Workers' Compensation Insurance Nightmare
By James Donahue
Everyone in the United States who works for wages is required by law to receive workers' compensation insurance. This insurance, paid by employers, is regarded as part of the payment the worker receives for labor performed.
Workers' Compensation Insurance was created to cover injuries received on the job, or treatment of some medical conditions that are considered to be job related. It sounded lie a good idea.
Like many government mandated programs, however, Workers' Compensation Insurance became a bureaucratic nightmare that fails to achieve what it was intended to do. Somewhere along the way it appears that the insurance companies had a hand in drafting the rules and making claims extremely difficult to acquire without hiring lawyers to help patients wade through the brambles.
My wife, Doris, and I learned from personal experience that rather than help, the program can actually prevent an injured worker from getting the medical treatment he or she needs to make a full recovery. It generates a financial trap that threatens not only the health of the victim, but the welfare of both the victim and his or her family.
Doris, who has worked for years in hospital laboratories all over the United States, sustained a back injury on October 27, 2001, when she lifted a box containing a sixty-pound bottle of liquid material needed for maintenance on a computerized testing machine she was using on the job.
She said the pain was so severe it knocked her to the floor. After it subsided, Doris checked into the hospital emergency room where she was seen by a physician's assistant, rather than a doctor. This man sent her home for bed rest, and told her to return the next day if she was still in pain. (She was.)
What Doris did not know when she reported her injury that night was that one of the papers she signed was a notice of claim for Workman's Compensation Insurance through the Michigan Hospital Association.
That hospital might have received payment, but a lot of doctors and hospitals that got involved in her case after that did not. As we later forged through the volume of paperwork and red tape required for dealing with Workers' Compensation claims we discovered that the program is a nightmare. Most people, unaware of the complex system of rules and regulations involved, would miss some of the hoops the first time through. We discovered that Workman's Compensation is notorious for not paying medical bills, and for shutting off claims for help if a single piece of paperwork, or a certain "T" is not properly crossed. If a doctor's secretary, or hospital insurance claims worker makes a mistake the bill sometimes becomes the patient's responsibility.
We discovered that doctors are so leery about the way the Workers' Compensation system works, they often turn away job injury patients rather than deal with the program. I suspect that those who agree to take on these cases usually give only minimal care, avoiding spending any time with the patient, diagnosing the problem, or bothering to even treat the injury. They run claimants through with maximum speed, sending them off to programs that generally work for the largest number of cases and (if they have a conscience) may cross their fingers and hope the patient gets better.
They do this because they usually don't get payment for their services, and I suspect that even if they are paid, the amount is far less than they get from fees to other patients. Also I am sure that Workers' Compensation involves, even for the doctor's office, lots of extra paperwork and there are multiple billings before a single penny is paid. This, unfortunately, requires additional staff and many extra hours spent interpreting the fine print on government forms and attempting to get volumes of paperwork completed.
Thus it was that we were caught in a web of red tape that became so complex in my wife's case, we spent months just trying to reach a diagnosis of what happened to her. As it was, six months after her accident, she had only been physically "examined" by one doctor. Of the seven doctors and three physicians' assistants who eventually became involved in her case, none of them seemed to agree on a diagnosis.
An attempt to by-pass the program and use our own medical insurance company to seek treatment failed. That is because our insurance company learned that it was a job related accident and referred the claim back to worker's compensation. And because we selected a doctor without approval from the worker's compensation consultant, our claim also was denied by worker's compensation. It was a classic "Catch-22."
We continued to fight using the following formula:
--Persistence in fighting, clawing and screaming every step of the way. Buying, begging and finagling every scrap of paper dealing with the case. And there was lots of letter writing to the Workers' Compensation office, the hospital where the accident occurred, and even to the local newspaper.
--Hiring a lawyer (outside of the area without local political ties or personal friendships with doctors and hospital administrators) who specializes in workers' compensation cases.
--Spending hours of research on the Internet in case histories and reports concerning back injuries. Every report obtained produced new "technical" medical words, in typical medical jargon. Every report thus required a new round of research until we deciphered the coded message and learned what the doctor was really saying.
