The Work Injury Fantasy League

That is what I like to call the workers compensation system here in Illinois.

Blogger Alert: I want to be very clear that I am not singling out a particular segment of the workforce based on the links provided. My cynicism extends across the board. The term “union” appears in this article as an example of lobbying only. It does not reflect my view of unions either way, so save the vitriol.

As part of my job, I handle work injury claims for my company. We are self-insured, which means that we have an insurance company process our claims, but I, in general terms, call the shots.

By law, companies are required to provide for “injured” employees. That might be by contracting with an insurance company who specializes in workers compensation insurance coverage, having a third party administered program or by entering the Illinois Risk Pool, where your claim goes out to any number of insurance companies who contracts with the state. But, as is the case with our company, we pay a premium that may be several hundred thousands of dollars and if we spend more than the premiums that are paid, then the owners have to write another check. Premiums are based on the previous three year injury claim history.

Now; I am going to get on my soap box.

If I am a newly-graduated lawyer, I am going to pack up and move to Illinois and take up residence in Cook, Will or Peoria County and open my practice to specialize in personal injury and work injury litigation. This will present the best opportunity to pay back your loans quickly and to establish your reputation among employees looking for their pot of gold. Word will travel quickly, just like the name of THAT doctor that will take you off work for a strained little finger.

Every couple of years here in Illinois, our statehouse starts rumbling with talk of over-hauling the workers compensation system because it is such a costly program for employers. Unfortunately, the talk never makes it to action because of the strong lobby efforts by lawyers, unions and medical care providers. And their efforts have paid off, because Illinois ranks second in the nation for work comp costs. A work injury claim in Illinois is roughly 40% higher in costs than that same injury in just about any other state in our nation. Here is where I blame the medical community as a work comp “accomplice”. Obviously, the “injury” has to be “work-related”, so a trip to the doctor establishes that link. RARELY, again, based on my experience, does a doctor rule out the notion that the “injury” could have occurred outside of work. The prevailing mind-set in Peoria seems to be that “everything happens at work”. That is my opinion; I don’t have facts to back it up (wink wink).

Before I get into the details of the latest outcry for work comp reform, I want you to imagine this: you have an employee with an old football injury to his right knee. Because your company does not do pre-employment physicals, any pre-existing conditions that come with the employee are said to be aggravated, if they so claim. In other words; in Illinois, if you aggravated it, you caused it and you buy the claim lock, stock and barrel. While the employee is unable to work, they draw Temporary Total Disability pay. So, if you earn $500 a week, you will get a check for $333 a week while you are off work. But it doesn’t end there. If you require surgery, your bills are paid 100% and at the end of the process, you receive a “settlement”. If you do it without an attorney, you get 100% of the settlement money. If you have an attorney, they get 20% of whatever the settlement amount is. But here is the beauty; if you have all of your loans insured, you make no payments while you are off work. All of the money that you receive is tax-free, including the settlement. Plus, on the following year’s taxes, your income will show a dramatic drop, so you will more than likely get every dime back that you paid in. In some cases, the employee actually makes MORE money than if he was at work, which is why many will fight to get taken off of work rather than work modified duty.  I am sure that I could think of others, but I am up against a hard deadline here!

And  “claimants” will be shown on video having “good days and bad days” (this is the defense used when an employee who is off work is caught doing things prohibited by their doctor-certified, off-work status). Video surveillance is legal but frowned upon by many arbitrators, so this tactic must be used sparingly and wisely. Note that the employee is now referred to as a “claimant”. That is because they have hired an attorney who has taken over their medical care and employment status, because, as they tell their “client/claimant”: employers are real bastards in this state.

The problem with what I described in the previous paragraph is that the process does little to motivate the employee into returning to work. At the end of the work comp process, some will simply take and spend their money and go to work for another unsuspecting company, where they most likely will file another claim of injury and start this maddening process all over again. Now; this is the cynicism in me, but I also realize that there are many good employees in the workforce who don’t try to game the system. However; I was actually asked by a new employee one time “where do I sign up for workmans comp?” Absolutely true. It is viewed by many with an intimate knowledge of state aid and unemployment benefits as just another government program to take advantage of. For the record, I despise the use of the term “workmans comp”. It is “workers compensation” or “workers comp”.

