The Workers Compensation Mess from the Inside

For years I have made a very good living representing injured workers. I have seen many changes in the law. Despite those changes the system continues to be a welfare system for all the participants from the injured workers to the judges. Contrary to popular belief the system is not broken because there are a lot of false claims. There are not. Most claims are legitimate.

When the legislature finally tackles workers compensation it will once again listen to the “experts”, those who work in the system. They all have a vested interested in the system staying as it is. So any change will only be a temporary solution. The system cannot be fixed. You cannot put a band-aid on a vein that is hemorrhaging and fix the problem. The system needs to be scraped and a new one put in its place. Why should you listen to me one of the participants? I am leaving the state of California so I will not have a vested interest in it.

Who is at fault? All the participants are:
The insurance carriers are the number one culprit of the high rates that are happening now. The carriers are inefficiently run and they do not have to worry about it, since they just keep raising the rates on its customers. The carriers litigate issues that are more economically resolved by settling. The carrier’s bottom line is to pay as little as possible for each claim.

The employers deny many legitimate claims. They do not send employees to doctors for fear that their insurance rates will increase. Employers do not have an incentive for telling the truth when a worker gets hurt or reports an injury. The employer’s bottom line is keeping its rates low.

The attorneys who represent the carriers have no incentive to quickly resolve a case. They get paid by the hour, so they spend many hours trying to get a $50,000 case down to $40,000. They go to court and find excuses to continue the case. Cases drag on for years, which make it more costly. Defense attorney’s bottom line is to make as much money as possible out of each case.

The injured workers attorneys function on quantity not quality. Applicant’s attorneys are paid 12-15% of the settlement, which is really low in comparison with other types of legal practices. They have to maximize benefits of the injured worker. The injured worker walks in with a hand injury and the body parts claimed become upper extremity and psychological symptoms. This is necessary because of the exaggerated low ratings of insurance company doctors. The insurance company doctor will usually give 10-15% disability regardless of the injury. The injured workers doctor may give a 40% disability. With a psychological report that gives the worker an additional 20-30% the injured worker can wind up with a more realistic permanent disability rating in his settlement. Applicant’s attorney bottom line is to increase the value of the case to make more money.

The doctors in the system all see the claim from the point of view of those who pay them, not from the truth of the injury. The injured workers doctor will give 40% disability on subjective findings alone, while the insurance company doctors will give 15% disability on a 5mm disc bulge with impingement. They both exaggerate. The same goes for treatment. The insurance company doctors under treat and the injured workers doctors over treat. The doctor’s bottom line is to keep referrals coming.

The judges in the system are also at fault. They avoid going to trial and make excuses of why the trial could not be heard or finish on the day scheduled. So the parties have to return many months later. This is a cost to all the parties involved. If judges were more proactive the system would not be clogged. The judge’s bottom line is to work as little as possible and still collects their salary and very generous pension. There are no penalties in the system for a judge being lazy. There are some good judges in the system. They work hard and make fair and equitable decisions.

A change in the system must be balance so that the employers do not have to pay the exorbitant rates that carriers are charging with the worker getting fair benefits and good medical care. But the change must be radical and complete so as to eliminate all the participants who have been leeching off the system for years, only then can we have a long-term solution.

Editor’s Notes: The author wants to remain anonymous because he or she represents injured workers in the Workers Compensation System. He or She is planning to leave California and follow his or her legal career in another state