Workers comp insurers are trying to dispute the widely held belief that they've been increasingly successful in shifting the costs of workplace injuries on to Social Security and Medicare. I'm not buying it. It's obvious at ground level that they're able to settle cases for vastly less than the true costs of lost wages and future medical care.
You are exactly right and this phenomenon is forced by the recent wave of so called "worker's compensation reform" statutes that have drastically cut rates, statutory filing times, and times to prosecute a case after it is filed. Also, use of the Sixth Edition of the Guides to the Evaluation of Permanent Impairment is still mandatory in my state. This gem was cooked up with the full help of the AMA apparently and drastically limits what a rating doctor can assign for impairment after say a police officer or fire fighter has a spinal surgery. This was cooked up supposedly to discourage back and neck fusions for the monetary award. A brilliant disincentive to stop rampant out of control workers compensation fraud. Funny thing though, the cops I represent are still requiring back and neck surgeries and the doctors are getting paid but they are getting screwed. Also, these reform packages are coming down from the top and are being dropped in to our legislatures to be rubber stamped. The pols don't even know what they are approving--just that it is pro business. We have been seeing the fall ouit since 2014 in my state and large portions of the new act are in litigation. The heinous provision that deducted permanent awards from those returning to the same job has been stricken as unconstitutional for denying a remedy. If you don't think these areas of the law ie ssd and comp directly tie to each other than you need an education. They are most definitely dumping those injured at work on to the federal ssa system.
ReplyDeleteThe FECA/OWCP for Federal Employees operates in the same manner. I just had a case where the employee went through 6 Reconsideration denials by non-Attorney CE’s, and with no input from a physician reviewing medical records, or an experienced Attorney anywhere along the way. Remarkably, after the employees SSDI was approved, FECA/OWCP medically accepted their conditions as work related, while still denying compensation. Five-six years into this nonsense is ridiculous. Oh, the employer was SSA.
ReplyDeleteTechnically, Medicare is not supposed to be the primary payer for medical care related to injuries covered by workers compensation but generally this has been ignored and Medicare has been used to cover those expenses once the disabled worker goes on Medicare. If the government cracked down on this practice, it would increase the cost of workers compensation settlements to cover future medical.
ReplyDeleteWC systems are set up in a manner that economically incentivizes WC insurers to wrongfully deny legitimately due benefits to injured workers, often shifting the burden onto the taxpayer. That has been true for a long time, although I suppose whether that has increased in recent times is an open question. Not convinced? It's just good business for them. Compare the penalty to the WC insurer for wrongfully delayed or denied benefits (minimal) to the profit the WC insurer reaps for every legitimate benefit it avoids paying (potentially substantial).
ReplyDeleteFor example, lets say a WC insurer denies 10 MRIs at $1K per test, which it should have paid for. Savings $10K. Maybe 2 in 10 workers will successfully sue and force the WC insurer to pay, with an additional $1K attorney fee and penalty. That's only $4K in payouts, still leaving a $6K profit to the WC insurer attributable to its policy of aggressively denying legitimate claims. They are in business to maximize profits, so of course that's what they do. The only way to change it is to make it unprofitable for them to engage in such practices. Any attempt to do that is met with a legislative stone wall from the pro business lobby.
What happens to the 8 people who didn't get the test they legitimately needed? The costs, which can sometimes be much more than just the costs of the tests, are passed onto the public in a variety of ways. It is an area that has long cried out for reform to provide greater protection to American workers and taxpayers.
ProPublica covered this issue a few years ago. https://www.propublica.org/article/the-demolition-of-workers-compensation
ReplyDeleteFor the last decade or so attorneys have been able to get lump sum settlements designed to avoid any offset DIB due to the receipt of the workers' compensation settlement. In this regard they may have been able to get the worker to accept a reduced WC settlement thus saving the insurance company money at the expense of SSA.
ReplyDeleteThe great irony of workers comp is how a supposedly no fault system is still so adversarial. To get benefits, WC claimants often face hired gun experts, insurance company stonewall tactics, and technicalities that make it easy for them to lose their rights. What do people do when faced with a complicated and frustrating system? They avoid using it unless there is no good alternative. Where public benefits provide an alternative, people will use those instead. Insurance companies know that and they milk it.
ReplyDeleteInsurance companies limiting exposure and payout! Outrageous behavior. Who would have ever thought that it was possible for a company to try and pass on costs to improve profit. Its unheard of!!
ReplyDeleteIf you are an adult, and you believe, truly believe, that insurance companies are there for your benefit and to protect you and your investments like home and auto, you absolutely and completely deserve to be duped.