Tuesday, July 8, 2014

The Pixelated Middle

It's a tale of two systems.

One system works nearly perfectly. The statistics support this perspective. Insurance companies make money. Injured workers get treatment. Physicians get paid. Employer's premiums are reasonable.

The other system is dysfunctional. There is anecdotal evidence of case after case where treatment requests are delayed, physician decisions are second guessed, and the social obligation is disregarded in the name of profit.

If you look out to the right or the left, you get a clear picture and it's one of the two alternatives above - polar opposites.

Look in the middle though and it's hard to reconcile the two different perspectives. The picture is pixelated, muddy, unclear - who knows the truth?
Why's the middle so fuzzy?
I go to conferences and talk with industry people and no one, it seems, can see the middle. Everyone seems to have a distinct opinion about how well workers' compensation does its job. Either it's doing swimmingly or it's a complete disaster, and there is not a whole lot of opinion in between other than "we can do better," which is a complete cop-out in itself.

The Texas Tribune published a blistering rebuke of that state's system, providing four vignettes of stories where the system failed, and failed miserably. Some take issue with the stories, saying they are atypical. Others say those stories should never have had to be told.

On the heels of that series is an editorial by Texas Commissioner Rod Borderlon citing statistics that make it seem the Texas system should be the model of all states.

In California there's this interesting cycle that folks just can't seem to leave alone. Some interests either want more money or want to spend less money so they come up with certain new twists on the law.

The courts get a hold of those new laws and apply their rationale and interpretation, which ends up being different that the originating interests had in mind, which, by the way, was never aligned in the middle any how.

Once judicial fiat issues there's a new round of interest group wrangling - again all out on the peripheries.

We see extreme cases where an injured worker decides to be his own lawyer, making workers' compensation his sole reason for existence to the point where he ignores The Rule of Law, perhaps in his quest to "stick it to The Man."

There are research groups identifying distinct geographic anomalies in statistical measures, but a failure in law enforcement to take any action for years until the pressure becomes unconscionable and then, after millions and millions of dollars have escaped the system and many injured workers have been broken does any action get taken.

The workforce demographic most in need of workers' compensation protection can't get the support of politicians in either state or federal government to recognize their participation in the economy, and consequently suffer disproportionately when an unfortunate accident occurs.

Though most states workers' compensation programs don't garner media attention, I don't know of any single state that isn't without controversy.

And it's easy to say, "it is what it is." Of course that is a simple excuse and base rationalization equivalent to Alfred E. Newman's "What me worry?" or Bart Simpson's "Don't look at me, I didn't do it."

Yes, quoting fictional characters is intentional here - because workers' compensation is a fiction. There is nothing in workers' compensation that is real. The system was created out of legislative bargaining. Statistics tell only part of the story. Shell games are done with accounting, and others just want to protect their jobs so there's little dissent.

The system functions acceptably if it's not used...

But the people for whom the system was originally created - those who basically live pay check to pay check - need the assurance of insurance.

When that pay check is interrupted by a work injury the social program should step in and start working immediately - not denials, not delays, not second guessing.

Those are the people in the middle where there is a lack of focus. They're the ones that are caught up between the extremes. The ones where the system fails because they are not a simple medical only, fix it and go back to work type of claim.

Those are the claims that actually require work on the part of the industry - all industry members - to get right.

I know there are success stories out there. I have blogged on them before. But there needs to be more. There needs to be a concerted effort on the part of professionals in workers' compensation to show the rest of the world that privatized social benefit systems work - and not just "some" of the time or even "most" of the time.

I suggest we start with this moral directive - that when the social mission collides with the business mission, the business mission take the back seat.

The business of work comp needs to be tempered and when someone or some group seeks to take advantage of others we need to do our concerted best to bring those folks to the forefront for public recusal regardless of whether they're operating as public officials or as private business persons.

A couple years ago I was asked to speak about the media's role in a healthy workers' compensation system. Though I went on for nearly an hour about The Press throughout history, the bottom line is that there's stories to be told, people to be kept honest and in check, that there are lies, damned lies, and statistics...

Not all stories can be told, nor can all statistics be examined. Hopefully though the picture of the middle will be clear. Not that we can ignore the extremes, but the extremes don't make for a well functioning system. Everything needs to work in concert.

1 comment:

  1. Right on the mark as always MR. DePaolo. I would say though, in reference to the line, "We see extreme cases where an injured worker decides to be his own lawyer. I would just like to say from my point of view, many of the iw's don't Decided to be our own lawyer's. We are being forced in to doing so. For many of our lower line cases are not worth the dollar amount it would take for the lawyers to want to fight for us... which I can not blame them. I would not want to work for free either. So the injured workers do end up, either giving up, which I think is the goal. Or going nuts trying to represent them selves in a system that is stacked against them intently legislatively. Left fighting on principle, or for principle, and no lawyer could ever live off fighting for principle. And the truth is, neither can the iw's.

    I know in my case over a 3 year period I have contacted at least 8 lawyers. The last couple telling me I had done all I could on my own, that they could do no better, and that I should run for office, if I wanted things to be fixed? Hmm?

    At what point do we call the iw's being locked out economically, and legislatively, intently, from obtaining justice in their care, what it is?

    Any time one group intently hinders another groups access to justice. There is going to be problems. Peace and thanks for all you do trying to report on the TRUTH and facts that are going on in our Workers Comp Systems across this country.