What’s Wrong With Workers’ Comp In America
Printer-friendly version
Send by email
By Sam Gold
Three words: Money, Power & Politics. Why do they even call it Workers’ Compensation? It’s certainly not about workers, it’s about insurance companies and their financial bottom lines, and the last thing in the world it does is adequately compensate workers for their occupational injuries which in many cases are due to the negligent actions and behavior of their employers. But hey, they have a “Get Out Of Jail FREE” card called the “Exclusive Remedy!"
When a worker can no longer perform his normal job duties, the law says he must be compensated for his inability to compete in the future job market. But what the insurers throw at the injured worker simply amounts to “Chump Change,” wholly inadequate and certainly not enough to make a difference to the worker.
These corporate behemoths in many cases will embark on a scorched earth policy of the 3 S’s - Stall, Starve, Settle; stall the legal proceedings as long as possible with frivolous litigation, starve out the worker until he and his family are thrown out into the streets or are forced to apply for welfare, and then settle the claim for literally pennies on the dollar.
Why won’t things change? Well it’s all about the power of money. The insurers use their million dollar war chests to influence the decisions of legislators around the country. Do you think these legislators are going to listen to the plight of their poor working stiff constituents who have no money to give them or listen to the wants of those who will gladly fill their re-election campaign coffers and special PAC’s with millions of dollars in corporate cash?
This is not a problem just facing Californians, but workers in all of our 50 states and in Canada too. Until our elected legislators are ready to follow their consciences and finally create a level playing field by passing some meaningful legislation to help the working man, instead of following the corporate money trail, nothing will change and we’ll still be stuck in a seedy system of corporate fraud and corruption.
And those who we think are there to protect us are equally involved as well. County district attorneys are on the receiving end of Department of Insurance money grants supposedly to fight fraud - but this money originates with the insurance carriers themselves. So who do you think the DA is going to listen to when some poor injured worker goes to them with a complaint about insurer fraud? I seriously doubt that they will bite the hand that feeds them.
And while we’re on the subject, how about those DA’s who go after innocent taxpayers with phony prosecutions. Don’t say that it doesn’t happen because it does - every day.
And here we are in the 21st century, where it’s not just about work injuries but with the advent of biotechnology. What happens when workers contract occupational diseases due to their exposure to genetically engineered compounds which the employers refuse to reveal anything about, stating the overriding need to protect their “trade secrets?"
Don’t you think that it’s time that someone looked out for us, the workers of America on whose backs this country was founded?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Sam Gold is an injured worker who is also volunteer director of the first national injured workers advocacy organization, Injured Workers Television Network.
- megan's blog
- Login or register to post comments
- Printer-friendly version
- Send by email
My daughter is an insurance investigator. She has told me stories of so many people and lawyers who attempt to fraudently game the system. Her last case was a guy who had gotten a 100% disability and no one could find him. Turns out he had gone to Thailand on a sex tour. When he finished that, he went to Hawaii for a surfer vacation. My daughter tracked him down to a beachfront hotel via his visa usage.
Anyways, there is another side to this issue. Not everyone who files a claim is legit and once on the system, they can milk it forever.
You're right. Not everyone who files a claim is legit, but by the industry's own admission, claimant fraud is less than 1%. So where is the other 99% and why don't we hear about it.
Those who try to game the system can't do it forever as the system has built-in checks and balances to prevent this from happening.
Insurance is a business, which by definition means "profit-based", and they are not health management, patient care, or compassionate care providers. Claims adjusters, examiners, or whatever you call them, are not trained to provide care, income replacement, and/or positive support, unless they absolutely must. However, they are trained to examine, explore, manipulate, and resolve (close) claims. This is true for all types of insurance, e.g. Workers' Compensation, auto, home, disability, life, etc. They are all "for-profit" entities that take risks based on projected returns.
as a injured worker dealing with my case for the last 4 years. I know with good documentation that the employer has just as much to do with the fraud as the insurance co.
and they some how managed to pay off the atourneys as well.
I can show with documentation were the employer and MY attorney were working together te get me to sell out. there is just way to much corruption in the work comp system. we need to get the word out and make a radical change.
Most workers' comp fraud is committed by providers & employers, such as misclassification of employees. Not as sensational as international sex tours but far more prevalent. If you're interested, here's a good story, written in plain English, that gives a background on the myth of workers' comp fraud: http://www.pbs.org/wgbh/pages/frontline/shows/workplace/etc/fraud.html#2
I liked your reply and read your quoted study. Since my daughter does work for an insurance company and does track fraud in the sense of fraudulent claims, looking at not paying the proper insurance payment is something I did not think of. I talked to her about this and she said that non-payment of insurance is fraud and is a big issue. However, since she doesn't work on that end of the business she doesn't think she knows enough to quantify it.
