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ProPublica and NPR Say That Workers' Compensation Is Broken

April 21, 2015 by Catherine Montgomery

Last month ProPublica and NPR launched a joint  investigative series about the state of workers’ compensation, unleashing a firestorm of debate and controversy.

The articles report on some heart-rending and truly abominable cases of denial of benefits, as well as offer up legislation research and industry data analysis.  

Stay with me to the end because this blog post is long and link-heavy, but the issues are incredibly important.

A clue as to the results of the investigation: the series is entitled “Insult to Injury: America’s Vanishing Worker Protections.”

The opening article, “The Demolition of Workers’ Comp,” sums up the findings:

Over the past decade, state after state has been dismantling America’s workers’ comp system with disastrous consequences for many of the hundreds of thousands of people who suffer serious injuries at work each year....
The cutbacks have been so drastic in some places that they virtually guarantee injured workers will plummet into poverty. Workers often battle insurance companies for years to get the surgeries, prescriptions and basic help their doctors recommend.

The authors, Michael Grabell and Howard Berkes, cite drastically reduced benefits, hugely varying benefits by state, arbitrary time limits to benefits, and the instatement of rules that overwhelmingly favor business, such as the  trend of allowing employers and insurers to make medical decisions.

California’s workers’ compensation system, in particular, was condemned for allowing insurers to “reopen old cases and deny medical care based on the opinions of doctors who never see the patient and don’t even have to be licensed in the state.”

All this is happening, the authors claim, while employers are paying the lowest workers’ comp premiums in 25 years. The costs, according to the articles, are shifted from employers to taxpayers, who now absorb the estimated $30 billion in medical costs and lost earnings that workers’ comp should be paying.

Almost at the same time as first ProPublica article appeared, OSHA issued a report that echoes many of the series’ findings.

But many in workers’ comp decry the series as misleading, poorly researched, hyperbolic, and far from complete. The Insurance Information Institute criticizes the investigation as relying on incomplete information and poor data analysis. Other commentators, such as Joe Paduda and Mark Walls, point out that the series is mostly one-sided; failing, for instance, to cover the secondary-gain motivation that frequently hinders injury recovery.

Some indication of the opposing views and controversy can be gleaned, as David DePaolo points out, on the various workers’ comp LinkedIn boards.

Some California fallout from the series so far:

  • Prompted by the series, the DWC will audit Travelers Insurance’s handling of a denied benefits case that was prominently featured in the lead article.
  • The California DWC sent out a newsline stating that “[a]greed-upon medical treatment must be honored; in effect, that SB 863 should not be interpreted as allowing claims administrators to reopen old cases barring a change in the injured worker’s condition.
  • The California Senate Labor and Industrial Relations Committee held a hearing about SB 863 and its impact on both injured workers’ care and employers’ costs.  

More to follow, I’m sure.

Whichever side you take, the series as well as the backlash, is worth reading.


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