, even when parties on all sides agree changes are needed.

With that in mind, Matayoshi is starting small, seeking modest changes and focusing on the overarching goal: to get treatment for workers quickly so they can get back to work. With the workforce still weakened after Covid-19’s “ Great Resignation,” it’s essential to keep people working when possible, Matayoshi said, although he also stressed, “I don’t want to make it sound so utilitarian.”

Miskovich noted workers’ comp covers only 60% of the worker’s wages, which is often not enough to live in high-cost Hawaii. So he agrees people need to be helped quickly.

Matayoshi credits the working group with teeing up bills for passage. There are perhaps four more in the works for the 2025 session.

“What we’re trying to do is reduce friction in the system,” Ueoka said.

Matayoshi considers the measures being massaged by the working group now to be low-hanging fruit. One deals with the role patients can play choosing vocational rehabilitation counselors who help the employees get back to work. Another involves the procedure for evaluating the ability for a returning worker to do certain jobs, known as functional capacity. Another issue involves placing some limits on the amounts doctors can charge for medications the doctors themselves sell.

Yet another measure would deal with formal requirements, which now include minutiae such as requiring claim documents to use 12-point font.

“Some of the more unscrupulous insurance companies are denying claims based on that,” he said.

Regardless of whether more changes come, Miskovich applauds Matayoshi for bringing the various sides together.

“When you look 15 years ago, we were on different planets,” he said.

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This story was originally published by Honolulu Civil Beat and distributed through a partnership with The Associated Press.