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A series of articles emphasizing practical
knowledge you can't find in practice guides
and interviews with experts who share
their techniques for effective and efficient
case management
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Articles emphasizing practical knowledge you
can't find in practice guides
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Profiles of people who changed workers’
compensation law.
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• Warren
Schneider
• Marjory Harris
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I returned from a legal convention to find the sky filled with
turkey
vultures.
I watched them land awkwardly in the branches of a big stand
of blue gums, then circle in the air and descend onto my neighbor's
property, where they were consuming a dead deer. Several at
a time would pick at the carcass while several more would stand
nearby on the ground. When they returned to the trees, another
bunch would descend to feed.
As I watched this nature drama, I was reminded how fractionalized
workers' comp had become, with various “vendors”
providing dubious services, frittering away the comp dollar
as they fed on the injured worker. It used to be that the comp
dollar was primarily spent on services that directly benefited
the injured worker, medical treatment and indemnity payments.
The claims adjusters knew their cases, knew the doctors, knew
a lot about medicine, and had the authority to make decisions.
Then came the “reforms” of 1989 and the next few
years. In an attempt to standardize claims administration, legislative
and administrative micromanagement turned a fluid system that
could deal with the myriad situations occasioned by work injuries
into a concrete and unwieldy bureaucratic system. Comp became
a minefield riddled with statutes and regulations filled with
mind-numbing minutiae. This encouraged the growth of specialized
vendors. It wasn't long before the claims administrator had
less and less say-so and ultimately became a clerk with a huge
caseload, little authority to make decisions, and ineffective
in dealing with the micro crises so common to people needing
relief from the physical, emotional, and financial havoc wreaked
by their injuries.
Increasing specialization of tasks related to comp management
had the unintended consequence of increasing inefficiency and
delays. With every change in the law, new services sprang up,
to capitalize on the obscurity of the new “reforms”
and to get their piece of the comp carrion.
To the nurse case manager were added the personnel of utilization
review and the bill reviewers, “clinical validation services”
and the like. Aren't these tasks that could also be done by
a nurse case manager? But why streamline when you can make something
absurdly complex?
And when you get a report from a forensic evaluator like an
AME or QME, why not spend some more of the comp dollar to have
another vendor critique the report to reduce the paltry WPI
even further? And since the other vendor’s report is not
admissible, why not try to get the original report writer to
reduce the WPI to an even paltrier amount by hiring a defense
attorney to take the doctor’s depo?
But wait, I have gotten ahead of myself. Before we get to this
point, we need to look into every nook and cranny of the injured
worker’s past to find “other factors” causing
permanent disability. We need surveillance videotapes showing
the injured worker going about his ADLs. We need to do many
evaluations to rule out or in sleep disorder, erectile dysfunction,
etc. We need to get a DFEC report, to show how off the mark
the PDRS actually is.
We need so much more than we used to need to administer a claim,
even though we pay out so much less in indemnity and services
to the injured worker. Or maybe I should say, we need all this
more effort and expense so that we can justify paying so little
that would actually benefit the injured worker.
And because this “reformed” system is so inefficient,
unlike the deer’s carcass, which is disposed of quickly
by the efficient turkey buzzards, flies fester in the lives
of those Injured at work. The maggots of anxiety and depression
eat away at them as they face uncertain economic survival. But
all those vendors get paid for their services. And sometime
in the not so distant future, the reformers will cry, “The
system is broken! It doesn’t work! We need reforms!”
Marjory Harris began practicing law in 1974 as a defense
attorney and later became an applicant's attorney and a certified
specialist. She continues to represent injured workers in the
San Francisco Bay Area and Inland Empire and mentors attorneys
on big cases.
Reach Marjory at (888) 858-9882 or email to
MHarrisLaw@verizon.net
www.workerscompensationcalifornia.com
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