Workers' Comp Program One of the Worst

Saturday, February 24, 2007 | 0

By Michael A. Warner

As one of the few attorneys who handle workers' compensation claims in the Amarillo area, I think there is a way for the Amarillo Hospital District to eliminate any "tax" for indigent care: Make insurance companies accountable for what they owe.

The state's workers' compensation system is an oxymoron. In the 1980s, the workers' compensation system was administered through the Industrial Accident Board. Those "greedy trial lawyers" lurking around every corner looking for "victims" could make a ton of money based on the system at that time by receiving a portion of an injured worker's lump-sum settlement.

Workers who had a back or neck surgery could receive a lump sum and sell their future medical benefits for a tidy sum. Attorneys literally could make $50,000 in a day through settlements. Injured workers would receive $50,000-$60,000 for an operated back or neck. Now it is about $15,000-$20,000, and the taxpayers pick up the remainder.

The Legislature, in its wisdom, decided too many insurers were leaving Texas because it was not profitable. The "New Law" was passed in 1989 to rid the system of the attorney vermin and "help" injured workers. Injured workers now would receive more benefits without having to pay "greedy trial lawyers."

Claimant's attorneys had to submit an attorney's fee affidavit to the Texas Workers' Compensation Commission (now the Texas Department of Insurance's Division of Workers' Compensation, since the TWCC was abolished Sept. 1, 2005). The DWC approves all, part or none of the attorney's fees and there are no more lump sums. Each injured worker luckily receives "lifetime medical" for his or her case. The attorney's fees were capped at $150 per hour in 1989 and haven't changed since.

Lawyers for insurance companies are not subject to these stringent standards. Injured workers' attorneys are only paid if they get their client benefits. Insurance companies do a pretty good job of paying their attorneys, not what is right but what the companies deem reasonable and necessary.

The 1991 Legislature chartered the Texas Workers' Compensation Insurance Fund to assist smaller companies with outrageous workers' comp premiums. Thus, the government became a first-party provider for workers' comp insurance for those who could not afford it - the fox guarding the henhouse.

In 2001, the Legislature changed the name of "The Fund" to Texas Mutual Insurance Company. Not only has the state been in the insurance business since 1991, it dictates how this great system operates.

Insurance companies are in business for one reason: profit. The government is no different, other than that it can't spend this surplus. Texas is one of the five most profitable states in which to write workers' compensation policies. Insurance companies seek to "reduce" premiums to assist Texas employers, because "The Fund," originally set up to "break even," is a bureaucratic cash cow, without accountability to the taxpayers, that stiffs injured workers.

An insurance company has to "answer" to the TDIC, which now has a vested interest in underwriting workers' compensation policies. How convenient.

The adjuster's training manual for Texas Mutual is only three pages long - Page 1: Deny. Page 2: Delay. Page 3: See pages 1 and 2.

Injured workers in Potter County are forced to seek assistance from the J.O. Wyatt Clinic, as there are a limited number of physicians who will even treat injured workers in Amarillo. No Amarillo neurologist will take a workers' comp case as the treating physician. If you are out there, please let me know - I will send you 50 patients tomorrow.

"Lifetime medical" is a joke for injured workers in the Amarillo area. Their complaints fall on deaf ears.

I challenge Panhandle legislators to come up with a solution. Until then, my workers' comp clients appreciate the taxpayers' taking care of them when there is an insurance company truly liable for medical and indemnity benefits.

Thank the AHD for giving illegal immigrants the opportunity to obtain better health care than injured Texans.

If any politician would like to have a debate on this subject, let me know. I can be found trying to protect what little benefits your constituents have left against attorneys hired by insurance companies from Dallas, Houston, Austin and San Antonio.

Michael A. Warner is an Amarillo attorney. This column first appeared as a guest column in the Amarillo Globe News. The newspaper's Web site is http://amarillo.com/.

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