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X-Raying Workers’ Comp 

Employers gain, insurers really gain, as for workers...

Thursday, Apr 22 2004
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The Arnold Schwarzenegger show moved to Long Beach this week, where he shouted “hasta la vista, baby” to fraud in the workers’-comp system at a Boeing plant in Long Beach. But if you’re a Boeing worker, you might want to hold the applause. Likewise, if you’re a worker without health insurance, or if you’re an older worker, or one with a sore back — you’d best think twice before jumping with joy, especially if you risk hurting yourself in the process.

For employees, reforms signed into law this week trade a few legitimate gains for a number of lost or reduced benefits. Employers, for their part, will have more control over doctors and treatments and the hope of lower insurance rates. Even better still is the outcome for insurance companies. They’ve emerged with a more profitable business climate and no obligation to share these gains. It was precisely what they wanted from Governor Arnold Schwarzenegger, whose campaigns they have heavily subsidized.

All these changes were wrought to tame an out-of-control $25 billion system, whose purpose is to help injured workers while also helping companies avoid litigation.

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“Throughout the reform, the most important thing for us was putting workers first,” Governor Schwarzenegger told his audience on Monday. “This reform will create workers’ compensation the way it used to be meant to be: to heal injured workers and get them back on the job.”

Democrats who signed on to this compromise, including state senator and liberal stalwart John Burton, hope it works out that way. But Senator Richard Alarcon (D–Los Angeles) voted no. “Clearly, there were tremendous reductions in benefits to workers,” said Alarcon, who chairs the Senate’s labor and industrial-relations committee, which has jurisdiction over workers’-comp bills. “The logic is that people were abusing the system. But these cuts will affect truly injured workers as well as those who abused the system. And because these reforms provide most of the control to employers, it is most likely that abuses would fall on the shoulders of working people. This didn’t turn out the way I wanted.”

 

So let’s start with that back of yours. It’s been bothering you off and on for years, but you toughed it out, didn’t miss a day on the job, didn’t ask for any lightening of the load. Until last week, when the agony forced you into bed. And now you can’t do your job, or work the hours you need to pay the rent.

You file a workers’-comp claim.

First off, you better hope that your pain shows up in an X-ray, or it will be a darn sight harder to get treatment than it used to be. If you fail this test, however, focus on the upside: Your sacrifice means that it also will be harder for the cheats to claim benefits.

The new system will squeeze out “fraud, inefficiency, incorrectness and litigation,” said Schwarzenegger spokesman Vince Sollitto. “In the past, because of the lack of objective standards for diagnoses or treatment, workers with the same kind of injury could get different awards. There was a large incentive for injured workers to litigate. We had the highest lawsuit rate in the nation and the worst return-to-work ratio.”

A running theme of the reforms is an insistence on “objective” medical findings to discourage fraud, even though the process will inevitably also work against some honest workers who are in pain.

Now, Mr. Sore Back, let’s say you used to play semipro baseball, or maybe you danced in the regional ballet. That’s pretty hard on the spine. So was lugging your three kids into the house when they fell asleep in the back seat on the way home — even if that was 10 years ago. And your previous job involved a lot of lifting, or maybe it was overly sedentary and involved too little lifting. And just maybe, at your age, the old back ain’t what it used to be anyway. Is it true that your grandfather had a degenerative disk? All that information gets considered. You may be 100 percent hurting, and 100 percent unable to work, but you’d get only 10 percent of the benefit if your current work in your current job has only borne witness to 10 percent of the damage.

And what if you’ve worked for companies that didn’t provide health insurance? Because of that, perhaps you didn’t get your stiffness treated while it was minor and an easier fix. Good luck with your claim, now that you’re nearly bent in two. Your pain is the system’s gain. After all, you can’t expect workers’ comp to serve the general health needs of the state’s 7 million uninsured. That’s partly what had happened before — workers were using workers’ comp as a fallback because they lacked regular health insurance.

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