Thursday, September 6, 2012

Bad Faith, Cost Shifting, Reform - Dissatisfaction or Lack of Relevancy?

Is it more than coincidence that yet another state's appellate court has rejected a worker's civil complaint for bad faith and fraud on the grounds that workers' compensation is the exclusive remedy?

Or that a study finds that an alarming amount of occupational injuries are not handled through workers' compensation?

Or that a really big state once again makes radical changes to its work comp system?

This year high courts in Texas and New Jersey both ruled that injured workers have no common law right to sue an insurance carrier for harm allegedly caused by its administration of a claim. Those cases were Texas Mutual Insurance Co. v. Ruttiger, handed down in June, and Stancil v. Ace USA, handed down in August.

A Connecticut case this week reinforced the concept in Desmond v. Yale-New Haven Hospital Inc. et al., No. AC 33072.

Desmond slipped and fell while working for the Yale-New Haven Hospital in December 2004. After her fall, she said her doctors diagnosed her with bilateral, acute post-traumatic carpal tunnel injuries that would render her permanently unable to use her hands if she did not receive medical treatment.

Her employer accepted her claim for workers' compensation benefits, but in May 2010, Desmond filed a 10-count complaint against the hospital accusing it of having made various filings with the state workers' compensation commission in a bad faith and fraudulent attempt to delay treatment, which resulted in a worsening of her condition.

The case was dismissed at the trial level.

Desmond appealed using a novel state specific argument which the appellate court decided did not apply.

That attempts are still being made to skirt the exclusive remedy of workers' compensation after so much case law does not make a trend.

But the creativity of claimants and their lawyers (Desmond was represented in the case by her attorney-husband) in trying to get around workers' compensation control might be reflective of something more disturbing - cost shifting.

There have been several studies and reports over the past few years indicating that less and less occupational injuries or illnesses are actually be paid for by workers' compensation systems.

Now the New Hampshire Department of Health and Human Services says that only about half of all occupational injuries end up going through the workers' compensation system.

In the Department's telephone survey of 6,892 adults in New Hampshire, 3,735 respondents reported working at some time during the previous 12 months, 4.9% and said they had been injured at work seriously enough to receive medical advice or treatment.

Of that total, 54% said all or part of their treatment was paid for through the workers' compensation system. About 25% reported their care was paid for by private or government insurance and another 21% said they paid for medical care through some other means.

"While respondents employed for wages are likely to be covered by the New Hampshire workers’ compensation system, our study estimated that only about half of those employed for wages and injured seriously enough to require medical treatment had some or all of their medical treatment paid for by workers’ compensation," the study concluded. "This represents a substantial financial burden falling on private and public insurers, as well as on individual families paying for costs out of pocket."

And as we are well aware, California's massive "reform" just 8 years after an earlier massive "reform" is certainly evidence of much gone awry.

I've opined before about whether or not workers' compensation in its present form is relevant to today's economy and society. Attempts to get around work comp exclusivity in the face of long standing legal precedence, studies indicating failure of workers' compensation to do its job, massive re-writing of laws; all should make us pause to wonder why - why is there such dissatisfaction with workers' compensation?

The reasons are probably as numerous as the way folks get injured on the job.

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