A new study by the Workers Compensation Research Institute (WCRI) asks whether employees injured at work are more likely to file under workers’ compensation instead of group health insurance when their group health plan has a higher deductible. That’s interesting but it misses the real issue. The real question is why an injured worker would ever consider seeking medical care outside the workers’ compensation system at all. Really? Workers’ compensation systems were enacted in Alabama (and other states) to provide basic benefits like medical treatment. If those systems worked as intended, this would be a non-issue. Yet, workers consider using private health insurance because the work comp system has largely failed its primary purpose.
I speak with injured workers on a daily basis. Almost all of them have one goal. They want to get better and resume their normal life with work and family.
The WCRI research article wrongly frames the issue as a decision based simply upon medical deductibles. Let’s really examine why an injured worker would consider private health insurance (instead of work comp) in the first place. Injured workers should face NO barriers obtaining necessary medical care under workers compensation. But, they do. Those barriers are substantial and unjust. Here are three big ones:
- Long Delays. As I sat typing this post, I received a call from an injured worker. The doctor prescribed physical therapy for him weeks ago. He has waited patiently but heard nothing from the comp adjuster. Silence. That’s awful but not unusual. I recently spoke with a lady whose doctor had actually been emailing and messaging an adjuster for SIX months requesting a simple injection. Thankfully, the doctor documented all his efforts (and the lack of any response). Physician appointments. Medications. Therapy. You name it. Treatment that should be routinely approved in minutes takes weeks. When the treatment is more complicated or questionable, delays are even greater. We should penalize work comp carriers for unreasonably delaying necessary medical care.
- Bad Doctors. We have world-class physicians in both Huntsville and Birmingham. Need a back surgery? I know several excellent surgeons in our communities. Sometimes we see these good doctors helping a seriously injured worker. Too often, we do not. Why? In Alabama workers’ compensation claims, the carrier (not the patient) picks the doctor. Some comp carriers are more interested in picking the doctor who will overlook problems, ignore patients, or opt against needed treatment. It’s an issue of saving medical costs or shifting those costs to other sources. If you have practiced in this area of the law for long, you see the same few despicable characters who earn a living generating bad opinions against working men and women. When work comp carriers delay care or pick a bad doctor, some injured workers simply opt themselves out of this system. We should amend our comp system to allow some element of patient-choice.
- Claim Pressures. The first two issues (long delays and bad doctors) are insurance company issues. However, both employers and comp insurers engage in claim pressure. With employers, this usually means a supervisor encouraging you to file under health insurance instead of work comp. Sometimes that pressure is couple with an implied threat of losing your job. With comp carriers, this usually means an initial decision telling you the claim is “denied” or “under investigation” in the hope you drop the issue. Either way, the message is not to fight for benefits. We should enforce and supplement laws designed to protect workers from unfair treatment following an injury at work.
In a work comp system full of barriers, private health insurance may initially sound appealing to injured workers. Yet, the choice to use private insurance is a huge risk. What if the injury does not heal? What if the worker is left partially or totally disabled? Because the worker may not have reported or treated the condition under work comp, he or she may be left unable to recover important disability benefits. Nobody thinks they will become disabled. Some people do. The wrong choice for treatment can close the door to important disability benefits.
Injured workers deserve better. We all deserve better. When comp carriers push injured workers into using private group health coverage or government benefits, it shifts the costs to the rest of us.