As far as the fraudulent claims end of it, I asked her to review the article. When she finished it she smiled and said, "yes, daddy, this is probably exactly what a college professor thinks." I asked her to qualify that. She said it was probably true that the insurance investigatros catch only 2%. She said that was because there were too few investigators. She said that of the cases she reviewed that the fraud rate was at least 10%. She said that most of them they don't review. I asked her why is that? She said, if a guy has a real partial disability and it is classified as a 100% disability it is hard to prove that it probably should be a 50% disability. So, since there are so few investigators, they skip those and go for the ones that are obvious. She said most of the people that are doing fraud are rather stupid. They might have a complete disability with confinement to a wheelchair listed. But, you go to their house and there are no ramps. Things like that. But, if the guy is smart, he will most likely get away with it.
The other thing they look at is doctors or chiropractors who file multiple claims through the same lawyers. Or, her favorite, are the guys who are all in a car together, get rear-ended, and all have whiplash injuries. This happens, of course, while they are on lunch or on company business.
true-- the amount of suspected workers' comp fraud is probably higher than reported/confirmed fraud. but you gotta think -- if that's true for claimant fraud, it would also be true for provider & employer fraud. i guess my ultimate point is when you think of abuse of the system, you should think of the abuse perpetrated by employers & providers because they're the ones doing most of it. now if an individual is hell bent on committing fraud in order to receive the pittance you receive on disability, they deserve what they get. i'll take my full paycheck any day of the week. most injured workers feel the same, they'd give anything to be able to work & provide again.
It's alot easier to show someone on TV gaming the system than to try to show a claims examiner deciding to stick it to an injured worker. That's why the Chambers of Commerce and DA's use the same dam videos on the 6 o'clock news to make the public believe that it's the injured workers causing the system to get to hell in a handbasket.
It's done that way so that it will deflect media attention away from those who are really turning the system into a mess, the employers by misreporting premium and the insurers by violating the laws with impunity since they have their "get out of jail free" card, they can't be held accountable for their illegal actions.
One of my closest friends is a Workers' Comp and disability investigator and when I think I've seen them all, someone comes along and tops the last one.
It's all about the Golden Rule; He who has the gold, makes the rules. They're the ones who have the money to corrupt our legislators. This is not just a California problem but a national one. Congress or the Senate can't touch it due to McCarran-Ferguson.
I'd love to go back to work where I was making $125K a year, but both my employer and his insurer made sure that it would't happen. Also you have to understand the insurance company mindset; spend a dollar to save a dime!
Even worse than influencing politicians is how these corporate interests have managed to influence average Americans. And it was all too easy...get some videos out of claimants cheating the system and voila! The narrative has been filled in for so many people. And it is not the thoughtful consideration of what kinds of laws they'd want protecting them or a loved one in that situation, it's outrage at those cheaters they saw on TV.
I think that your daughter is assuming that a PD rating of 100% would mean a total incapacitated. This is not true in the according to LAW. 100% PD rating in workers compensation LAW is based on AMA guidlines. It is a "legal" means of determining an injured person's PD rating in employment. PD rating differs in the schemes of Social Security Insurance, and differs more in other forms of Insurances.
A person who lost limbs for example: both arms and both legs due to an auto accident may be considered TOTAL or 100% disabled from driving. Or may be considered 100% in the workers compensation scheme if the auto accident occured in the course of employment. But in REALITY may not be considered "TOTAL" from "enjoying a sex tour in Thailand", per se or enjoy watching a surfing in a live surfing trip in Hawaii. The right to enjoy is not fraudulent just because a injured person has determined to be rated 100% permanent disability.
For a "claims adjuster" to make such a reckless claims of fraud to such individuals without to proper medical credential (such as your daughter) may be placing her career in jepaordy if the individual injured person in this case was to claim "defamation"; false claims act on her part; and non-compliance to claims adjuster practice based on ERISA. AND! May even cause her insurance employer AT-RISK for these violation under "vicarious liability" for making such fraudulent claims. I suspect that her distaste was coming from her personal jealousy. That should stop. As long as medical evidences has been found by the medical profession that the claimant is permanently "totally" disabled and legal evidences has been determine appropriate according to the LAWS and Court, criticism should END THERE.
If your claims adjuster daughter wishes to exercise her rights to free speech, she is within her rights. But making such false claim publicly, may also have such consequences, if the actual injured person in her example is to file suit against her for defamation. Spreading such information and/or dangerous lies without the proper basis is not only detrimental to her career but may adversely affect the reputation of the insurance company she is working for. Without the proper legal or medical credential she has no basis for calling the injured person private activity a "fraud" against insurance and society.
First, are you saying that every investigator has to be a medical doctor? That would make the law impossible to monitor. Secondly, the guy didn't have his limbs cut off or anything of the sort. He was surfing in Hawaii.
This raising of medical/legal mumbo jumbo on everything like this is precisely why our society is breaking down. You just got to use common sense.
