Injured Workers Turning to Medicare and Medicaid

Friday, March 7, 2008 | 1

By Sam Gold

People are injured on the job every day. No matter how hard we try, workers will always get injured. It's simply the nature of the beast. We live in a mechanized society. There's nothing that unravels a family more quickly than a work incurred injury. Wages are lost, bills stack up, and tempers flare. Families get torn apart from the pressures placed on workers who are injured.

In a perfect world, workers' compensation laws should do a pretty good job of keeping an injured employee's family afloat, but when you start messing with the safety net of Workers' Compensation, like Governor Schwarzenegger and his big business buddies did in 2004, the stark reality is that injured employees and their families will ultimately end up on Medicaid, Medicare and Welfare. And the private insurers are laughing all the way to the bank.

They started out by eliminating an injured workers' right to choose his/her own doctor and, instead, forced them to go to only certain doctors who are in their employer's Medical Provider Network, which has spelled nothing but trouble for California workers. These doctors don't seem to care about the injured worker, only about repeat business from the employer. And that was only the beginning.

Next they forced all requests for medical treatment to be subject to utilization review (UR), which is just another fancy word for delay, deny and refuse treatment. Claims examiners would send requests for the littlest thing to UR with little or no documentation included. What else could the UR doctors do but refuse the requests due to a paucity of supporting documentation?

Now the latest attack is in the area of permanent disability with doctors misinterpreting the intent of apportionment to causation and hacking away large percentages of Permanent Disability awards for such petty excuses as age, sex, race, religion and sexual orientation. There is a state law that forbids this but heck, they don't care.

We should keep in mind that the Permanent Disability settlements are meant to compensate an injured worker who can no longer compete in the workplace with others. It is part of a lifeline that is supposed to last for a reasonable time until the injured worker can find another vocation with which to support his family, or in the worst of catastrophic cases, for the rest of his or her life.

It's been four years now since Governor Schwarzenegger's only claim to fame, Senate Bill 899 has certainly done the job it was intended to do and that is to put thousands of injured people on Medicaid, Medicare and Welfare. It's just another classic example of the promotion of special interests over the rights of the working class.

So keep your heads in the sand. When you pull them out you'll find that taxes are going higher and higher. Why, because you are now subsidizing the Workers Compensation insurers who are making billions of dollars in obscene profits by simply shirking their financial responsibility and refusing to pay for medical treatment that was part of an contractual agreement made almost 100 years ago.

It's a very sad state of affairs. Makes me want to move to another state...

Sam Gold is an injured worker who produces a television program on the California workers' compensation system, "Injured On The Job," in San Francisco.