Thursday, May 8, 2014

If I Could Teach The World to Sing

A new comer to the workers' compensation industry remarked to me a very simple truism - an underlying fundamental in workers' compensation is that nobody trusts each other.

Workers, whether before or after injury, don't trust their employer, and particularly so once a claim has disappeared from HR's desk to the insurance company or claims administrator to process the claim, let alone efficiently.

Insurance companies and claims departments don't trust vendors, whether directly contracted or not, to actually provide what they say they would or to charge within fee schedule or contracted terms.

Providers, particularly medical vendors, don't trust carriers and claims administrators to pay them, let alone timely.

Regulators aren't trusted by anyone in the system to get done what needs to get done to process claim disputes efficiently.

The word and advise of defense attorneys isn't trusted by their clients to actually be what is represented (and that includes billing).

Attorneys representing injured workers aren't trusted by the defense community to act fairly or in the actual best interests of their clients.

There are exceptions of course, but this new comer, in his inexperienced, rookie eye, has made a very keen observation.

This universal mistrust is at the heart of reform efforts, stems from layers of either abuse or fraud at some point in time or another, and fosters a constant effort to micro-manage nearly every aspect of the system.

Employers aren't trusted by government to secure and pay for compensation coverage.

Carriers aren't trusted to provide benefits.

Brokers aren't trusted to place coverage where needed.

Judges aren't trusted to come to a reasonable legally justifiable decision.

Everywhere you turn mistrust permeates the system.

I guess it sort of makes sense. Mistrust was at the heart of the "Grand Bargain" from day one. Remember that workers' compensation came about because employers could not trust their injured workers to clean them out of factory and store with a jury verdict.

And workers didn't trust their employers and bosses to take care of them if injured in the course of rendering services so the company could make a profit, even after a jury verdict.

I think that this grand mistrust eviscerates nearly every nook and cranny of workers' compensation, which is why central pods of decision making authority have been compromised over time, and why our work comp laws, particularly in the most untrusting states like California and New York, are hugely complex.

Which is why claims adjusters no longer just settle vendor bills and why litigants can barely agree on a doctor to render an opinion.

Maybe this is just a reflection of modern society.

This mistrust drives a lot of business. Bill review, independent medical review, investigations, payroll reporting and carrier auditing - it doesn't matter where you are in the system. Someone, somewhere along the workers' compensation landscape is looking jaundice-eyed at YOU.

I think much of this is just the kind of information we are exposed to.

Rarely do we hear any stories of deeds done good.

When was the last time you heard of anything in the media about an injured worker having a successful outcome and overcoming adversity to get back on the job?

When was the last time you heard about an employer thankful they had insurance and that the claims administrator did a good job?

More often than not we see press releases of fraudulent acts and the criminals who perpetrate them getting taken to task.

Or stories of cases where the injured worker seemingly got more than they deserved or should have received.

I can't resolve this mistrust. You can't either.

But I do have a suggestion - when something actually goes right in this wacky world of work comp, take just a moment and say, "Thank You."

Maybe I'm being a little polyannish, and maybe my liberal Italian heritage has overtaken rational thinking.

Perhaps I watched too much TV in the 80's when Coca Cola had the whole world singing in perfect harmony.

Perhaps I trust too much.


  1. Agreed, Mr. DePaolo. We need to focus on and promote the positive nature and success stories of the workers' compensation world!!!

  2. Keep the HOPE, Peace

  3. And once the positives shine through, perhaps new thinking will too. That is why I write my blog, to get people thinking again, instead of succumbing to the vendors they don't trust, the attorneys they don't trust (present company excepted), and so on. If I was just sitting on my behind and not meeting people engaged in making our health care system better, I'd be no more useful to the work comp industry than your newcomer, rookie-eyed associate. But I have met people who have come from many different backgrounds and have ideas that can help work comp break out of the broken, dysfunctional "Grand Bargain" morass you describe. And by the way, I discussed your writing about CA with someone the other day and they wanted to know why CA is like that. The only thing I could tell them was what I know from when I worked on WC Stat Reporting and read the CA WC Stat Reporting manual. It read like some surfer dude wrote it, but that's another story.

  4. David,
    Thank you for keeping an open heart and mind while in the perilous and often cynical jungle of workers' compensation.

    Kevin Gregerson