Thursday, September 11, 2014

Start With The End

California workers' compensation suffers from hearing loss.

The noise is incredible. Insured employer groups are unhappy that rates are still going up despite "reform." Injured workers are shouting about inability to get treatment timely. Attorneys are yelling at each other, and the tumult of doctors running out of the system because they can't get paid is getting louder.

Service vendors are screaming for payment, insurance companies squawk about ratios, third party administrators raise clamor about margins, and the government sighs in despair trying to keep everything in order.

Despite the wailing and commotion, nobody is talking to each other. Expectations are distorted. Experiences aren't shared.

And everyone complains while trying to protect their turf. Self-insured or high retention employers seem to have the only positive reflections because of the direct control they have over their experiences.

At the California Workers' Compensation and Risk Conference in Dana Point, CA yesterday, I realized that while everyone is shouting at each other and tossing blame around, no one is actually listening.

Sure, people "hear" what is going on. There seems to be agreement that California just can't get workers' compensation right and that it is too complex, too lethargic, too unresponsive, too expensive...
Self explanatory...

And everyone has their "fix" which gets reflected in some reform measure and then fine tuned along the way with court decision alterations and legislative tweaking.

Missing is the harmony.

One of the sessions I had the opportunity to attend was, "Navigating Through the New Penalty Landscape."

In that session Dawn Watkins, Director Integrated Disability Management for the Los Angeles Unified School District, made an insightful observation: expectations are not in sync with the relatively new limitations in work comp.

Physicians haven't adjusted to the fact that not every "prescription" ordered is going to be authorized or provided. Injured workers don't understand that work comp isn't a free-for-all. Employers aren't getting that just because "reform" happens that their premiums are not going down. Vendors don't realize that it's not business as usual.

Watkins, I think, raised a very poignant example - employers/carriers need to "listen" to applicant attorneys. Employers don't need to agree with what the attorneys say, or want, but the applicant attorneys "see the wrong things that we do" and if time is taken to understand what fostered the litigation, corrective steps can be taken.

I saw Bill Zachry, VP Risk Safeway, Inc. and his omnipresent single lens reflex camera around the exhibit floor. Zachry has a very interesting take on conferences. He looks around to see which industry sector is exhibiting the most because that indicates where the most money is going.

Years ago chiropractic groups dominated the exhibit halls. Now it seems defense firms are most prevalent.

In it all, there is a communication going on: sectors through their exhibitions are telling Zachry where focus needs to be in order to bring some sense to this affair we call workers' compensation.

Workers' compensation has evolved into a system of mistrust. The whirlwind of noise occurs because no one trusts another, even if they are supposed to be on the same team.

And each special interest group exacerbates the mistrust by communicating only amongst themselves. There are separate conferences and conventions for applicant attorneys, employers, brokers, doctors, defense attorneys, etc. In each of these the chorus sings the same out-of-tune song - the "other side" is to blame.

Perhaps we need to take a break from workers' compensation for a short time and breath a little. Perhaps some meditation is in order so that we can focus on what we really need to do.

Watkins, referencing the initiation of a claim, said, "we need to start with the end in mind."

That is where the conversation needs to commence. The "problem" with the California workers' compensation system is that we can't seem to agree on what that end is.


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  2. If pictures are worth a thousand words this picture has to be worth twice that!