GUEST VIEW: PROFIT MOTIVATION DOOMED WORKERS’ COMP

Dr. Robert Milas – Sep 14, 2016

Workers’ Compensation was the first form of social insurance to be developed in the United States. Its purpose was to provide cash benefits and health care to workers and their families who were either injured, maimed or killed in the performance of their work related activities. In return, workers would lose their ability to file a lawsuit against their employers for damages of any kind. There would be mutual benefits for employees and employers to such a plan.

Employees would receive swift medical care with 100 percent coverage of their medical expenses within a three to seven days, while still receiving adequate financial coverage to support their families. Employers would have some control over expenses avoiding costly and prolonged litigation – a win, win for everybody.

So what went wrong? Unfortunately, the profit motivation for both industry and insurance companies came into play. Companies could avoid increased rates for their insurance if the work related factor were eliminated. Thus, many claims fall by the wayside because employees foolishly choose to work through an injury and neglect to file the appropriate “paperwork.” After the employee can no longer function, the claim is denied as non-work related. If the claim is eventually determined to be legitimate, the worker is referred to a health care practitioner of the employer’s choice for assessment of the validity of the claim and treatment – a process that can take weeks.

All the time this is occurring, the patient is under the guidance of a case manager, who may or may not be familiar with such injuries, and is being paid either directly or indirectly by the employer. Today, we all realize that continued employment is unlikely without that case manager being considered productive and cost efficient.

The injured employee exists in a limbo, frequently being shunted from one practitioner to another to receive care while the basically untreated injury morphs into a chronic condition. In the interim, the injured worker loses his or her self-respect, ability to earn a wage to support his or her family, and is reduced to a shell of a person frequently losing savings, spouse and home.

I am convinced that there must be a better way to ensure that both the injured worker and his employer are treated fairly. We in the richest nation of the world have to accept that any workplace regardless of how safe, will have injuries. Machines breakdown and a human body is no exception.

It is time to remove direction of care of injured workers from vested interests and have a non-bias civilian entity have input into the care and treatment of injured workers. Without such, these individuals will fall through the cracks and become the financial burden of society in general while enriching insurance entities and employers at society’s expense.

Dr. Milas is a neurosurgeon in Rock Island.