--Once determining what was known about my wife's case, we pressed the doctors to go farther to order more tests to either rule out or confirm (our) suspected diagnosis. This is the hardest part, because doctors sometimes become angry when patients enter their office knowing too much about their medical history, and instructing the doctor what we wish done next.
I think this latter problem has something to do with ego. We must all remember when we are in medical centers that the doctor isn't the patient. He is the guy who has the power to order the tests, the treatment and the medicine. Even though we know what we need, the law does not allow us to do it ourselves.
It took us months to fight our battles. In the meantime, Doris' condition worsened to the point where she was losing control of her body. It turned out that the lesion in her spine was affecting nerves that were, in turn, threatening to make her a permanent invalid. We feared that what began as a spinal injury that could have been treated with proper diagnosis and care, was by now threatening to put her in a wheelchair for life. The final diagnosis, which we obtained after checking into a medical facility in Ann Arbor (on our own dime) was that Doris probably was suffering from the early stages of multiple sclorosis.
In the meantime, even after our lawyer succeeded in getting Doris reinstated for benefits, her paychecks, which amount to only about 60 percent of the amount she received while on the job, began arriving later and later.
Our concern about worker's compensation programs is that they are designed to wear down the average person who might be too sick, or too weak to fight. Like the Income Tax, the paperwork and the complex moves required to successfully endure a Worker's Compensation case are enough to confuse the most intelligent victims.
This is just one more argument in favor of socialized medicine. If we were living in a socialist country, or had a workable medical program operating in the United States, I suspect Doris would have been quickly back on her feet, back on the job and living a normal, productive life.
The MS diagnosis was never confirmed but the medical treatment she eventually received did its job. Doris lived the rest of her life without becoming an invalid although she did suffer a few attacks of temporary blindness and problems with muscle coordination. Her death in 2013 was from pancreatic cancer, which may have been triggered from all of the intense X-rays she endured while attempting to satisfy Workers Compensation demands.
By James Donahue
Everyone in the United States who works for wages is required by law to receive workers' compensation insurance. This insurance, paid by employers, is regarded as part of the payment the worker receives for labor performed.
Workers' Compensation Insurance was created to cover injuries received on the job, or treatment of some medical conditions that are considered to be job related. It sounded lie a good idea.
Like many government mandated programs, however, Workers' Compensation Insurance became a bureaucratic nightmare that fails to achieve what it was intended to do. Somewhere along the way it appears that the insurance companies had a hand in drafting the rules and making claims extremely difficult to acquire without hiring lawyers to help patients wade through the brambles.
My wife, Doris, and I learned from personal experience that rather than help, the program can actually prevent an injured worker from getting the medical treatment he or she needs to make a full recovery. It generates a financial trap that threatens not only the health of the victim, but the welfare of both the victim and his or her family.
Doris, who has worked for years in hospital laboratories all over the United States, sustained a back injury on October 27, 2001, when she lifted a box containing a sixty-pound bottle of liquid material needed for maintenance on a computerized testing machine she was using on the job.
She said the pain was so severe it knocked her to the floor. After it subsided, Doris checked into the hospital emergency room where she was seen by a physician's assistant, rather than a doctor. This man sent her home for bed rest, and told her to return the next day if she was still in pain. (She was.)
What Doris did not know when she reported her injury that night was that one of the papers she signed was a notice of claim for Workman's Compensation Insurance through the Michigan Hospital Association.
That hospital might have received payment, but a lot of doctors and hospitals that got involved in her case after that did not. As we later forged through the volume of paperwork and red tape required for dealing with Workers' Compensation claims we discovered that the program is a nightmare. Most people, unaware of the complex system of rules and regulations involved, would miss some of the hoops the first time through. We discovered that Workman's Compensation is notorious for not paying medical bills, and for shutting off claims for help if a single piece of paperwork, or a certain "T" is not properly crossed. If a doctor's secretary, or hospital insurance claims worker makes a mistake the bill sometimes becomes the patient's responsibility.
