For all the barriers to care and benefits injured workers face in highly litigious states like California, where providers are recoiling from the system, workers in other states have a different problem: there aren’t enough applicant attorneys to help secure their treatment and benefits.

Shrinking payouts and benefits, tightened eligibility requirements, and more business-friendly laws have made the comp space a losing proposition for attorneys in states like North Dakota, where, according to the Wall Street Journal, just two attorneys, both nearing retirement, are willing to represent injured workers.

Alaska and New Mexico also reportedly show signs that there aren’t enough applicant attorneys to go around. It’s the latest sign that the “Grand Bargain” of workers’ comp, whereby employers agree to cover all work-related injuries in exchange for not being sued by injured employees, could be fracturing.

This is a reality facing too many American workers: systemic issues pushing necessary professionals out of the system, leaving many without the care they were promised in the event of an injury.

In One State, Injured Workers Can’t Find Lawyers…

North Dakota is one of four states (plus Puerto Rico and the U.S. Virgin Islands) that bar private insurers from the comp market, with state-run entities providing the coverage. After North Dakota’s Workforce Safety & Insurance (WSI) agency ran major deficits in the 1990s, legislators cut benefits, tightened eligibility, and capped attorney fees.

The result was double-edged.

North Dakota employers now enjoy the lowest premiums in the nation. WSI is beyond solvent and returns massive dividends to employers. However, injured workers can face an uphill battle, with almost no lawyers willing to take up their causes.

According to WSI critics, WSI’s reported 90% initial claim acceptance rate obscures a trend of the agency denying treatment and benefits down the road. Workers who aren’t getting what they or their doctors believe to be appropriate have little recourse, given that exactly two lawyers, ages 67 and 68, make up 100% of the attorney pool willing to take on comp cases.

The result, at least in some tragic cases highlighted by the Journal: injured workers with no legal training or experience are draining their savings and cashing out assets to survive while engaging in protracted battles with WSI.

…In Another State, Injured Workers Can’t Find Doctors

Meanwhile, in states like California, premiums are sky-high, and there is no shortage of applicant attorneys willing to go to the mat for injured workers.

The only problem: healthcare providers are recoiling from the system.

Facing persistent payment abuse by payers, providers can expect little protection from functionally inert state agencies like the California Division of Workers’ Compensation. Overwhelming administrative requirements create overhead that, in conjunction with some of the nation’s lowest fee schedule rates and rampant reimbursement discounting, makes treating injured workers a dubious financial proposition.

Well over a century ago, Maryland passed the first statewide workers’ compensation law, having concluded that it was the only fair way to hold employers accountable for the health and safety of their employees. The “Grand Bargain” has since become a battleground pitting various interests against each other, from patients to claims adjusters, small medical practices with limited resources to massive private equity firms with the budgets of small nations.

Somewhere along the line, it became far too difficult and fraught for medical and legal professionals, depending on the state, to offer injured workers the support they need to ensure that the bargain still works for them.

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