There is another paradox. If your company requires a post-accident drug screen and the “injured” employee tests positive for an illicit drug, they STILL collect work comp, because the system is based on the theory of “no fault”, but what I have witnessed is that the system is based on the idea that it is the employer’s fault and therefore, they pay. It is a system that is rife with abuse.

But, even with case after case of “questionable” claims with questionable outcomes, none of that has been enough to move legislators to DO an over-haul. Nope; it took a newspaper and their reporters to uncover work comp “irregularities” at the Menard Correctional facility to breathe new life into talks of work comp over-haul. And it was done with a FOIA request for emails and of course, if you have a case number, you can go right to the Illinois Workers Compensation Commission website and see who has filed a claim. I’ll be honest; I had no idea that putting a key into a cell door lock and turning it could be so hazardous to one’s health. In fact, in one case; it TOTALLY disabled a guard into retirement, where I am sure he receives a pay differential in addition to disability payments and all the while, he is seen painting, mowing and power-washing his garage. Must be those “good days” kicking in. The link to that story is provided at the end of the blog.

Did I mention that the WARDEN of Menard has his work comp claim and received a plus-$70,000 settlement? Check out the picture of him holding up fish that he caught, while he was “recovering” from surgery. Forward-thinking physical therapy?

AND, I didn’t know that a worker comp arbitrator could hear their OWN work comp case and pay themselves a settlement! There is growing evidence that it happened. In yet another case involving an arbitrator, she asked that her settlement be “fast-tracked” because she was “cash-strapped”. Ah; only in Illinois! You can’t possibly make this stuff up. The link is provided.

The stories in the links that I have provided speak for themselves. It is mind-boggling to anyone with a tacit understanding of workers compensation that a system designed to provide for the basic needs post injury for employees can deteriorate into a gift bag of abuse and outright fraud. It has become an entitlement program to employees at the expense of employers. “Impartiality” no longer exists and “compensability” is just about everything that is brought before the Commission. It has become a “retirement” strategy for some and a “get rich quick” scheme for others, including arbitrators.

When we talk about budget cutbacks, wages and benefits on unsustainable paths and costs associated with government intrusion creating an anti-employer climate, you get what we have in

Illinois.

So, when we talk about the “whys” in dealing with our problems nationwide with cutting budgets and maintaining services, I didn’t want us to forget that there are other costs beyond salaries and benefits. When you add insurance costs including workers compensation, that h*** that we are in tends to get a little deeper.

But, the bigger message here is that I realize that we have taken a good program and corrupted it. There is plenty of fault to go around in this “no fault” system. What is happening isn’t even a waste; it’s criminal…as in illegal…as in insurance fraud, but just like employers proving that the injury didn’t happen at work, you would be shooting at a fly on the wall with a BB gun from one hundred yards and hitting it. It ain’t gonna happen! Rarely, if at all.

http://www.bnd.com/2011/02/13/1589826/e-mails-show-inner-workings-o...

Workers' comp arbitrators under investigation are put on paid leave

http://www.bnd.com/2011/03/02/1612842/madigan-asks-for-fraud-invest...

Attorney general calls for fraud investigation into Menard worker's...

http://www.sj-r.com/top-stories/x256216597/No-simple-fix-to-Illinoi...

'I can't do that every day': Corrections worker on total disability...

Agency mum on workers' comp case; info on injury not available to p...

'Beware the Carpal Tunnel!': State workers discuss 'flood' of worke...

Quinn on worker's comp probe: 'Any wrongdoing has got to be ferrete...

Feds step in to investigate potential fraud in Illinois workers' co...

'We need a system that works': Quinn wants workers' comp reform pla...

State Rep. Dwight Kay: Joint liability is a job-killer in Illinois

http://heraldnews.suntimes.com/news/4609950-418/feds-to-probe-worke...

http://www.businessweek.com/ap/financialnews/D9MF42L01.htm

 The views and opinions expressed are those of the author, Art Goodrich, who also writes under the name ChiefReason.  They do not reflect the views and opinions of www.fireengineering.com, Fire Engineering Magazine, PennWell Corporation or his dog, Chopper. Articles written by the author are protected by federal copyright and cannot be reproduced in any form.