Work Comp Carriers Seek To Limit Medical Care Through So-Called Reforms

A primary purpose of Alabama’s Workers’ Compensation Act is to provide medical care to injured workers so that they may heal and return to gainful employment. Yet, the system often fails injured workers. When the system fails, all of us suffer the costs.

The last year has seen efforts by the insurance industry to reduce medical benefits in many states throughout the United States. All of these efforts come at the expense of workers and their families. Here, in Alabama, Senator Arthur Orr proposed a bill that would arbitrarily cut off medical care at a point in time. Make no mistake — someone will bear the cost of needed medical care. The question is:  Will the insurance carrier that collected premiums pay this cost or will the taxpayers bear it? If the insurance company does not use some of its collected premiums to pay the cost, then either the government will provide care through programs like Medicare or we will all pay the costs of lost productivity by the worker later.

As part of their efforts, the insurance industry has engaged in a media and lobbying blitz aimed at convincing everyone that costs are being driven by excess prescription medications, especially pain medications. Workers’ compensation attorney Jon Gelman recently had a great post on this issue titled “Sidetracked by Drugs.” I am going to copy it here (with full credit to Jon of course):

 Sidetracked By Drugs

The core health care delivery problems that exist in workers’ compensation are not being driven by the alleged excess prescriptions of pain relief medication. That is a symptom of a system that has been derailed.

The focus of major employer and insurance initiatives of so-called reform legislation in multiple jurisdictions has been to reduce the delivery of prescriptive pain relief. Actually, that is an enforcement issue only that globally exists in the health care industry. New York’s Mayor Michael Bloomberg, is working diligently to identify and database the few prescribers and physicians involved.  A national effort modeled after the New York process would go a long way to curtail excessive and unorthodox prescriptions.
To use the prescription drug abuse issue to attack workers’ compensation generally is merely sidetracking the real problem with the medical delivery system which is the global denial of compensability of workers’ compensation claims by employers and insurance carriers merely to delay and avoid payment of medical benefits.
The recent decision in Federal Court recognizing RICO violations by an insurance carrier, the employer medical expert, and the employer itself, puts the real focus on the problem.  That decision demonstrates the need to get the workers’ compensation train back on the tracks and redirect the system so that it pays benefits to injured workers in an efficient and timely basis.

I agree completely with Jon that this is an issue largely created by insurance carriers to attack the workers’ compensation system. If we want to deal with the few providers involved in prescribing excess medications, we could easily do so. The real problems in the system are the denials and delays in needed medical care. I hear these issues on a daily basis from my clients. Most injured workers want needed care as quickly as possible so they can return to work. I also hear from doctors who want to provide treatment but constantly have their requests delayed or denied. Then, when the doctor finally does get permission to provide the prescribed care, the carrier delays payment. All of this leads to frustrated and angry workers who don’t get better. It also leads to frustrated health care providers. Some of the best physicians eventually give up and refuse to take any more of these cases due to the administrative issues of approval and payment. The call to reform should focus on getting medical care to the injured workers who need it, not attacking them.

1 Comment

One Response to Work Comp Carriers Seek To Limit Medical Care Through So-Called Reforms

  1. Pingback: Workers' Compensation System and its Impact on Workers | Alabama Injured Worker Forum

Leave a Reply

Your email address will not be published. Required fields are marked *