Friday, June 29, 2012

Supreme Court and the Relevancy of Work Comp

Thursday's US Supreme Court ruling in National Federation of Independent Business, et al vs. Sebelius, etc. et al, had most workers' compensation observers opining about the impact of mandated health insurance on the cost of workers' compensation.

Yet, when I read the news and the opinion itself, in particular after having just written about the insane financial failure of the present workers' compensation system in California, my immediate thought was that we are one more step closer to declaring workers' compensation in its present form redundant, unnecessary, illogical and administratively, financially and socially irrelevant.

In our present iteration, workers' compensation, regardless of all its faults and costs, remains a very necessary element of a modern economy - all modern economies, and growing economies like China, recognize the need for protection of the work force that is responsible for creating national abundance. It is what defines a responsible society.

Workers' compensation has two basic elements - providing medical treatment to cure and relieve a person from the effects of an industrial injury, and to provide indemnity for inability to work while being cured and to offset the permanent effects of an injury on future income.

While there are limitations on employer participation in the Affordable Care Act, mostly related to the size of an employer's work force, and an individual requirement to have insurance, I suspect that a majority of people that do work are now going to be covered for medical care.

In that sense, then, what is the logic behind maintaining a medical component in workers' compensation? Why does there have to be any "cost shifting" at all?

Critics to this line of thinking say that general health care and industrial medicine are distinctly different because workers' compensation has in place the indemnity component, so physicians need to address medical issues differently, taking into account whether an injured worker can return to work, the nature and extent of any potential disability and the myriad of various reporting points in the monitoring of a worker's medical condition.

All of those arguments have one fundamental flaw - they all assume that a physician who is treating an injured worker must know all about impairment and disability.

That of course is nonsense. Most systems recognize a specific type of physician - those that have been trained to evaluate impairments and render opinions on disability. They are called Qualified Medical Evaluators, or Independent Medical Evaluators, etc. Disputes or concerns about impairment and disability are dealt with by those experts.

Treating physicians treat. Evaluating physicians evaluate. That is no different than what occurs under our current system. Some physicians do both, and quite often those physicians get one or the other incorrect.

And study after study has demonstrated that tying indemnity to medical status only increases disability - there is a reward system in place that unintentionally creates a more disabled work force.

If all of the work force has medical coverage then why go through machinations and discriminating maneuvers to determine through "causation" standards as to whether a worker should get treated via the workers' compensation system or the general health system?

Doing so just defies logic.

I can certainly support such activity when it comes to the indemnity component - put money on the table and people inherently try to find a way to put some of that in their own pockets.

But doing so for medical treatment lacks human compassion and social responsibility.

The US Supreme Court's action on Thursday isn't going to change things overnight. It should, however, further provoke the debate about the relevancy of workers' compensation in its present form.

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