I recently spoke to the Alabama Self Insurers Association, in a session called “The Wild & Wacky World of Workers’ Comp”. A large portion of my message was that many people – in fact most – outside the workers’ compensation system either do not know what comp is or have no clue how it operates.

That is a problem for them and the industry. We see this all the time right here in my office.

It is surprising how many people are completely clueless when it comes to workers’ comp. Many (MANY!) believe that workers’ comp in this country is a singular entity, a nebulous yet all controlling concern that runs the entire system. Of course, if there was such an entity, they would have a website.

And their domain name would naturally have to be WorkersCompensation.com.

We see it all, as people routinely contact us believing we are the government agency/insurance company/claims management/evil operation in charge of their policy or claim. And of course, as the guy who runs the show, I am the one responsible for the denial of their claim. The delay in their settlement. The lack of authorization on their prescriptions, or the one who should know Johnny down the street is committing fraud.

This basic lack of awareness or information hurts both the newly injured and the industry established to tend to them. The belief that workers’ comp is in any way simple, controlled by one overarching entity, does not leave the injured worker at all prepared for the juggernaut of complexity headed their way. Likewise, newly injured are often confused and frightened. They lack much control over what is happening to them, their income and livelihood are at risk, they are handed off to someone they do not know who works for a company they have never heard of, and everyone from the Doctor on down is too busy to answer their many, many questions.

It is a recipe for litigation stew, and we are unfortunately excellent cooks.

These misperceptions also encourage the disability mindset that we have spent so much time discussing of late. The perception that there is a system that will compensate you if you never return to work is enticing to some, and unconsciously affects many entering the system. I recently dealt with this in my own family.

I have a 35 year old nephew who has been, for all practical purposes, estranged from our family for many years. Working as a pizza delivery driver, he has a wife and two young children. We are not often in contact with him, but we are continually impressed that we can count on him being there when he needs something.

I got an email from him several weeks back, in which he explained that he had been beaten during a robbery while delivering a pizza. He needed advice related to workers’ comp (After all, I am the guy who runs, to quote my favorite Canadian monopolistic workers’ comp CEO, “the whole shitaroo”). He detailed his injuries to me, one of which was a “9mm aneurysm” in his left temporal artery, “not hemorrhaged yet just enlarged”. He did not make me aware of any other injuries other than the temporal artery aneurysm and a broken nose.

His primary question was regarding his medical care. He was concerned that workers’ comp had sent him to an ENT Plastic Surgeon to repair his nose, and that surgeon also would repair the aneurysm. He felt he should have a Neurosurgeon for that, and comp would not provide one. I am not a Doctor – I don't even play one on TV – but I believe these type of aneurysms are often treated in vascular clinics, and can be repaired with a high degree of confidence, as “Simple elective ligation and excision of the aneurysm is curative.” My advice to him was to check on the credentials and history of this specific doctor, but barring any negative information found, he would likely be able to successfully treat this.

But here is the real message: His email also advised me that his paperwork says “MMI unknown at this time, Anticipate permanent impairment.” He went on to tell me that this was a “life changing” incident, and that he may never be able to drive again, at “least not for work, even if I wanted to.” He had also consulted two attorneys, both who declined to represent him, calling his case “open and shut” and not seeing a need for him to “give up a portion of my settlement on such an easy case.”

Now, I wasn’t born to workers’ comp yesterday, and I recognize the sound of the total disability engine being revved up to full RPM when I hear it. Beyond the medical question I am not sure what advice he expected, but I was probably the last person he should talk to about permanent “disability”. My response to him follows:

[State redacted] largely allows the employer and their representatives to direct medical care. There are some things you can do early in the process, but at this point getting a neurosurgeon approved will probably be difficult. I don't know your condition or related risks, but they obviously are confident Dr. [redacted] is up to the task. You can do a pretty thorough check on [redacted] by seeing if he has had any complaints filed against him with the state or the AMA. Most of those records are readily available online now.

Outside of that, I can only recommend that you take as active a role in your own recovery as possible. Ask questions and expect answers – any settlement you get will likely be predicated on the percent impairment you are assigned at MMI. Workers' comp will not compensate for pain and suffering, only for potential economic loss based on your expected abilities at MMI.

Again, not being familiar with your condition or if motor skills are affected, you should remember that impairment is a physical condition, while disability is often a mental one. I have met people in this business who are missing both arms or both legs and they still climb mountains (literally – one I've met has an interesting site at http://www.thesolutionrevolution.com/ ).

They have an impairment, but are not disabled. You need to try to get to that type of situation here – you have a family to support, and comp is probably not going to do that at any level that will meet that need.

The point is somewhere this young man may have been given the (false) impression that there was a path to guaranteed income without the normally required effort to acquire it. It sounds as if he has crossed paths with at least two honest attorneys, who assessed his case for what it is, and likely do not see the pot of gold at the end of his disability rainbow. However, misperceptions about workers' comp and what our disability system entails lead us often down this path.

The bottom line is that we need much more effective education and communication for employers and the people who work for them, preferably before workers’ comp is ever needed. Clear information about what comp is, and more importantly about what it is not, could save us tremendous trouble in our future endeavors. An informed and involved injured worker is more likely to become a recovering worker if they know the rules of the game before they draw their first hand.

If you are a claims person dealing the cards, it would behoove you to remember that. The person you are dealing to does not know the rules, and their misperceptions about both your responsibilities and theirs could make this a very expensive and unproductive game.

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Read Part II in the Perception Series: Why Disabled People Have a Perception Problem

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