Workers’ Compensation: The Degradation of an American Institution

workers-compensation

Workers’ comp: it’s a murky morass of problems and opposing interests, and reforms over the last twenty years have only made it murkier. NPR and ProPublica recently came out with a report on their investigation of the state of workers’ comp laws and the results are less than pretty. They’re downright unpalatable. The people who most need help are being denied the justified claims they have on the system. The reforms, sadly, were not enacted with the intent to help workers injured on the job.

Like any issue, this has more than one side. Some would argue that workers’ comp costs for companies were spiraling out of control, preventing business owners from bringing their economy-supporting boosts to communities which need them. So, with that in mind, reform was enacted in several states across the country with the result that costs have been cut severely, allowing businesses to take up residence in new areas. Sounds like a plus, right? For the companies, yes, it is. But for the individuals who work for those companies, not so much. From what NPR reports, the system no longer favors workers at all and the worst of those injured on the job even less.

NPR gives three extreme examples of men and their families who are victims of a de-stabilized workers’ comp system. You might argue that extreme examples are just that—extreme and not indicative of the whole. But these people are the ones most in need of help and they are falling through ever-widening cracks of a failing system. Dennis Whedbee, Joel Ramirez, and John Coffell were each injured on the job and each received sub-standard care because of reforms.

Dennis Whedbee was working on an oil rig in North Dakota when he lost part of his arm in an oil eruption. His coworkers stepped in, administered life-saving first aid, and he was flown off to a hospital where he immediately underwent the surgery needed to repair the damage to his arm. His surgeon then referred him to a specialist in his home state of Pennsylvania. The specialist took into account his injury and his active lifestyle prior to the accident and recommended that Dennis receive a myoelectric prosthesis, which features a hand and fingers that can be moved with the remaining muscles in his forearm. Considering his varied interests, such mobility is a necessary thing. But the North Dakota workers’ comp system thought otherwise. They flew him to another doctor in Minnesota who said that the fancy prosthesis wouldn’t work for Dennis’ still healing shoulder and recommended a simpler and lighter version with a split hook in place of a hand.

Well, the lighter version is only a few ounces lighter. And the split hook? That opens and closes by movement from the shoulder. That same shoulder the doctor said needed more time to heal. But the hook cost $50,000 less than the myoelectric hand, so that’s what was recommended.

To add insult to injury, any money “saved” by companies whose insurance premiums exceed their workers’ comp expenditures, get that money back from North Dakota’s WSI, or Workforce Safety and Insurance agency. Since 2005, the WSI has paid back around $900 million to various North Dakota companies, more than enough to outfit every worker who has lost a hand or arm on the job with a myoelectric prosthesis in the entire country for the past 14 years.

But what about the people who are abusing the system? The workers who are not really hurt at all but are determined to collect a payout? Doesn’t that problem alone necessitate the reforms made? NPR covers that issue, too. In their findings, the majority of the fraud committed in the system is not coming from the workers themselves, but from the companies who are underreporting payroll and the severity of injuries sustained. So, cutting out system abuse is only allowing for more of it to occur.

Take, for instance, Joel Ramirez. He was on the job in California when he was asked to move a pallet of crates which had been improperly and unsafely stacked. One of the crates came crashing down on him, folding him in half and injuring his spine so badly that he is now paralyzed from the waist down. But, when that happened, he received the compensation he needed, which included an in-home health aide. Wonderful, right? Up to a point. And that point was in July of 2013 when a law designed to help workers get their claims faster took effect for old cases, too. You see, as a result of the law, workers’ medical files in compensation cases were farmed out to doctors who never see their patients. Old cases are now subject for review by these sight-unseen doctors if there’s a request for even the smallest change, such as a refill for a prescription.

Such was the experience of Joel. His doctor requested a change unrelated to his paralysis, triggering a systematic review of his entire case. And the doctor reviewing Joel’s case made a recommendation that ended up taking away his in-home care, leaving him unattended while his family was at school or work. Without that care, Joel was left soaking in his own urine and feces for hours on end or laying on the floor because he fell trying to move himself from the couch to his wheelchair. When his appeal to his case came before a judge, it was found that the doctor who never saw him didn’t realize that his ruling had resulted in the rescinding of Joel’s in-home care. The judge, thankfully, was able to bring back the health aide for Joel, easing the burden of his care from his family.

And finally, we have John Coffell, an Oklahoma man with a back injury. His work-related injury resulted in a herniated disc and intense pain. He was given limited compensation for a set time, forcing him back to work before he was recovered, which in turn caused his injury to worsen significantly. But his weekly compensation, which had been cut due to the Oklahoma reforms, pushed his family straight into poverty. The weekly workers’ comp check had been roughly two thirds of a worker’s pay. The reforms brought it down to slightly over half. So John’s family, which had a few ill-timed setbacks, fell even farther behind, resulting in the repossession of his truck and an eviction from their home.

Where is the line drawn? At what point do we say enough? How many more people, through no fault of their own, have to lose the help they need before the focus of workers’ compensation laws move back to where it should be? The system as it is now is positively inhumane.

Information cited from NPR.org, “Injured Workers Suffer As ‘Reforms’ Limit Workers’ Compensation Benefits,” March 4, 2015.

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