Is the Workers’ Compensation framework sufficient in helping all injured workers thrive?

By Kristen Chavez (CEO and President of www.workcompcentral.com)

Or, is it designed for those who are able to recover within a defined period of time at a set cost?

In the coming months, I plan to blog about specific points in the claims process, that based on feedback from injured workers, limit their ability to fully understand the process, participate in their recovery and receive benefits they feel necessary to sustain their families and wellbeing. 

Unfortunately, for those who are severely injured, benefits are not always sufficient to help them secure an acceptable level of recovery, health and standard of living.  

Across the country, news outlets cover stories of injured workers lamenting about the mishandling of their claim.  Often times we dismiss these accounts, feeling that they are over sensationalized or prompted by others to forward a specific agenda.   However, when taking a closer look there are some glaring similarities in these injured workers’ stories.  

In California, NBC covered an injured worker, Donovan Dixon that was severely injured in a trucking accident.  Dixon fell 70 feet, sustained burns to over 60% of his body and was in a coma for three months.  Almost two years after the catastrophic event, Mr. Dixon was denied a customized bed requested by his primary treating physician. 

In Texas, 73-year-old Jane Hayes was involved in a head on collision while traveling home from a three-day employer retreat.  The accident cost Hayes her leg.  On the day of the surgery to amputate her leg, Hayes received a letter denying her claim.  

North Dakota’s Supreme Court ruled against Dennis Whedbee, concerning the need for a prosthetic arm.  Whedbee was injured during an oil rig explosion resulting in the amputation of his left arm below the elbow.  Mr. Whedbee’s physician recommended a myoelectric prosthesis which would allow him to continue working.  An IME was secured who recommended against the myoelectric option which was later upheld by the State’s Supreme Court. 

In New Mexico, Officer Jeremy Romero was involved in a horrific accident in 2014 during a high-speed pursuit severely injuring his lumbar spine.  After enduring several surgeries, he was given a 5% chance of walking again.  Initially, Officer Romero and his family received overwhelming support and the best medical care available.  He was coined as “robocop” by the media when he received a motorized exoskeleton. However, after the media frenzy faded, Officer Romero states so did the benefits supplied.   In order to use the exoskeleton a chaperone is required.  When Officer Romero is alone, he requires a standing frame glider and specialized wheelchair.   These items were ordered by a Judge over a year ago, but according to Mr. Romero he still has not received the needed equipment. Today, he and his wife pay for care out of their pocket.  He refuses to take opioid medications instead relying on other measures.  He claims these alternatives to dangerous opioids are routinely denied by the insurance carrier.   As his general health is declining, this is leaving Officer Romero to feel helpless, hopeless and a burden on his family.  

So, how do we do what is right for those severely injured?  Is it pushing legislative reform to create exceptions to treatment and benefit caps?  Or, is it realizing that in some situations, as an industry, we need to recognize the shortfalls in the law and supplement that by individual actions that result in helping severely injured workers regain an acceptable quality of life? 

I invite our industry to have a meaningful dialogue around how we can help this segmented population of injured workers.  

I do believe there is a place where meaningful conversations can happen. That is Comp Laude®, Comp Laude® is a forum designed to bring together all stakeholders in the process including those severely injured.  We can learn much from listening to their experiences, good and bad, to help improve the process they deal with every day.