A Win-Win Workers' Comp Approach for Employers, Employees and Taxpayers


Posted on 04 March 2011

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By Assemblymember Luis Alejo

Victor works in the Central Valley for a landscape business. One day, he’s asked to climb a tree to prune its branches. That’s not out of the ordinary, but this time, Victor loses his footing and crashes to the ground.

Writhing in pain, Victor is driven by his employer to a nearby clinic, where they discover that he’s fractured his spine. He’s then transferred to a hospital, where they treat the break, recommend surgery and hand Victor a $5,000 bill.

Victor returns to his employer with the bill and the news that he needs surgery. His employer not only ignores the recommendation for surgery but also refuses to pay the bill.

This is a true story. Victor is one of the 3.7 million laborers in California that work for less than $10 an hour to grow the food for our tables. They often endure grueling conditions, exposure to pesticides and a high risk of accidents.

Their employers are legally required to provide workers’ compensation insurance, which guarantees medical care and financial support to any worker injured on the job. Yet, many of these low-wage workers are effectively excluded from coverage. Either their employers don’t carry insurance, in violation of state law, or they don’t tell their workers that these benefits exist for them.

One person who makes sure workers know is Dori Rose Inda, a former social worker turned attorney who worked with community partners to establish the Agricultural Workers’ Access to Health Project to improve injured workers’ access to the care and financial assistance that their employers must legally provide. As a result of her work in Monterey, Santa Cruz and San Benito counties, nearly 900 workers have received instruction on how to access medical care and financial support for job-related injuries and illnesses.

Dori leads a statewide collaborative of more than 25 public agencies, nonprofits, attorneys and employers dedicated to improving enforcement of the workers’ compensation system so that taxpayers no longer subsidize uninsured businesses. Employers already obeying the law should especially appreciate Dori’s work, since they would pay less as more companies get their own insurance.

Dori has also collaborated with Kaiser Permanente to have a community clinic in Watsonville serve as a workers’ compensation provider. She calculates that replicating this service-delivery model throughout California could save taxpayers $100 million a year — by shifting the cost of treating injured workers at clinics from government coffers to the employer-funded workers’ compensation program.

For her work, Dori will today receive the prestigious James Irvine Foundation Leadership Award, which recognizes Californians making progress on difficult state issues, provides $125,000 in support and encourages replication of these successful projects. That’s just what we should do.

Expanding her model wherever possible will require ensuring that community clinics have the resources and the systems in place to treat injured workers and cover the cost through the workers’ compensation insurance system. Clinics are strategically positioned to play a critical role as we implement federal health care reform, since they already provide primary and preventive care to low-income and underserved communities. Since they are often already treating these same workers, a better understanding of how to do this through workers’ compensation will help them obtain payment from that insurance program (rather than utilizing their tax-supported funding).

Victor unknowingly worked for one of those uninsured employers. Fortunately, he found Dori’s program, which helped Victor navigate the process for the Uninsured Employers Benefits Trust Fund. Victor ultimately obtained the additional treatment that he so desperately needed.  

In the end, Victor was fortunate. But many injured workers aren’t so lucky. If we, as consumers and employers, benefit from their labor, then we must ensure that they’re protected – by existing laws and programs – when they’re hurt. It’s the right thing to do, and it’s entirely within our reach.

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Assemblymember Luis Alejo represents California’s 28th district.

rs’ compensation insurance system. Clinics are strategically positioned to play a critical role as we implement federal health care reform, since they already provide primary and preventive care to low-income and underserved communities. Since they are often already treating these same workers, a better understanding of how to do this through workers’ compensation will help them obtain payment from that insurance program (rather than utilizing their tax-supported funding)

You are absolutely correct in your observation. Often times cost for work injury is wrongfully shifted to other public programs. That is a very big issue. In my personal experience, I discovered that many of expenses that should have been charged to WC insurance carrier were inadvertantly charged against Medicare. Had I not discovered this and insisted my personal insurance billing coordinator to correct those improper charges, those thousands of dollars of medical cost may still be in MEDICARE's books. Perhaps situations like this may have contributed to the current fiscal problems we have in this vital MEDICARE program.

The other problem is that the Center for MEDICARE Service (CMS) should do a better job at scrutinizing the medical cost charges by various Medical Provider and program. Furthermore, CMS should exercise it reimbursement rights under the Subrogation clause. The Public also has a responsibility to make sure that medical charges against their insurances are accurate.