Each year, our workers’ compensation system in Alabama faces new threats from the insurance industry. In some states, like Texas, the system has been dramatically altered leaving many injured workers unable to recover and return to gainful employment. Opt out systems like those in Texas often allow the largest and richest employers to write their own rules! Really, does anyone think companies like Walmart will write plans that truly protect their workers???
In Alabama, the system remains unfair. Year-after-year, our legislature refuses to address the injustice. Whenever the Alabama Legislature does consider even a slight improvement, it is simply an exchange for removing another valuable benefit. Indeed, big business and big insurance lobbyists view any slight effort to modify work comp laws as an opportunity to remove or reduce benefits.
Injured Alabama workers with a partial disability impacting their ability to work are often compensated below Federal poverty levels. Our state has not increased partial disability payments in over two decades! While benefits to workers are over two decades behind inflation, some of our legislators continue to propose new laws that would cut off other important benefits. These same legislators have raised their own pay (and that of other state officials during this time period).
What are the purposes of our workers’ compensation laws? Why were they created? A recent article titled Workers’ Compensation: The System’s Devastating Economic Impact on Workers’ Lives provides an excellent answer:
Workers’ compensation was created for two primary purposes—to provide at least partial compensation for lost wages and to pay for medical treatment and rehabilitation services for workers injured or made ill on the job.
The problem is that our system fails its intended purposes! Insurance carriers routinely refuse or delay needed medical care in an effort to save themselves money. Yet, the cost to society of leaving an injured worker unable to recover for an extended period of time is far, far greater. Every day, I see denials of medical care that are wrong. Is it right for medical care to be refused because the insurance adjuster simply ignores requests of the treating physician for weeks? Many adjusters ignore calls and emails from their own authorized doctors and the injured workers who need care.
Is it right for the insurance carrier to pick a surgeon and then subject all of their surgeon’s recommendations to some far away medical reviewer who may not even practice medicine? Alabama law has procedures for what is termed as a “utilization review.” In truth, this is largely a scam process for insurance carriers to subject valid medical requests to an outside “reviewer” in order to deny the treatment. I frequently see medical care denied because some person in California second-guessed the Alabama doctor after looking at the records. Of course, these “reviewers” never see the patient. Many times, these “reviewers” are only given partial records by the insurance company. Sometimes, these “reviewers” are not even doctors. Many of the ones who do possess a medical degree have never cut it as a real practicing doctor. Instead, they make their money rubber-stamping paperwork used to deny care. What should you do if your treatment is wrongly denied in this process? I can tell you what I do — I file a motion with the court to fight the denial. I try to force the far-away “reviewer” to come to court. Insurance companies know these denials are ridiculous. If you really fight, they usually give up before the truth is discovered by the judge.
Is it right for the insurance carrier to deny requested care repeatedly because of some claim as to missing paperwork that nobody understands? Some insurance companies use paperwork red tape to delay doctor’s offices. Somehow, the adjuster always needs a new form or always claims he did not receive the paperwork.
Because our system does not penalize or prevent insurance carriers from wrongfully or needlessly cutting care and benefits, the entire system is dysfunctional. Some adjusters provide care while a few bad ones delay endlessly. Usually, the worst these bad adjusters or their companies can suffer is a court order requiring the care at issue. Penalties are rare. Bad behavior is NOT deterred.
The first question I am usually asked by injured workers is, “How quickly can I get back to regular work.” When people are hurt, they want to get better. This is a primary goal of workers compensation. Yet, needlessly delaying or denying care frustrates this essential purpose. This costs the worker and his or her family tremendously. It also costs the rest of us in lost productivity. The article I mentioned earlier points out the results of allowing insurance carriers to disrupt the important goals of the system:
By compromising workers’ capacity to earn a living, injuries and illnesses unleash a cascade of destructive impacts affecting access to housing and food, stability of relationships, and poverty-related health problems.
It is unconscionable that workers’ compensation places much of the economic burden of occupational injuries and illnesses on workers and their families. This makes workers’ compensation all too often the accomplice, if not direct perpetrator, in pushing workers – especially low wage workers – into debilitating economic insecurity. Injured and ill workers report depleting their savings, sometimes taking out retirement funds or even declaring bankruptcy in their efforts to cope.
All of us need the system to work. Yet, it often does not. I have seen far too many clients who were forced into selling their possessions or declaring bankruptcy after months of begging for basic medical care so they could return to work. I have seen clients whose marriages and families were upended by the pain of injuries and the anxiety of the system. What’s more – the long-term trend does not look good:
Because every state has its own workers’ compensation program, there’s a dangerous race to the bottom as states compete to attract businesses by reducing workers’ benefits. In addition, the largely privatized nature of the system guarantees ever-deepening power disparities between workers and employers. This skews the system to primarily represent the interests of employers and the insurance industry, ensuring that discussions on workers’ compensation and reform initiatives are focused on the cost of the system.
Costs are important. If we are going to focus on costs, let’s look at the true costs. By that, I mean numbers beyond the short-term costs to insurance carriers paying claims. These insurance companies collect premiums and make a nice profit. In fact, they have the luxury of statistically knowing the frequency of claims so they can plan for their profit. Any focus on costs should focus on the much larger costs to communities when injured workers are unable to return to productive employment, unable to support their families, and unable to get the medical care they need. The costs to our communities and taxpayers at every level, are tremendous.
Medical disability costs a worker lost income. Medical disability costs a family lost support and opportunity. Medical disability costs communities lost productivity. Medical disability costs our government (us as taxpayers) resources. All these costs are far, far greater than the medical bills an insurance company should have paid in the beginning.
If we want a valued workforce that builds and sustains our communities, we must focus on requiring our workers’ compensation system to provide the important benefits originally intended. To do that, we must hold insurance companies accountable for wrongly delaying and denying valid claims. If you are suffering from a work-related injury, it is also essential you seek skilled advice from an attorney with a track record of fighting for clients in court.
The Blackwell Law Firm represents injured workers across Alabama. We have tried workers’ compensation, car accident, and other personal injury cases, to verdict in counties across our state. If you have questions, let us know. We are happy to discuss your legal issues.