We discovered that doctors are so leery about the way the Workers' Compensation system works, they often turn away job injury patients rather than deal with the program. I suspect that those who agree to take on these cases usually give only minimal care, avoiding spending any time with the patient, diagnosing the problem, or bothering to even treat the injury. They run claimants through with maximum speed, sending them off to programs that generally work for the largest number of cases and (if they have a conscience) may cross their fingers and hope the patient gets better.
They do this because they usually don't get payment for their services, and I suspect that even if they are paid, the amount is far less than they get from fees to other patients. Also I am sure that Workers' Compensation involves, even for the doctor's office, lots of extra paperwork and there are multiple billings before a single penny is paid. This, unfortunately, requires additional staff and many extra hours spent interpreting the fine print on government forms and attempting to get volumes of paperwork completed.
Thus it was that we were caught in a web of red tape that became so complex in my wife's case, we spent months just trying to reach a diagnosis of what happened to her. As it was, six months after her accident, she had only been physically "examined" by one doctor. Of the seven doctors and three physicians' assistants who eventually became involved in her case, none of them seemed to agree on a diagnosis.
An attempt to by-pass the program and use our own medical insurance company to seek treatment failed. That is because our insurance company learned that it was a job related accident and referred the claim back to worker's compensation. And because we selected a doctor without approval from the worker's compensation consultant, our claim also was denied by worker's compensation. It was a classic "Catch-22."
We continued to fight using the following formula:
--Persistence in fighting, clawing and screaming every step of the way. Buying, begging and finagling every scrap of paper dealing with the case. And there was lots of letter writing to the Workers' Compensation office, the hospital where the accident occurred, and even to the local newspaper.
--Hiring a lawyer (outside of the area without local political ties or personal friendships with doctors and hospital administrators) who specializes in workers' compensation cases.
--Spending hours of research on the Internet in case histories and reports concerning back injuries. Every report obtained produced new "technical" medical words, in typical medical jargon. Every report thus required a new round of research until we deciphered the coded message and learned what the doctor was really saying.
--Once determining what was known about my wife's case, we pressed the doctors to go farther to order more tests to either rule out or confirm (our) suspected diagnosis. This is the hardest part, because doctors sometimes become angry when patients enter their office knowing too much about their medical history, and instructing the doctor what we wish done next.
I think this latter problem has something to do with ego. We must all remember when we are in medical centers that the doctor isn't the patient. He is the guy who has the power to order the tests, the treatment and the medicine. Even though we know what we need, the law does not allow us to do it ourselves.
It took us months to fight our battles. In the meantime, Doris' condition worsened to the point where she was losing control of her body. It turned out that the lesion in her spine was affecting nerves that were, in turn, threatening to make her a permanent invalid. We feared that what began as a spinal injury that could have been treated with proper diagnosis and care, was by now threatening to put her in a wheelchair for life. The final diagnosis, which we obtained after checking into a medical facility in Ann Arbor (on our own dime) was that Doris probably was suffering from the early stages of multiple sclorosis.
In the meantime, even after our lawyer succeeded in getting Doris reinstated for benefits, her paychecks, which amount to only about 60 percent of the amount she received while on the job, began arriving later and later.
Our concern about worker's compensation programs is that they are designed to wear down the average person who might be too sick, or too weak to fight. Like the Income Tax, the paperwork and the complex moves required to successfully endure a Worker's Compensation case are enough to confuse the most intelligent victims.
This is just one more argument in favor of socialized medicine. If we were living in a socialist country, or had a workable medical program operating in the United States, I suspect Doris would have been quickly back on her feet, back on the job and living a normal, productive life.
The MS diagnosis was never confirmed but the medical treatment she eventually received did its job. Doris lived the rest of her life without becoming an invalid although she did suffer a few attacks of temporary blindness and problems with muscle coordination. Her death in 2013 was from pancreatic cancer, which may have been triggered from all of the intense X-rays she endured while attempting to satisfy Workers Compensation demands.