Insurance Is Designed To Fail
Everyone in the United States who works for wages is required by law to receive workers' compensation
insurance. This insurance, paid by employers, is regarded as part of the payment the worker receives for work performed.
Workers' Compensation Insurance was created to cover injuries received on the job, or treatment
of some medical conditions that are considered to be job related.
Like all government mandated programs, Workers' Compensation Insurance is a bureaucratic nightmare
that fails to achieve what it was intended to do. My wife, Doris, and I recently learned from personal experience that rather
than help, the program can actually prevent an injured worker from getting the medical treatment he or she needs to make a
full recovery. It generates a financial trap that threatens not only the health of the victim, but the welfare of both the
victim and his or her family.
Doris, who has worked for years in hospital laboratories all over the United States, sustained a
back injury on October 27, 2001, when she lifted a box containing a sixty-pound bottle of liquid material needed for maintenance
on a computerized testing machine she was working on.
She said the pain was so severe it knocked her to the floor. After it subsided, Doris checked into
the hospital emergency room where she was seen by a physician's assistant, rather than a doctor. This man sent her home for
bed rest, and told her to return the next day if she was still in pain. (She was.)
What Doris did not know when she reported her injury that night was that one of the papers she apparently
signed was a notice of claim for Workman's Compensation Insurance through the Michigan Hospital Association.
That hospital might have received payment, but a lot of doctors and hospitals that got involved
in her case after that did not. As we forged through the volume of paperwork and red tape required for dealing with Workers'
Compensation claims we discovered that the program is a nightmare. Most people, unaware of the complex system of rules and
regulations involved, would miss some of the hoops the first time through. We discovered that Workman's Compensation is notorious
for not paying medical bills, and for shutting off claims for help if a single piece of paperwork, or a certain "T" is not
properly crossed. If a doctor's secretary, or hospital insurance claims worker makes a mistake the bill sometimes becomes
the patient's responsibility.
We discovered that doctors are so leery about the way the Workers' Compensation system works,
they often turn away job injury patients rather than deal with the program. I suspect that those who do agree to take on these
cases usually only give minimal care, avoiding spending any time with the patient, diagnosing the problem, or bothering to
even treat the injury. They run claimants through with maximum speed, sending them off to programs that generally work for
the largest number of cases and (if they have a conscience) may cross their fingers and hope the patient gets better.
They do this because they usually don't get payment for their services, and I suspect that even
if they are paid, the amount is far less than they get from fees to other patients. Also I am sure that Workers' Compensation
involves, even for the doctor's office, lots of extra paperwork and there are multiple billings before a single penny is paid.
Thus it was that we became caught in a web of red tape that became so complex in my wife's case,
we have been months just trying to reach a diagnosis of what happened to her. As of this writing, six months after her accident,
she has only been physically "examined" by one doctor. Of the seven doctors and three physicians' assistants who have been
involved in her case, none of them seen to agree on what happened to her.
An attempt to by-pass the program and use our own medical insurance company to seek treatment failed.
That is because our insurance company learned that it was a job related accident and referred the claim back to worker's compensation.
And because we selected a doctor without approval from the worker's compensation consultant, the claim also was denied by
worker's compensation. It was a classic "Catch-22."
We got as far as we have by using the following formula:
--Persistence in fighting, clawing and screaming every step of the way. Buying, begging and finagling
every scrap of paper dealing with the case. And there was lots of letter writing to the Workers' Compensation office, the
hospital where the accident occurred, and even to the local newspaper.
--Hiring a lawyer (outside of the area without local political ties or personal friendships with
doctors and hospital administrators) who specializes in workers' compensation cases.
--Spending hours of research on the Internet in case histories and reports concerning back injuries.
Every report obtained produced new "technical" medical words, in typical doctor jargon. Every report thus required a new round
of research until we deciphered the coded message and learned what the doctor was really saying.
--Once determining what was known about my wife's case, we pressed the doctors to go farther to
order more tests to either rule out or confirm (our) suspected diagnosis. This is the hardest part, because doctors sometimes
become angry when patients enter their office knowing too much about their medical history, and directing the doctor in what
to do next. I think it has something to do with ego. We must all remember that the doctor isn't the patient. He is the guy
who has the power to order the tests, the treatment and the medicine. Even though we know what we need, the law does not allow
us to do it ourselves.
It took us months to fight our battles. In the meantime, Doris' condition worsened to the point
where she was losing control of her body. It turned out that the lesion in her spine was affecting nerves that are, in turn,
threatening to make her a permanent invalid. What began as an injury that could have been treated with proper diagnosis and
care, now threatens to put her in a wheelchair for life. And the battle goes on.
In the meantime, even after our lawyer succeeded in getting Doris reinstated for benefits, her paychecks,
which amount to only about 60 percent of the amount she received while on the job, have been arriving later and later.
My concern about worker's compensation programs is that they are designed to wear down the average
person who might be too sick, or too weak to fight. Like the Income Tax, the paperwork and the complex moves required to successfully
endure a Worker's Compensation case are enough to confuse the most intelligent victims.
This is just one more argument in favor of socialized medicine. If we were living in a socialist
country, or had a workable medical program operating in the United States, I suspect Doris would have been back on her feet
by now, back on the job and living a normal, productive life.