My father in law has been a widower for many years, and since he lives alone my wife and I try to meet him for a meal out a couple times a week. One of those meals has turned in to a regular event, and we meet him early every Sunday morning for breakfast before he goes to church. We’ve been dining in the same restaurant for years, and have become expected regulars. This restaurant is part of a large and presumably self insured chain, well known throughout the midwest and Florida. We’ve had the same server, (we’ll call her Carol) who presets the same booth in preparation for our arrival, for the last couple years. 

That changed about three months ago. We arrived one Sunday to find that Carol had fallen at work, and injured her knee a few days prior. All we knew was that there was a fracture involved, and it was not clear if or when she would be coming back. As the weeks went by we received status updates, and were happy to learn she was on the mend, and would soon be returning. This past Sunday was her first day back.

She was telling us about the accident, and having to drive herself to the emergency room after it happened. I asked her if the workers’ compensation people had treated her well, and her answer was both disappointing and instructive. She huffed a breath of frustration, and in her thick New England accent said, “Workers’ comp? Those workers’ comp people were terrible. They were worthless”.  

You will not be surprised that I asked her to elaborate. 

Carol had gone to the emergency room of a local hospital, where she underwent X-rays, her leg was stabilized and she was given pain medication. This was a Friday afternoon, and the ER doctor had advised her to follow up with an orthopedic specialist that following Monday. That Monday morning she received a call from the adjustor regarding her claim. She was told that she would have to wait 7 to 10 days before they would authorize a trip to a physician for her leg. She became quite animated as spoke about it, telling me they were crazy if they thought she was going to sit over a week when the Emergency Room had given her clear instructions to follow up on Monday. She told us she wasn’t about to sit around and let her leg get worse when there was no logical reason to do so.

I can’t say that I blame her.

She followed up with the doctor on her own, and ended up processing the medical care through her group health insurance. I was surprised they would pay for it, but she told me they authorized treatment and “were great; they took care of everything”. I did not even inquire about indemnity payments, and am frankly unsure of how this entire claim was treated. 

I can tell you that the 7 to 10 day delay in medical care she was told she must endure is ridiculous. 

I am sure there will be people in the industry who could explain it to me. There are no doubt technical and legal reasons, perhaps related to the initial review and acceptance of the claim. And that, quite frankly, can be one of the biggest problems with the workers’ compensation industry. We are a “people business”, established to provide care and assist recovery, but our actions and processes are based in legal and technical minutiae. Without a healthy dose of common sense, those two worlds rarely exist in copacetic harmony. 

Here we have a worker – a long term employee – injured on the job. The injury was witnessed, the fracture was real. Yet she is left by her employer and our system in senseless limbo, immobilized at home and wondering about her future. 

And we wonder why people retain lawyers.

Workers’ compensation has been under assault from several fronts of late. This has left many in the industry feeling embattled, and there have been open calls to highlight and discuss the good that the industry accomplishes. I understand and support those efforts. However, we must also understand that every workers’ compensation failure need not be a catastrophic one for our industry to be poorly defined. Simple (and stupid) actions like the delay I describe do as much collective damage every day as a major Propublica article. 

We need to remember that our actions define us, and for this particular injured worker, the definition of our industry is “terrible and worthless”. Can anyone successfully refute her perception?

Leave a Reply

Your email address will not be published. Required fields are marked *