Work Comp Insurers Paint Misleading Picture Of Medical Costs!
Generally, workers compensation provides two important benefits. The first is medical care. The second is money you receive for your impairments or disabilities. These are essential benefits for working men and women facing a serious work-related personal injury. I’ve helped injured workers for more than 25 years. Almost every single client has the same worry — How quickly can I get my medical care and resume my normal life. Medical care and recovery are the main concerns. Most injured workers start the process hopeful.
Too often, insurance carriers then ignore, delay or deny their need for medical treatment. If you’ve suffered a serious work-related injury, you may have experienced the frustration of waiting on a work comp adjuster to call or approve care. You may have experienced the tricks used by insurance carriers to avoid providing necessary treatment. I understand. You do have options.
Let me get to the point of this post. Recently, I read an article about a misleading study produced by the National Council On Compensation Insurance (NCCI). What is the NCCI? Take a look at its Board of Directors! It’s a virtual who’s who of the biggest work comp insurance executives. You think they might be biased just a little! Years ago, the tobacco industry had similar groups telling consumers that smoking was healthy!
What About All The Costs Of Medical Care Work Comp Carriers WRONGLY Shift To Health Insurance Or Medicare?
The NCCI study only examines a very, very narrow set of costs. It appears to just compare the basic medical bill for a single patient to receive treatment under one system versus the other. That’s misleading.
Every day, I speak to workers suffering serious injuries who’ve been forced by a work comp carrier to seek treatment under regular health insurance or some government plan. These workers were injured on-the-job. They needed care. They were entitled to medical treatment under work comp. Yet, the comp adjuster ignored their calls or wrongly denied their claims. Eventually, they had to seek treatment elsewhere. Real research shows the overall cost of care wrongly shifted away from comp insurance carriers is tremendous. Here’s my first problems with the study — A true study would consider ALL costs to the healthcare system.
If you are an injured Alabama worker needing work comp benefits, you have options. Be proactive. If needed, seek proactive legal counsel. If you allow the comp carrier to shift your care to private health insurance or a government program, you could make it difficult to later get needed disability benefits from work comp.
Work comp carriers obviously try to shift costs at the onset of an injury. Adjusters ignore calls. Adjusters delay care. Those are typical tricks to shift the costs of care. But, that’s not the end of their effort. Many work comp carriers also condition any case settlement on an agreement requiring the worker to give-up or close their right to continued medical care. In other words, future costs are also wrongly shifted at many settlements. At that point, costs are often shifted to Medicare and Medicaid. The rest of us pick up the tab. If you are an injured Alabama worker considering a settlement that closes your medical rights, you could leave yourself with no ability to pay for later care.
What About All The UTILIZATION COSTS Work Comp Carriers Incur Trying To Avoid Valid Claims? Why Are Those Included?
You may not know what I mean by “utilization costs.” Let’s assume you suffer a bad back injury at work. The work comp carrier sends you to its gatekeeper doctor. In Huntsville, that’s usually the Occupational Health Group (OHG). These doctors don’t do much. After a few weeks you are still hurting and unable to function. You get a MRI which shows you have a ruptured disc. You need specialized care. The work comp carrier has no choice but to send you to an orthopedic surgeon or neurosurgeon. That specialist see you and determines you need surgery. Now, you have a problem. The comp carrier was OK paying small charges for office visits. But, the adjuster definitely does not want to pay for a surgery. So, the adjuster has some outside doctor issue a report saying the surgery is NOT necessary. This outside doctor may be somebody far from Alabama who does nothing but review records and generate reports. That’s what we often see from “utilization reviews.” They are reviews of prescribed care. Too often, they are simply a means to generate paperwork allowing a denial. That’s wrong.
Too many injured workers and too many lawyers simply accept these false “utilization reviews.” But, you don’t have to accept them.
Back to the NCCI study. When you deduct all the utilization review costs (the costs carriers incur trying to avoid medical treatment), the comparison is much different. Once those are deducted, the one-on-one comparison for specific procedures looks pretty even to me.
If you are an injured Alabama worker wrongly denied medical care by an artificial “utilization review,” you have options. I’ve fought these battles many time. I believe our local judges clearly understand the difference between a local medical specialist who prescribes treatment after an examination AND a hack from far away who simply generates reports to deny claims. Both may have medical degrees. But, only one is a real doctor providing real care.
How Can You Compare Care When The Most Disabling Conditions Often Occur In Traumatic Work-Related Accidents?
How can you even have a fair comparison of specific treatment? Think about it. In the United States, we have many people who become disabled due to chronic illnesses like diabetes or end-stage renal disease. These conditions are not often attributable to work comp. So, you cannot compare the costs of treating a diabetic patient under group health to the (largely non-existent) costs under work comp. I would expect work comp costs to be lower for these conditions. No good comparison exists.
The same is also true for some of the most severe conditions like chronic neck and back injuries. Many of the most debilitating back and neck conditions occur at work. Naturally, many of the most complex and chronic head, shoulder, and spinal conditions were caused by work-related accidents. So, you really cannot fairly compare the costs of certain surgical or rehabilitative care. I would expect work comp costs to be higher for these conditions. No good comparison exists. The NCCI people should no better as well.
What Should We Really Be Asking?
Health insurance and workers compensation coverage serve two important but different purposes. Because of that, no fair comparison exists. The real issue is very different.
What is the real issue? The real issue is simple — What costs are wrongly shifted from work comp? It’s an important question. Work comp insurers collect premiums to pay for work-related care. When they shift their costs to private plans, our premiums increase. When they shift their costs to government plans like Medicare and Medicaid, our tax burdens increase. When they shift their costs, injured workers also lose in many ways.
What should we do? If you are hurt on the job, you need medical care. Work comp should provide it. Be proactive to get the care you need. Alabama workers’ compensation laws are unfair to injured workers. But, you do have rights. Seek good legal advice to protect yourself and your family.
The Blackwell Law Firm is an Alabama personal injury firm. From our office in Huntsville, we help seriously injured people statewide. If you have questions about any personal injury issue, let us know. We are happy to discuss answers. Our consultations are always free and confidential.