Top industry bloggers debated the hottest issues facing the workers’ compensation and risk management industry at the 2015 California Workers’ Compensation and Risk Conference.
- Moderator: Mark Walls, Vice President Communications & Strategic Analysis at Safety National
- David DePaolo, President at WorkCompCentral.com, LLC
- Robert H. Wilson, President & CEO at WorkersCompensation.com, LLC
- Thomas A. Robinson, Writer/Contributor at LexisNexis
- Michael Gavin, President at Prium
Is the grand bargain of workers’ compensation eroding?
Robinson: Exclusivity is still relatively resilient. That portion of the grand bargain is still doing relatively well. The Oklahoma Option is threatening to bleed into neighboring states, but exclusivity from a legal standpoint still remains resilient.
Wilson: I think Padgett was a wake-up call to a degree. When the grand bargain was struck, the people that created it are no longer here. Employers today don’t necessarily appreciate the protections they are afforded and this can threaten the system.
DePaolo: The grand bargain was negotiated 100 years ago and has morphed into something different. When you get down to basics, though, it still works.
States are looking at treatment guidelines and formularies. Do you think this is different from what they have been experiencing in group health?
Gavin: No, it’s not. Good providers tend to view formularies as things that keep misbehaving doctors in check. Formularies in group health are intended to signal items like preferential pricing. Those concepts don’t exist in work comp. Formularies are coming. We are going to see them soon. You can’t compare them – they all take different approaches – and California is developing its own.
What about treatment guidelines? Why is California different?
Gavin: This is an important questions because the work comp system is fragmented nationally. We have 50+ sets of rules and guidelines on how to manage our system. That level of complexity is incredible. Now we are introducing a list of medical guidelines to this. How do you reconcile that? Injuries are the same in all states. They aren’t unique in California. These are the mini bargains in the grand bargain.
Wilson: I think we have a problem with a perception of increased disability from a societal standpoint. Often, injured workers perceive their injury differently from the reality. We have to gain a better understanding of the psych component to better help our workers.
DePaolo: Work comp in the U.S. is a states’ rights issue. Every state wants to control its own population. It’s a bargaining chip in state politics.
Gavin: All of the stakeholders like employers, employees, governors, etc., do share the desire to have injuries resolved and get people back to work. I think the conflict occurs in how much we willing to pay to do that? I think the grand bargain is constantly being rebalanced to try to get there.
The recent OSHA whitepaper criticized the state workers’ comp system. Will we see the federal government intervening in workers’ comp soon?
Robinson: In the opt-out argument, there is a federalization issue. But I completely agree, at its core, work comp is segmented and set up as a state-by-state approach. I think it was originally developed for states to test what worked to find the best solutions, but it has not happened that way.
Wilson: I agree, but that doesn’t eliminate those that would like to see federalization. I hope that does not happened. CMS has not helped Medicare Set Asides become a smoother process. Just because states want to hold on to their independent systems, that will not keep the federal government from trying to intervene at some point. I’m not saying it is going to happen, but it could happen.
DePaolo: I disagree. I don’t see this happening. The population that votes won’t tolerate it and there’s no appetite for it. There are bigger political issues on the table.
Gavin: I don’t see the federal government wanting to take it over, but I could see federalist dialogue about whose responsibility it is to pay for it.
Is there corruption in our industry?
DePaolo: Yes. Just like any other industry there are bad things going on. It is well hidden. I have sources that have told me money is changing hands regularly. People are making allegations, but they won’t name names. Nothing can be done if they won’t name who is doing it.
Walls: Any company I’ve ever worked with would fire you immediately if this was happening.
Wilson: There is abuse and fraud in any industry. I have been a vendor in this industry for 16 years and have never encountered it. I deal with very ethical people and am proud of the people I deal with. They are interested in doing the right things for their employees. I don’t think it is as broad as you are suggesting.
DePaolo: People are making allegations, but they won’t identify who is doing it. Nothing can be done if they won’t name the offenders. If you want things to change, provide documents and name names.
What do you see as some of the areas we should be looking to improve in the system?
Wilson: Quite often we don’t mention the injured worker when we are talking issues in workers’ comp. All too often people don’t understand the workers’ rights and the responsibility we have to them. We should make ourselves available to them and explain this complicated system, the process, and how it pertains to them when they are injured. People don’t understand what we do. We need to recognize that and return the human element into what we do. We should change the name to “workers’ recovery” and take the emphasis off the “compensation” aspect.
Robinson: We need to involve the injured worker a great deal more than they currently are. Some time, energy and resources spent post-injury are some of the best long-term help. The craziest cases I’ve seen usually result from something happening early on.
Gavin: We are going to have to learn with addiction. It will be difficult but, I think contemporary research is telling us that the opposite of addition isn’t sobriety, it’s connection. If we aren’t considering the psycho-social issues, we have no hope. We have to think more holistically.
DePaolo: I think California has so many forms and regulations to manage what should be a simple proposition. There are nearly 200 forms. We have become so procedurally oriented that we forgot what workers’ compensation is all about.