It's Just Work Comp

A former work comp adjuster and now a legal assistant for a work comp/personal injury in Oklahoma, wrote to me the other day about a claim that has been pestering her for too long.

Pestering as in she has been helping her attorney on a claim that has lingered far too long, resulting in unnecessary disability, and likely will result in the complete lack of employment in the future for this injured worker.

She sent me a copy of the letter she sent to the injured worker's treating physician outlining the history of the injury and treatment, or more accurately, lack of treatment in a timely manner and I need not repeat it here - the history is convoluted and lengthy as one would imagine from a 2011 injury claim that is still "active" in 2014.

Bowzer: "What's the Big Deal?"

In the meantime the injured worker racks up 61 weeks of temporary total disability awaiting the proper treatment.

The most important piece of the story, however, is this former adjuster's recognition of how this happens, that she was a part of this, and that this case is unfortunately exemplary of the state of workers' compensation around the country.

She wrote to me:
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Awareness is important in these matters.  Everyone has to understand the impact our decisions have on the innocent bystanders, which in most cases is the injured worker.  After all, what does the general person know about the practice of medicine, diagnosis, and surgical procedures.  They are trusting the folks in the white coats.  We grabble and argue with one another and these people are caught in the middle and have no control over anything.  Caught in perpetual turmoil.  How many of us would put up with this?  Do you want some adjuster, who lives and works in another state that you have never even met making decisions that impact your life?   

It is wrong on so many angles, including my own.  I am certainly not without sin in this matter. However, I am glad that ultimately I did the right thing and have not pushed for litigation to authorize an unnecessary surgery that would more than likely leave my client worse off than he is now.    

This crap is nationwide.  I mean, really why is there so much controversy in work comp?  It doesn't seem to be present so much in other areas of insurance such as personal health and third party liability. You know? Let's say you have personal health insurance, you go to your doctor because you injured your back.  You may get a letter from your carrier asking how you injured your back.  You answer stating I injured my back at home digging a ditch.  Your health insurance pays for your treatment. There is no court proceedings.  There is no fall out from your employer because you have to take time off work to attend physical therapy or whatever.  You are not suddenly held under a microscope and made to feel like a liar.  No, you just get treatment that is paid for per the provisions of your policy.  

So why isn't the same with the work comp injury?  You injure your back at work.  You should receive treatment as outlined in the provisions of the work comp policy.  Of course the work comp policy is defined generally by the state.  In Oklahoma that would be Title 85 or Title 85 (A) depending on the date of injury.  As a work comp adjuster I need to apply benefits as provided in the provisions of the work comp title.  It isn't rocket science.

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Indeed, why is there so much controversy in workers' compensation? 

It isn't rocket science - but we keep trying to make it so, with "evidence based guidelines" that are more about politics than science. 

And even if such guidelines were scientific, why does there have to be review after review, resulting in delay after delay?

What's the big deal?

Maybe a clue is in the deals that go on within work comp such as private equity firms buying claims adjusting firms for a billion or so dollars.

Or maybe its within short-sighted authorship of laws meant to transform dysfunction but resulting in greater confusion and ambiguity.

Maybe we try to make work comp too much about who's right or who's wrong rather than just recognizing that this is a privatized (for the most part) social benefit system.

Maybe we shouldn't emphasize "costs" when we all get together at our think tank type conferences - group think that puts all of the focus in the wrong places.

Maybe we need to reconfigure the conversation and instead of asking why things cost so much we should instead be asking why there's any controversy at all.

Remember? Work comp is a No Fault system. It's not my fault. It's not your fault. It's not the fault of the employer, the worker, the attorney, physician, broker, carrier or whomever ... unless timely and appropriate benefits aren't provided.

THEN we have fault, controversy, hearings, appeals and ... costs.

It's not rocket science. It's just work comp.