The California Department of Industrial Relations (DIR) plans to address the state’s broken Utilization Review (UR) system—by paying frequent contract recipient RAND Corporation $300,000 to study UR data on injured workers’ access to care during the first 30 days of a claim.
However, as we reported previously, the DIR’s Division of Workers’ Compensation (CA DWC) never collected the UR data that RAND presumably needs to study.
Accordingly, why did the DIR award RAND a lucrative $300,000 contract for research that can’t occur without UR data? Without UR data, what can RAND possibly analyze? Tea leaves? The stars? Vibes?
The questions are even more critical given the Commission on Health and Safety and Workers’ Compensation (CHSWC)'s concerns about the quality of RAND’s work and the frequency with which the DIR grants RAND these contracts.
In 2016 and again in 2019, California legislators mandated UR data collection and transparency through Senate Bill 1160 and Senate Bill 537. The laws required the CA DWC to collect and publicly report data on how often claims administrators approve, deny, or modify treatment requests.
The CA legislature’s UR data demands were straightforward:
SB 537 amended California Labor Code Section 138.8 to:
Legislators intended to reveal UR denial patterns, identify bad actors, and lay the groundwork for reform. Fast-forward to 2025, and the CA DWC has implemented none of these legal mandates.
There is no UR database, published statistics, or known attempts to impose accountability. The CA DWC has opted to ignore California law.
Now, the DIR is offering more taxpayer money to RAND to study non-existent UR data.
Enter RAND Corporation, the California government’s go-to research contractor. Now, RAND is poised to make another $300,000 to analyze how UR impacts injured workers.
According to Commission on Health and Safety and Workers’ Compensation (CHSWC) members, RAND wins these contracts with little or no competition despite producing studies that Commissioners find lacking scope, methodology, and valuable insights.
As one CHSWC Commissioner put it in a meeting earlier this year:
The RFP instructs RAND to use data from the Workers’ Compensation Information System (WCIS) and Electronic Adjudication Management System (EAMS). However, neither WCIS nor EAMS includes UR approval, modification, or denial data.
In the same CHSWC meeting, regarding a RAND study concerning firefighters, a Commissioner noted (emphases ours):
We’ve seen and reported on the consequences of UR without oversight:
daisyBill data show that claims administrators fail to approve around 30% of doctors’ recommended treatments year after year. Yet the CA DWC has shown no interest in analyzing these UR denials despite being legally required to do so.
Instead, the DWC shields claims administrators, leaves injured workers in limbo, and signals that UR will remain a free-for-all (performative studies aside).
California workers’ comp doesn’t need another “study.” It needs DIR and DWC compliance.
The laws already exist, and the legislative mandate is clear.
The CA DWC needs to collect the UR data so stakeholders can conduct meaningful studies and take real action.
Instead, the CA DWC fails to enforce UR laws and allows claims administrators to operate in the shadows. Rather than funding a study of hypothetical, non-existent UR data, California could spend $300,000 establishing the digital infrastructure necessary to collect actual UR data.
Until the CA DWC starts following the law, we struggle to see how RAND’s taxpayer-funded UR research can produce anything valuable to stakeholders.
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