subject: Playing the Blame Game [print this page] People who are involved in worker's compensation agree on the fact that there are problems in the system and the blame is always put on someone else. Employees, employers, and insurance companies are accused of fraud. The California Department of Insurance, for example, draws a bead on the bosses.
One of the fastest growing areas of workers' compensation insurance is employer fraud. An employer who underreports the payroll or who classifies an employee wrong is committing fraud. The top insurance regulator has a different view toward this. A California insurance commissioner points out that employees who are paid a lot abuse workers' compensation insurance.
This current crisis can be the fault of any group, an attorney who deals with workers' compensation issues says. His strongest defense will be used for the workers. There are hardly any cases of fraud committed by workers. He refers to a number of sources including the California applicants' attorneys association Web site, which says that out of 4 million injuries reported between 1993 and 1998 only three people were arrested per 1,000 claims and only two per 1,000 were convicted.
He wants employers and employees to see that they are both still facing against insurance companies. The cost of insurance dropped five years after the deregulation of the insurance industry in 1995. But the number of claims was also way down and insurance companies made large profits by investing those premiums in the runaway stock market.
The incidents during 9/11 have added to the problems. Insurance companies closed business because of these terrorist attacks, in addition to losses in the industry that amounted to $40 billion. He believes that the 235 private insurance companies that still provide workers' compensation in the state of California should be included in the Web site of the state.
Another point of disagreement is that when there's a claim, prices rise, and when there's no claim, prices stay as they are. Senate Bill 191 which aims to reward claim free employees is a legislation he supports.
The conditions of the patients one physical therapist serves can be described with the word compitis. The recovery time for work injuries is different from the recovery for non work injuries, this gentleman says.
An injury resulting from a sport or motor accident would probably heal faster than a work related one, he said. Patients covered by workers' compensation would most likely appear in the health specialists' books thanks to this streamlined system of payment.
As soon as the paperwork is done, health specialists can anticipate the arrival of the check. This is different from HMOs, whose system is very time consuming, costly, and difficult.
Around 15% of patients served by one chiropractor make use of workers' compensation, while other chiropractors' patients estimate to be around 40% of their total number. According to him, chiropractors would charge for additional medical services just to take advantage of the system. He is knowledgeable about how patients abuse the system. Patients pretend they have injuries although certain tests can be done to detect malingerers.
