By Samuel H. Pond
- Beware the wolf in sheep’s clothing.
Across the country, in state houses largely influenced by insurance industry interests, there is an insidious attack on workers’ rights masquerading as “workers’ compensation reform”.
These sham reforms would return many workers, especially those in dangerous industries, to the dark days of the Industrial Revolution when little recourse existed for injured workers or their families.
Here in Pennsylvania, supporters of a bill sponsored by Rep. Ryan Mackenzie, R-Lehigh, have already begun to encroach on the workers’ compensation system as it exists.
In a November 2015 memo to his colleagues, in which he sought support for his proposal, Mackenzie said it would implement “treatment guidelines” which have “successfully controlled costs, mitigated the frequency of surgery, and reduced the volume of addictive pharmaceuticals needlessly administered to workers.”
According to Mackenzie, injured workers would benefit from treatment guidelines.
Treatment guidelines, which are trumpeted as systematizing and creating uniformity in how workplace injuries are addressed, shift individualized care to an “evidence-based” statistical approach. But medical care needs, particularly for serious injuries, cannot be analyzed by numbers or measured with algorithms.
Treatment guidelines, which would be developed by politically appointed panels having little or no public accountability, would allow the legislature to abdicate important statewide policy decisions.
In practice, treatment guidelines will reduce injured workers’ injuries and conditions to statistics to be manipulated and handled according to data charts and tables of “most efficient” practices, removing a treating doctor’s judgment altogether.
Clients too often struggle to prove their injuries and receive the compensation they’re entitled to because of insurance companies’ lack of compassion under the current law.
If this bill is passed, any remaining compassion will be eradicated.
One of our most memorable clients was a man affectionately named “Moose,” and his case is a prime example of the issues within the workers’ comp system.
Moose was a long-time union operating engineer before a malfunctioning piece of construction equipment left him permanently paralyzed and wheelchair-bound.
Despite his doctor assuring the insurance company that his medical conditions were work-related, the insurer continued to fight covering certain medical expenses.
Moose’s home was not functional in his injured condition, but the insurance company refused to pay for home modifications – something workers’ compensation should cover.
Moose’s daughter put off her wedding in order to help her parents pay for modifications to their home so Moose’s wife did not have to continue to bathe him in the living room – there was no bathroom on that floor.
Our firm was able to recover the money owed to Moose’s family for the home modifications, but not for months until after they were completed. It’s also well known that paraplegics suffer respiratory issues as a result of their condition.
The insurance company did not believe so, and our firm fought their denial until the day Moose died, more than six years after he was injured.
The current workers’ compensation system is stripping away the humanitarian intention of the original law.
Any further modifications to the law that removes human voices and human opinions will leave injured workers struggling to make ends meet and to receive quality medical care.
Mackenzie’s proposed legislation has not yet come to a vote by the Republican-controlled General Assembly. It’s still before the House Labor & Industry Committee.
The Workers’ Compensation Section of the Pennsylvania Bar Association has recognized this mounting threat to workers’ rights and has responded with a resolution opposing the legislation.
First, the resolution notes that the usually parroted impetus for reform – cost containment – is not a problem in Pennsylvania. In fact, “loss cost filings,” which are the base line premium variable that is used to calculate insurance premiums for employers, have decreased every year since 2012.
The resolution notes concerns with evidence-based medicine as proposed in the Mackenzie bill that should be of concern to both sides of the bar.
The politicized nature of the appointed panels who will determine the guidelines can easily operate as a double-edged sword. In the real world, that sword is more likely to cut the injured worker.
All lawyers tasked with protecting injured workers must not allow Pennsylvania to become a state where profits are put before people’s health.
Our elected officials should be responsible policy-makers and be aware that their constituents’ health and well-being is not for sale to the highest bidder, or the lowest common statistical denominator.
This bogus “reform legislation” presents real threats to workers. Tell our elected officials to protect workers’ rights, not destroy them.
Samuel H. Pond is the Managing Partner of Pond Lehocky Stern Giordano, a workers compensation law firm, in Philadelphia.
Source – http://www.pennlive.com/opinion/2016/03/heres_why_a_workers_comp_refor.html