Industry Bloggers Debate Effectiveness of Workers’ Compensation

Is the workers’ compensation system still a grand bargain for employers and injured employees? Industry bloggers gathered at The California Workers’ Comp & Risk Conference in Dana Point to answer this question with an overwhelming “NO!”

The panel featured Mark Walls from Safety National and the Work Comp Analysis Group, David DePaolo from WorkCompCentral.com, Dale Debber from Providence Publications, plaintiff attorney Robert G. Rassp and Rebecca Shafer from Amaxx Risk Solutions.

Below is a synopsis of their discussion.

Walls: Is the workers’ compensation system still a grand bargain for employers and injured employees?

DePaolo: What are we supposed to be doing with this system? The system doesn’t work with the way that we work today.

Debber: In today’s climate, we are likely to see work comp gone soon. It’s not excluded from Obama Care. It is, however, quite easy to see a federal system come in where indemnity can be transfered to a state disability system, pricing could be based on SIC codes and healthcare transfered to group health. It’s also a possibility that all risk could become equal despite what job you do. We’ll see at the next election.

Rassp: Legitimate injured workers are complaining that adjusters are treating them the same as fraudulent claimants. I’ve witnessed many people get a better standard of care outside the workers’ comp system. Cost savings like that associated with SB 863 is getting transfered out of the system. We should allow bundled medical care without UR – like a person would get if they got hurt at home.

Shafer: I am working on a case where it took 2.5 years to get medical care for an employee who had a traumatic brain injury. I wouldn’t have believed it if I wasn’t dealing directly with this person and what they have been through. This isn’t rocket science and we should be able to provide better care, regardless of who’s paying for it. This should have been simple, but it’s stuck in a system that over complicated it.

Debber: We need to take care of our workers. What’s going on in workers’ comp where little gets accomplished quickly?

DePaolo: Self-insured companies seem to be having a better experience than those who don’t self-insure because they get to have better control over their claims.

Shafer: Self-insureds are giving standards, rules and regulations to their TPAs and that helps.

Rassp: So much of the dollars spent are for outside costs that aren’t related to immediate care. There is a huge conflict of interest from vendors. From an injured worker’s perspective, they don’t care if their benefits are bundled or unbundled, they just want to get better.

Walls: There are more people involved in the system than ever before. The spend on each claim is going up. We are paying more vendors than ever. Are we getting better results?

Panel: NO!

Debber: If the government got out of the way, we could get injured workers treated better and quicker.

Shafer: We were probably better off before MPNs. Some companies don’t use them. The worker with brain trauma that I refered to earlier got a first list of doctors that didn’t even take that type of patient. Two weeks later, the claimant received a new list with doctors in the wrong jurisdiction. Working through an MPN has been very disorganized and sluggish and is not helping the injured employee quickly.

DePaolo: Why are we different? Several doctors have stopped taking work comp cases because of these headaches and complications. Finding physicians to take the patient is becoming a large problem.

Walls: What about the employer’s point of view? Comorbities are turning into claims. Presumption laws are covering a lot of illnesses unrelated to the employee’s actual job. Workers’ comp keeps expanding.

Debber: We’re seeing the non-rebuttable presumptions for fire and police – some are valid – but we’re taking it to the extreme.

DePaolo: Work comp has always been political football. People think, “How do we keep these public servants if we don’t provide this care?”

Walls: There are employers out there, though, that have the attitude that every claim is fraudulent.

DePaolo: We have an image problem with work comp. How are we going to attract the next generation? Millenials want to do things that benefit society and the system was designed to do that but, somehow, we’ve lost that focus. Maybe we need to recharacterize ourselves. We’re not taking care of the workers’ compensation brand. What’s the message that work comp is sending to the rest of the world? Overall it’s viewed poorly and fraud related to it gets a lot of attention.

Shafer: It’s an education problem that starts with the brokers. Brokers are in charge of the insurance arrangement. If the broker was educating the client, we’d be in a better spot. The broker should be delivering knowledge to the client.

Debber: I’m not going to blame the broker. I don’t think it is that. We have lots of big employers that pay less than small employers because of things like premium discounts. A broker is there to work out an economic transaction.

Shafer: Most brokers have resources that can help manage the system.

Rassp: I think it’s the ability of the adjusters to understand the constitutional mandate to provide good care. Case loads are almost so high that they are unmanageable. It boils down to the education and philosophy of the claims administrator, and someone needs to control that. It’s not the broker, but the partership between employer and claims administrator is where we are failing.

Shafer: Many employers aren’t aware how to do that. They can’t ask for what they don’t know.

DePaolo: There is a competing social mission and business mission in workers’ comp and that’s the overall problem.

Shafer: We need to focus on the injured worker. Communicating in a compassionate way to injured employers is out of the rhelm of how employers act. Sometimes it’s as simple sending a get well card. Employers should make compassion a core value when dealing with injured workers.

Debber: I think we’re getting the worst physicians in work comp because we dont pay them and we paper them to death.

DePaolo: We hassle them before they are allowed to do anything.

Shafer: Cost containment is sometimes achieved by paying more (for better physicians). I think it’s something that has to do with the employers purchasing the least costly insurance policy instead of the one that’s most effective.

Walls: How do we fix the system to get it back to what it’s supposed to be? Should we start over?

DePaolo: The problem with doing something like Texas Opt Out is that it benefits large employers that have the resources to put together good programs. But small employers don’t have the resources and need a system in place. We have to fix what we’re working with – not start over. The team is the worker, the employer, the state – and those are the only parties we need involved.

Rassp: There is a certain element that is going around in acadamia that says the more laws and regulations you have, the less common sense exists. We need to go back and look at the laws we currently have and simplify them. Workers’ compensation ran nice and smooth years ago. We miss that. There was a much more doable system with less friction.

Shafer: We need to get back to basics, which consists of the injured worker communicating with the carrier and TPA as a team. How do we get that injured worker back to work? We need communication tools with a post-injury response for injured employees.

Rassp: The most success I’ve seen is when the employer has a bundled set of services. All of them are pre-authorized and it avoids the nonsence of putting everything through UR.

DePaolo: We, in the industry, do a terrible job of managing expectations and the state isn’t doing a good job of managing our expectations. The injured worker is so far removed from the process as is the employer.

Debber: David DePaolo is correct.