No I am not saying that that medical credential should be part of an investigators' qualification. I am implying that they should not make legal or medical judgement on the basis of their own observation. With regards to the "limb" that is just an example how to distinguish the legal determination of a "total disability in [various] schemes of insurance industry(ies).
Your daughter (insurance investigator)is just THAT. Her work and duty as an insurance investigator is narrowly defined. Sharing such accusatory remarks to you and echoeing your daughters that professors does not know the reality calling it "qualifying"and YOU projecting this to the public is reckless. Period. Without any credibility in the matter you are contributing and spreading gossips which may cause inflammatory acts against injured workers as a whole.
Let me give you another example: The California Labor Law says that if a person is injured on the job can prove; that when the partial industrial PD rating is "combined" with a pre-existing medical disability rating that is at leaset 70% up to 100% may be considered partial disabled with additional life pension for those rated 70% to 99.9% Permanent Disabled or Total(if rated 100% PD. In this scenarion the injured worker fractured bone and suffered mental illness in the couse of employment. The worker filed claims and was determined 50% PD for the actual industrial injuries. However the claimant has pre-existing disabilities. When combined with the industrial disabilities claimant was ultimately legally determined to be 100% PD or TOTAL.
Would you say that the claimant is a fraud just because an investigator has observe this individual swimming in a pool or perhaps seen in a movie theater--Just because the claimant is determined 100% PD?
The point I am getting at is that an investigator's visual observation as "FRAUD" may contradict his instantaneous perception of "total disability" against the legal terms of that determination. What one sees on the surface may just be part of the story.
Unless the investigator or yourself has an X-ray vision like one used in medicine so see what is actually going on medically beyond the surface of the injured person, investigation has no basis for making such reckless public assertion. it is imflamatory and does a dis-service to the profession and to the wrongfully accused.
yea, in black and white documentation I can show an unbelievable amount of missclassified employees includeing myself. but there is no one to enforse the laws. and then the stute of limitations to file are so short the employee wont even hear about the law until the limitations are up. so does that mean the employer didnt do anything wrong?
Worker deaths in the United States from toxic chemical exposures and other work illnesses are conservatively estimated by NIOSH and other researchers at 50,000 to 60,000 lives lost each year.
Worker deaths often cost a corporation far less than correcting a safety/health hazard in the workplace; and the employer is virtually immune from prosecution for the depraved indifference that results in severe injury, toxic exposure, or death.
It is estimated that workers’ compensation misses over 90% of occupational disease deaths. Workers’ compensation, from its inception, was never designed to cover occupational diseases, and the long latency period makes it unlikely to think that workers’ compensation coverage for occupational diseases would ever be realistic.
It is a major and costly health issue – costly in lives, and costly in dollars, with the economic burden for occupational illness, injury and death falling most heavily on families and on taxpayers, and only minimally on workers' compensation.
I tried to document what you said at 50,000 to 60,000 workers killed per year. I thought to myself, is it that many? Why have I known so few. So, I went to the Bureau of labor stats and it said that the total number of fatal injuries in the US was 4547. Even that is a bit misleading since 506 of them were homicide. I am not saying that homicide is good, its just that its hard to really call that an industrial accident. It is just labeled that way because someone was killed at work.
So, the number the government puts out in http://www.bls.gov/news.release/pdf/cfoi.pdf is more like 4041 per year.
You said: "Workers’ compensation, from its inception, was never designed to cover occupational diseases, and the long latency period makes it unlikely to think that workers’ compensation coverage for occupational diseases would ever be realistic."
IF you are correct that "occupational diseases" was "never designed to be covered under workers compensation insurances, then we have a very serious problem since these CLAIMS has been made in the past and has been accepted by the insurance and court. This is not only non-compliance to statute "if true" but fraudulent on the part of the insurance and judicial system for accepting liabilities of occupational disease claims from the injured workers.
Secondly, you said: "the long latency period makes it unlikely to think that workers’ compensation coverage for occupational diseases would ever be realistic."
Could you expand and produce any factual evidences or legal case that your assertion is true?
lastly you said: " It is estimated that workers’ compensation misses over 90% of occupational disease deaths."
Where did this statistic come from? Isn't it true that legally, injured workers must file an occupational diseases claim in workers compensation before a determination can be made? If the occupational disease resulted in "death" in the workers compensation scheme, that would be to the advantage of the WC Insurance according to the WC Laws in California. So there is more of an "incentive" for insurance to prevent life to injured claimants and accelarate "death" once they have been determined eligible for Total Permanent Disability to reduce the cost to their liabilities. According to the WC LAW, upon the death of the eligible claimant; the PTD benefit ceases and does not get passed on to the claimants' dependants. This is a loophole in the LAW that favors "WC Insurance". Who made these laws? California lawmakers. Who influenced them into making this a law? Chamber of Commerce; Insurance Company; and Defense Attorneys for Employers and Insurance.
