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Workers’ Compensation — Where Is The Fraud?

I recently published a post discussing the scene of a Las Vegas convention for industry insiders managing workers’ compensation medical benefits. My post is titled — An Industry Built Upon Suffering. It is a true statement — an entire industry of managers has been built upon the misery and suffering of injured workers simply seeking medical care. That’s wrong.

Workers’ compensation benefits in Alabama were created to provide injured workers with medical care. Most injured workers need and desire this care quickly so they can heal and return to work.¬†Instead, we now have an entire industry of benefit managers who work to complicate, delay and deny the needed relationship between an injured employee and his/her doctor trying to help.

Contrast the lavish Las Vegas party of insurance insiders against the typical injured employee. The insiders enjoy excess. Yet, injured employees are often left untreated and unable to provide for their families. While away in Las Vegas, those insiders are receiving messages at their offices from injured workers begging for medical treatment. I hear from injured workers daily who call and call the adjusters asking for care without response.

A recent post by North Carolina attorney Leonard Jernigan highlights the issue. In his post, Leonard discusses ¬†the biggest workers’ compensation fraud issues of 2015. He provides details on the biggest fraud cases as well as the actual amount of fraud in the system. It’s an eye-opening read. I would urge you to review that post. To put the cases and dollar amounts reported by Leonard in perspective, the math reveals 99.8% of the fraud is committed by employers/insurers/health care managers. The amount of fraud by actual workers is less than 1/2 of 1%. That’s very revealing math. It clearly reveals where the problem in our system exists. Yet, the study misses the largest source of fraud. What’s missing? The true cost of the effort to delay or deny care created by an industry of insurance managers interfering with medical treatment.

In my practice, I see and hear the daily struggle by injured workers for benefits. No valid excuse exists for insurance managers to ignore pleas for medical care or to bog doctors down in paperwork designed to delay the process. This may save the company a medical bill but it also adds tremendously to the overall costs of the system. And, it leaves injured workers without the treatment needed to return to gainful employment. That costs all of us.