The Patient-Centered Guide to Workers Compensation: Introduction
Today begins a series of posts about workers compensation that is written from a patient-centered perspective. Many of you reading this have workers compensation insurance. Workers compensation insurance pays for your medical bills and part of you salary if you are injured on the job and can no longer work. You may be under the assumption that the workers compensation insurance company will be on your side if you get injured on the job but this is often not so. In my line of work, I run into all sorts of problems that patients experience with workers compensation insurance. It is my hope that these posts will make you more aware of these problems and when possible, suggestions will be made on how to address them. To those of you who do not have workers compensation insurance you should still read these posts because you are not going to believe some of things that go on in the workers compensation system.
So let's begin with understanding one key fact. Workers compensation insurance is a business. It is not an organization designed to be your friend or to take care of you with the hopes of making you feel better. Like any business, workers compensation companies do not want to lose money. When you are not working they are losing money. If it is clear to the workers compensation insurance company that you are only going to be out of work briefly (e.g., broken arm) then you are not likely going to experience problems because there is an end in sight. It is in cases, however, where there is no end in sight to disability where you will begin to encounter resistance. For example, if you left work because of a back injury and your doctor wrote notes saying you are out of work indefinitely and the prognosis is not determinable yet, this is a perfect recipe for a battle with the workers compensation company. And trust me, they can really apply the pressure when they want to.
Before I go criticizing workers compensation insurance companies I should mention in fairness that there are people who fake injuries and illnesses so they don’t need to work and can live off workers compensation payments. This is known as malingering. In my experience, malingering is actually quite unusual but it does happen from time to time. It only takes a few bad apples to spoil the bunch. As a result, workers compensation insurance companies are especially on guard for malingering. This suspicion can drastically alter your benefits, regardless of whether you feel it is warranted. Stay tuned tomorrow for more specific examples and scenarios. Go here for the fist step.
So let's begin with understanding one key fact. Workers compensation insurance is a business. It is not an organization designed to be your friend or to take care of you with the hopes of making you feel better. Like any business, workers compensation companies do not want to lose money. When you are not working they are losing money. If it is clear to the workers compensation insurance company that you are only going to be out of work briefly (e.g., broken arm) then you are not likely going to experience problems because there is an end in sight. It is in cases, however, where there is no end in sight to disability where you will begin to encounter resistance. For example, if you left work because of a back injury and your doctor wrote notes saying you are out of work indefinitely and the prognosis is not determinable yet, this is a perfect recipe for a battle with the workers compensation company. And trust me, they can really apply the pressure when they want to.
Before I go criticizing workers compensation insurance companies I should mention in fairness that there are people who fake injuries and illnesses so they don’t need to work and can live off workers compensation payments. This is known as malingering. In my experience, malingering is actually quite unusual but it does happen from time to time. It only takes a few bad apples to spoil the bunch. As a result, workers compensation insurance companies are especially on guard for malingering. This suspicion can drastically alter your benefits, regardless of whether you feel it is warranted. Stay tuned tomorrow for more specific examples and scenarios. Go here for the fist step.
posted by MedFriendly | 9:18 PM
1 Comments:
Thanks for your excellent and unbiased series on workers comp. I just wanted to add a few observations to the issue of people on WC being videotaped. The real fraud in the WC system is not malingerers faking injury, but WC insurance companies using fraudulent means to deny WC claims to injured workers. A number of studies have shown workers comp fraud representing less than 2 percent of claims. As this article puts it: "Certainly, the tens of thousands of workers killed every year were hardly aiming for a free ride on their employer's tab."
There is an interesting article here from some guy who used to videotape workers comp claimants for a living, and he discusses the ways in which they were taught to avoid taping anything that would tend to support the claim, while taping things out of context that would tend to make it look like the claimant was malingering. I had a friend who was a retired cop who got a job doing what this guy did, videotaping people, and he barely lasted a week. They told him the same thing they told this guy, to always avoid videotaping any activity that supported the subject's claim, such as walking with a cane, or grabbing their back in pain after bending over. He told me they showed him training videos that were obviously cut and pasted together apparently to cut out the non-incriminating bits or present things out of context, and he couldn't believe any of this could actually stand up in court, as he had some experience and knowledge of the rules of evidence as a cop. He believed all the propaganda about "malingerers" cheating the system until he saw the reality with his own eyes and saw the games the insurance companies play to defraud people and destroy their lives. He quit in disgust.
One of the major sources of fraud is so called "Independant Medical Examiners" who are basically rent-a-quacks who get up to $1,000 to produce fraudulent medical reports. Often, they will do a back exam that is supposed to take 45 minutes in less than 5 and produce 5 pages worth of narrative based on that abbreviated exam. IMEs have been caught using reports that were verbatim identical between multiple patients, or using boilerplate reports that only differ in the numbers being presented. New York State has an IME fraud bill that every injured worker should know about.
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