This story illustrates how we are hurting injured workers which is equivalent to kicking them while they are down. This is about half the article so to see the whole article click the story SF Gaurdian.
I have personal experience with this and it is real. I saw this on another blog and had to post it. I will be calling and/or writing the Gov. to ask him to reform his reforms by saving money from insurance companies and not injured workers by stopping medical treatments please do the same.How Schwarzenegger is saving Wall Street by decimating workers' comp – a report from the front lines. IT WAS AN extremely fashionable thing in California politics last year to rant and rave about the workers' compensation insurance system. Newly elected governor Arnold Schwarzenegger made it a top discussion item, and the newspapers followed suit. To many people, it might have seemed like a bizarre obsession. As a political issue, the arcane system of laws governing how to treat work-injured people is mind-numbing.
It's true there were real problems with the system. Skyrocketing insurance rates were hurting businesses, and the insurance companies were still reeling from 9/11, a slow economy, and the unintended consequences of California's 1995 deregulation of the industry. And there was naturally some waste and fraud associated with the massive state bureaucracy.
Schwarzenegger needed a simpler story. The actor turned pol insisted the problem was litigation-happy attorneys and the injured workers themselves – a group he painted as cheats and scammers. Only by strictly limiting cash payouts to workers and keeping the attorneys at bay could he right this upside-down program – a system so shaky that more than 20 insurance carriers had gone belly-up in recent years.
He bullied legislators into passing a reform package just five months after he took office, and he has since declared victory: "Workers' comp reform has been a tremendous success," spokesperson Vince Sollitto told me. Since then, most lawmakers have moved on, occupied with other political fights.
But the real story behind workers' comp is still unfolding. Just days after the new law kicked in last April, life began to change dramatically for injured Californians. Once-routine medical visits were heavily scrutinized as potential crimes. Insurance companies started saying no to just about everything – according to doctors, workers, and attorneys I interviewed – almost as if they were testing the limits of the new law. …..
Fighting for careIt was late afternoon, and the plaza near Oakland City Hall bustled with people walking briskly under a gray midwinter sky. Mike Gerson emerged from a pair of massive glass doors and sighed. A grimace appeared on the attorney's weathered face. "You see?" he asked. He'd been showing me the ropes at the East Bay's main workers' compensation court, a place where miserable-looking workers sit in a waiting room for hours while attorneys cut deals in fast-paced, acronym-laden sessions down the hall.
It's never been a real friendly place to visit: this is where injured people wind up when they're fighting for medical care or when there's a disagreement over how to settle their cases. Workers' compensation laws can confuse professionals, let alone these neophytes.
……
As of April 2003, there were 3.69 million active cases in the state, and a million workers file new claims each year. About 200,000 of them are in the market for an attorney each year. (The state also keeps statistics on fraud, by the way, which show that only a tiny percentage of workers are even suspected of gaming the system – along with a handful of insurance companies, doctors, and attorneys.)
The law – passed last April by the legislature as Schwarzenegger threatened to bring even more stringent reforms to the ballot – cut costs in several other ways as well. It limited compensation for lost wages, gutted the state's job-retraining program, gave insurance companies the right to strictly manage medical treatment, and – perhaps most significantly – slashed the amount of money an injured worker can get to pay for the medical costs that will come with a lifetime of disability. Rules being promoted by workers' comp chief Andrea Hoch have made these changes even more severe.
The state hasn't done a study to show how payments for permanent disability will change, but according to UC Davis researcher Paul Leigh, those benefits will be cut by as much as 70 percent. A carpal tunnel syndrome patient he cites would see her payment – meant to cover medical care for the rest of her life – drop from $116,000 to just $17,000. Why? Much of this disability is measured in pain, and after the initial treatment, pain no longer counts. …..
Reform or bailout? Schwarzenegger has become known as a prodigious and persistent fundraiser in his short tenure. His top-dollar dinners have generated almost as much press as his policy proposals. His various committees have taken in more than $1.2 million from insurance companies, including at least $560,000 from workers' compensation firms, according to an analysis by the Santa Monica-based Foundation for Taxpayer and Consumer Rights (FTCR). And so far the reforms have been kindest to insurance firms. Financial reports at the end of 2004 showed they were pulling in dramatically higher profits – just eight months after the law's passage. AIG, the largest private carrier in the state, reported $11.05 billion in profits for 2004 – up 19 percent from 2003. The California Applicants Attorneys Association, which represents lawyers for injured workers, reports that this is in spite of a dramatic 1,300 percent increase in payout by AIG for hurricanes, earthquakes, and tsunamis. Another one of the big guys, the Zenith National Insurance Co., also saw income rising. The CAAA's review of Zenith's books shows workers' comp income shooting up 250 percent, from $29.3 million in 2003 to $104 million last year.
From this perspective, the "reforms" start to look more like a massive corporate-bailout scheme: keep rates unregulated and give the insurance companies the right to cut costs any way they can. Some smart investors may have seen the bonanza coming: billionaire Warren Buffett, one of Schwarzenegger's top financial policy advisers, opened a new line of workers' compensation insurance just a few months after the law was signed, through his company Berkshire Hathaway.