At whoes detriments? If the injured worker his and her defendants falls through the cracks as a result of death of the injured worker the TAX-PAYER will pick-up the responsibility when they are shifted to public-programs funded by tax-payer. It was a clever designed to "shift" the cost to the TAX-PAYER when should it be a liability of the powerful Insurance Industry. The premise behind insurances is so that the covered individuals does not become a "public burden", and protects them and their family from catastophic financial events caused by injury and disease.
This is a problem. The efffects of occupational diseases which does not arise in the "latent period" is not the only issue in the workers compensation, as described here. It is what happens after that is ALSO important--the illegal "COST-SHIFTING" that often comes after becomes the problem in our system. The TAX-PAYER therfore is hit with COST and even more COST to the TAX-PAYER to correct the current flaws and loopholes in the LAW. The "latent" effects is generally uncovered by the public until very late in the game--paticularly when the public is not educated on the "latent" effects as a result of the current existing LAWS.
It departs from the promises of our Constitution. People should be more aware, learn more and NOT WAIT until they are faced with a devastating INJURIES.
One thing I bought up in my article had to do with occupational diseases. Now that we are immersed in the field of biotechnology and workers are dealing with genetically engineered compounds, they risk the possibility of getting infected with some real serious stuff. During my career, I worked many hours at Genentech and observed first hand what goes on. Also spent lots of time at the Lawrence Berkeley and Livermore Labs.
When confronted with these issues of an employee contracting an occupational disease, the first thing the employers do is to fight releasing and information about what their employers were dealing with citing "trade secrets" as an excuse not to do the right thing.
Until there is a level playing field, nothing will ever get done to help those who need our assistance. Any big insurance will simply walk all over us.
That is true: "Now that we are immersed in the field of biotechnology and workers are dealing with genetically engineered compounds, they risk the possibility of getting infected with some real serious stuff.".
How about those employees that worked with sulfuric acid while in the Silicon Valley in manufacturing silicon wafers? What is the latent effects of THAT? Studies has not been made the effects of working with these chemicals some twenty to thirty years ago. There has been many deaths caused by cancers--lung cancers and breast cancers. Is there a link to the death of employees that worked with sulfuricacid--a dangerous chemical compound?
If there is an occupational diseases linked to working with coal by coal miners in this industry; what more could there be with sulfuricacid?
I think that the point that Patrice was making (and you should certainly read her book) is that some of these injuries/diseases take years of gestation before they rear their ugly heads but by then some of these employers have been out of business for years and the insurers will launch a scorched earth policy if you try to hold them accountable. Nothing but a bunch of vicious sociopaths!
How do you hold them accountable when the have a "Get Out Of Jail, FREE" card in the form of the Exclusive Remedy.
I can't tell you how many jobs I was terminated from because I refused to go into an area of friable unencapsulated asbestos with no containment or asked to handle carcinogenic chemicals without the proper safety equipment.
In the end, it's up to individuals whether they are stupid enough to put themselves in harms way.....
How do you hold them accountable when the have a "Get Out Of Jail, FREE" card in the form of the Exclusive Remedy.
I can't tell you how many jobs I was terminated from because I refused to go into an area of friable unencapsulated asbestos with no containment or asked to handle carcinogenic chemicals without the proper safety equipment.
In the end, it's up to individuals whether they are stupid enough to put themselves in harms way.....
I might add that even those individuals that ARE NOT stupid enough from placing themselves in harms way; by means of potential hazardous working conditions ARE being harmed "indirectly" by the cost increases in workers compensation insurance premiums for business owners and reduction in workers protections and WC benefits to the injured worker. While the employers and employees are getting ding and ripped off--the Insurance are gaining PROFITS year after year. I might also add that recent news indicated that some WC staffs are getting a raise in wages; while at the same time benefits has deteriorated even more since the passage of California's SB899.
This LAW affect us all one way or another (directly or indirectly)regardless whether an individual is a business owner; corporate owner or an individual tax-payer.
Employer should question any increases on WC insurance premiums and request justification and qualification for any increases in premiums. Labor market and individual employee and tax-payer should be careful and study any existing labor laws should do an independent analysis of any "reforms" to the labor law. New Laws should be scrutinized and studied the effects to the current laws and whether it affects the injured workers and employers in a positive outcome and thus level the playing field between these group that depend on the workers comp insurance and those that has an interest of the Insurance and their brokers and providers.
So far since inception or WC; the real premise has been lost. It had become a menace for the BUSINESS and TAXPAYERs in a broader sense but a highly profitable for the WC Insurance industry if not for all Insurance Industries.
Amen
Thank you for the share, have to say everyone has a perspective so do you have it, I am sure you will realize that how helpful it is.
Chris Harris