City looks into workers’ compensation complaints

OCEANSIDE — Councilman Chuck Lowery requested that city staff look into whether Oceanside’s workers’ compensation provider is meeting city needs.

He said his request was sparked by complaints from all categories of city employees.

“It’s all over the board, it’s not simply one group, elected officials, department heads, and staff have complained about the lack of responsiveness on the part of the company,” Lowery said.

Mayor Jim Wood said he has also heard complaints from city staff and employee union representatives. Issues include poor communication, lack of concern for employees, and delayed responses in having claims reviewed and paid.

“I heard about it too, and want to have it looked into,” Wood said.

Wood added city employees have repeatedly complained that they are dealing with a company that does not care.

“The one thing in common in the feedback is that it’s a joke working with TRISTAR,” Wood said.

The City Council unanimously voted to direct staff to report back on the provider’s service history, how it handles complaints, and the number of ongoing claims on March 4.

Wood said he would like an independent outside party to review services, and added a staff report would be a good first step in determining where a problem might lie.

The city hired TRISTAR to handle workers’ compensation claims three years ago, after the city staff member who performed the job retired.

There were attempts to fill the city position, but complex workers’ compensation laws, and demands of 900 full time employees, 200 hourly workers and 500 volunteers resulted in continuing with TRISTAR services, which cost the city $223,000 annually.

Human Resources Director Pat Nunez said communication between TRISTAR and the department has been good.

A company supervisor has met face to face with department staff to iron out any issues.

Six months after services started a third claims adjuster was added to better serve the city. Each adjuster is assigned to a specific category of claims, which streamlines responses.

Nunez said another improvement in service is that a claims adjuster, whose communication style did not match the city’s, was replaced at the city’s request.

Nunez said immediate care of injured employees is the city’s first concern.

To ensure that, human resource staff has arranged for MRI scans to be given without prior approval at plan approved medical facilities, and personally contacts workers who file a claim.

“We do everything we can to help that person, and get them back to work,” Nunez said.

Currently there are hundreds of ongoing workers’ claims that range from long term open claims, to serious injuries, and minor scratches.

Nunez said she has seen delays when employees wait weeks or months to file a claim.

She added the only complaints she had heard are employees’ disagreements with adjusters’ determinations on approved care or coverage.

Still, some employees have obtained lawyers to help them get results. Unfortunately, this adds more steps to the line of communication, and causes holdups.

City staff will return to council with a report within 30 days.


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