Meanwhile, the cost of insurance has dropped slightly for business owners – about an average of 16 percent – and prices may come down again later this month. But many businesses, particularly small companies or those with high-risk employees, are reporting little to no change, and some are even seeing rate hikes as insurance companies get creative with their billing plans.
High costs to businesses were what originally drew the public's attention. The state insurance commissioner, who has only an advisory role, had suggested 10-to-20 percent hikes several years in a row, but some companies reported having to pay hikes of 30 to 50 percent a year for the past few years. Yet those increases seem mainly due to deregulation and the high cost of health care in general.
Just as deregulation of the electricity market sparked a self-destructive path for energy firms, things went sour for insurers right around the time they convinced legislators to open up the workers' comp market. After the deregulation law kicked in, companies underbid each other in a frenzied customer grab. With health and legal costs rising, company reserves dwindled – even as worker injury rates declined. When the national economy tanked, the remaining financial cushion was deflated. Those that stayed solvent did so by charging ever higher rates.
"It's a cycle that we see in the insurance industry just about every decade," FTCR executive director Doug Heller explained. He said the insurance companies sunk themselves. "The economy goes south, stock prices are down, and bonds are devalued. When that happens, investment income declines. So they tighten their belts – or tighten the noose around policy holders."
No surprise there. After all, this is the insurance industry we're talking about, the same field targeted by New York attorney general Eliot Spitzer in a wide-ranging corruption probe. One of Spitzer's top targets is AIG, which is accused of inflating profits in a deal cut with Buffett's Berkshire Hathaway.
Squeezing workersI was shocked the first time I heard a story about someone made homeless by a work-related injury: I had always, perhaps naively, believed the system had an obligation to workers who'd hurt themselves on the job. But as I interviewed more and more people for this story, I heard too many tales of homelessness, bankruptcy, and even suicide.
One man I spoke to has a Ph.D. from the Massachusetts Institute of Technology, yet a debilitating RSI in his arms has left him emotionally and physically worn and unable to earn money in his field. "I've been totally devastated by this," he told me. "I was homeless for a while. I lost pretty much everything you can lose."
That wasn't what Gov. Hiram Johnson had in mind for us when he called on California to create a workers' comp insurance system after he took office in 1911, though Johnson was looking out for business at least as much as for injured workers. ….
The thing about an injury that comes from your work is that it's all-consuming in its devastation. If you love what you do, your wounds divide you from your passion. And it's hard to feel good about yourself when you can't live up to your potential. If you are working to put food on the table, as most of us are, the anxiety attendant on work-related pain is a constant. …..
Several surgeries and court appearances later, Harlan has a stomach-grinding $40,000 debt on the credit cards she's used to support herself while the insurance company delays her health care.
As with most work-injured people I spoke with, this was just one of many stories Harlan has about the challenges of the system. She's had problems stemming from an insurance industry merger, dealt with bizarre questioning about her prior health history (one insurance representative implied that because she'd had back pain during childbirth, she might have a predisposition to pain), and faced off against the sluglike pace of the state agency that oversees workers' comp disputes. "We're almost two years behind in my treatment because of the court delays," she told me.
...profession is under attack by Schwarzenegger, who says chiropractors and acupuncturists in particular are wont to overtreat. But that's a tough call: the alternative is to use painkillers, which are more easily approved but often have lingering nasty side effects. ....by refusing to treat pain, and by limiting care for chronic injuries, the Schwarzenegger law is actually making injuries worse. "Trauma initiates chronic degenerative changes. [But now] health care is limited to functional restorations. Not pain, or tingling.... There's a denial that once a joint has been injured, it changes over time, so the idea is that over the years there's less reason to treat. In fact, there's more reason to treat." ....... "They don't want to pay for anything they call maintenance; they want to treat to cure. They're basing this on an old 19th-century model of a guy who got his hand caught in a machine, and we have to pay for his prosthesis and we're done with him.... If a person's diabetic, you don't say to them, 'Well, you've had enough insulin.' " The frustrating experience of fighting with insurance company medics has many, including Glassman, opting out of the industry. The new law kills your right to choose your doctor anyway, leaving patients to grapple mainly with doctors hired by employers and insurance companies whose primary interest is in cutting costs.while there are deep problems within the system, there's a larger societal issue that needs addressing: "Ultimately, some of it comes down to not having universal health care that follows you from job to job." That way you wouldn't have to prove your pain was job-related – you would just be treated. …..
While it's all sorted out, injured people will still need support, and the already overtaxed county hospitals and social welfare systems will have to bear some of the burden – even as they themselves are under assault. With the shredding of the safety net in full effect, what was once a financial muddle for a handful of insurance companies will become a crisis of far grander proportions: an injured public, without access to health care or a way to pay for a roof over their heads.
"It's part of the Grover Norquist program – returning to the days of Dickens, essentially," Lee Worden, a 35-year-old with a decade-old RSI, told me. (Norquist is a conservative policy strategist and a Schwarzenegger ally.) "You can't look at this separately from the dismantling of the safety net. Pretty soon we'll have a direct path from white-collar employment to workers' comp to the streets. It's not really shifting the burden to programs like G.A. [General Assistance]. It's sinking all boats at once."
