I could just as well have titled this article, “WSI, Just Give Dennis Whedbee His Goddamned Hand”. Investigative Journalism website ProPublica, in partnership with NPR, issued a scathing analysis of the workers’ compensation industry this morning, looking at what they term a continued degradation of protections and benefits for injured workers. The North Dakota monopolistic insurance agency Workforce Safety and Insurance (WSI) was prominently featured for everything that is wrong in comp today. 

ProPublica’s analysis shows that as many as 33 states have dramatically reduced benefits in the last two decades, largely abandoning standards established after the 1972 Federal Commission on Workmen’s Compensation, chaired by John Burton. These cuts, pursued mostly in the name of cost containment, have ultimately left some injured workers’ in poverty and have shifted costs to the taxpayer. The picture they paint is not a pretty one. 

Statistics can be a tricky thing, and there has not been time to review and verify the interpretation of their results, but frankly much of what they said hit home for me, with much of their message having already being conveyed in this blog. While the system works pretty well for the majority of non-critical injuries, it shows we can easily screw up those of the catastrophic impairment rendering kind. What they found should prompt all of us, as an industry, to take a long, hard look inward, and ask ourselves if this system is really all it should be.

Most appalling within the ProPublica article was a detailed look at several real life examples of the workers compensation system at its absolute worst. The WSI example, an oil field worker named Dennis Whedbee, lost his arm just below the elbow when a capped well suddenly ruptured. Despite his own doctor’s determination that he was a candidate for a fully functioning modern prosthesis with a movable hand, a doctor hired by WSI declared that a “hook prosthesis would suffice”. The agency ultimately admitted it’s refusal to provide the full hand prosthesis was in the interest of controlling costs. Whedbee rightly points out that he “lost a hand, not a hook”. The doctor that denied the full prosthesis, by the way, was located in Minnesota. The carrier had to fly Whedbee to his appointment from his home state of Pennsylvania.

I suppose that shows that distance is not an obstacle when you want to deny an injured worker any dignity or quality of life. After all, the cost of a plane flight to a doctor friendly to your cause is far less expensive than just doing the right thing. 

Another case in California was equally appalling. Joel Ramirez was “crushed” by an improperly stacked crate that weighed 900 pounds. It folded him in half, wedging his head between his feet and crushing his spine. He was left completely paralyzed from the waist down, was declared PTD and assigned 24 hour home health care. After SB 863 went into effect, however, a routine request by Ramirez’s physician resulted in his entire case being reviewed under California’s new IMR process. The physician used for that had no background in treating spinal cord injuries, but based on his findings the home health care worker was removed. This left Ramirez, who had no sensations below the waste, at times soaking in his own feces and urine for hours until his wife came home from work (A judge eventually ordered the restoration of home health care).

Did I say anything about lost dignity? 

Here’s the deal; these weren’t “red flag” cases. They weren’t suspicious soft tissue injuries no one could see resulting from an accident no one witnessed. These were bone crushing, limb separating injuries of the worst magnitude. There was no debate as to the compensability of the claim. Yet these people were screwed by a system that was supposed to protect them. 

Does anyone out there see the outrage in that? Of course they do.

I have the distinct privilege of working with many people in the workers’ compensation industry, and consider it a true honor. By and large, they are good, hard working, honest people who believe in the purpose and presence of our industry. They are honest in discussing the flaws of our system, as well as with their desire to see changes that would truly benefit those we serve. I can’t think of a single person I know, either as a friend or business associate, that would act in the manners described previously. Yet, we know they are out there. After all, some sociopathic son of a bitch somewhere made those decisions to deny or remove needed benefits. 

I frankly don’t know how some people sleep at night.

We can cite existing laws. We can hide behind established processes. Those are, however, actions of pure cowardice. They are convenient excuses to perform and defend inherently wrong actions. Just because it is legal, “that don’t make it right”. And cases like those described above should anger all of us.

I am not an enemy of the workers’ compensation system. I believe in the scope and purpose of our industry as it was originally intended. However, we have lost our way in certain circumstances. People who read my blog on a regular basis know my position on what we need to do – no need to rehash it here now. Suffice it to say that the threat to the stability and viability of workers’ compensation is real. The survival of our system, intended to serve both employers and their injured workers, is at stake. Forces are at work to dismantle and destroy workers’ compensation. Strong challenges to exclusive remedy and opt-out are two examples of this reality.

And those threats exist because our system has failed to change with the times. Far from being enemies of comp, I, and others, are trying to save it. We believe in a better way that offers improved outcomes with simplified processes. We know we need to take a hard look in the mirror, recognize our flaws, and fix them.

We have met the enemy, and he is us. 


You may read the full ProPublica article at http://www.propublica.org/article/the-demolition-of-workers-compensation.


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