go*big*red
04-25-2003, 02:39 AM
Hi, everyone.
I feel I must start this thread even though I think I'll be bringing down the wrath of the "Employee's Advocate Gods" on me.
I have had experience with w.c. from an employer's and an injured worker's view point. Important to note that this is Colorado and each state has different laws that w.c. has to abide by because it is governed by the individual state, not the federal government.
Also important to note that I am not a w.c. advocate but w.c. is a necessary "evil" as an employer and we would have lost our business many times over if we didn't have it.
1) We have a Preferred Provider (ppo) policy whereas when an employee is injured, if it is not a life threatening emergency and is during normal business hours and in the city where the ppo's office is, they are REQUIRED to go to that dr. If not, they stand to lose all their benefits right then and there. I would like to stress that the ppo dr. is not just contracted with w.c. and has a practice and is in business. If this dr. were to be unfair to an injured employee, he/she would very likely lose their practice especially in a small town such as this one. They are not "w.c." drs. per se. Just dr.s trying to make a living as we all are. The reason we have this type of policy is that it saves us money on premiums. Our premiums are 50% higher than the norm for our industry - reasons that will be explained below.
It is possible to go to another dr. for a second opinion but MUST be approved through w.c. first or again, the injured employee stands to lose all benefits.
2) Here in Colorado, the w.c. used to be owned by the state itself and called Colorado Compensation Insurance Authority. The state of CO got out of the insurance business and it is now Pinnacol Assurance but we as employers can go to other insurance companies now to get w.c. i.e. American Family, etc. - one of the many benefits of free enterprise.
3) My experience as an employer and an injured employee is that w.c. is not trying to get out of paying an injured worker benefits. Simply trying to determine if it is work related. The employer has alot to do with that as well. If we say it was work related, then it was and no questions are asked. If we aren't sure - no witnesses or whatever - then an investigation insues. Sadly, that takes some time. However, again, an employer can push procedures along and drs. appts. going through the proper channels. I know this because I have done it.
4) Lastly (for now anyway) is the issue of videos. Yes, they are done more and more now. But,....... only because of the fraud that is so prevalent now. We have had two cases of fraud from injured employees. Yes, they were injured, but when they got better, they lied and said they weren't. Please understand I am not saying that about anyone on this board. I just had a single level PLIF and understand all too well the misery of severe, debilitating back pain. However, there are those that do lie and unfortunately, that has marred the entire system.
We had a total disability claim - 100% disabled - deemed unfit to do any type of work at all shingling his house immediately after his case was paid and closed.
We had another partial disability claim - 35% impaired who could absolutely not do the work we do ever again recently start applying for jobs with our competitors.
So, if video survailence (sp) is available and at our fingertips - you bet, we will do it if there is probable cause. Doing so has saved us two other fraudulent cases.
The mis-nomer is that it is not coming out of the employer's pocket - WRONG! Of course it is and when you are a small business like ours, that hurts - bad! As I stated earlier, our premiums are 50% higher than our competitors.
5) Okay, this is lastly - re: pre-existing conditions. In Colorado, if we hire a person with, say, Rheumatoid Arthritis and this job exacerbates that condition and renders the person partially disabled - we just bought that disability for that person. Likewise for DDD - with or without back pain prior to the job injures due to the DDD an unstable back - we buy that as well.
I sincerely hope I did not make any enemys with this thread as I enjoy this board and the interaction. I just needed to say these things.
Thanks
------------------
gbr
JDD
2 Discograms
4 Level failed IDET
4 Confirmed torn lumbar discs, 2 full thickness
Issues now with c-spine & thoracic
Fusion of L5/S1 scheduled 3/5/03
Fusion successful - feeling better all the time
[This message has been edited by go*big*red (edited 04-25-2003).]
I feel I must start this thread even though I think I'll be bringing down the wrath of the "Employee's Advocate Gods" on me.
I have had experience with w.c. from an employer's and an injured worker's view point. Important to note that this is Colorado and each state has different laws that w.c. has to abide by because it is governed by the individual state, not the federal government.
Also important to note that I am not a w.c. advocate but w.c. is a necessary "evil" as an employer and we would have lost our business many times over if we didn't have it.
1) We have a Preferred Provider (ppo) policy whereas when an employee is injured, if it is not a life threatening emergency and is during normal business hours and in the city where the ppo's office is, they are REQUIRED to go to that dr. If not, they stand to lose all their benefits right then and there. I would like to stress that the ppo dr. is not just contracted with w.c. and has a practice and is in business. If this dr. were to be unfair to an injured employee, he/she would very likely lose their practice especially in a small town such as this one. They are not "w.c." drs. per se. Just dr.s trying to make a living as we all are. The reason we have this type of policy is that it saves us money on premiums. Our premiums are 50% higher than the norm for our industry - reasons that will be explained below.
It is possible to go to another dr. for a second opinion but MUST be approved through w.c. first or again, the injured employee stands to lose all benefits.
2) Here in Colorado, the w.c. used to be owned by the state itself and called Colorado Compensation Insurance Authority. The state of CO got out of the insurance business and it is now Pinnacol Assurance but we as employers can go to other insurance companies now to get w.c. i.e. American Family, etc. - one of the many benefits of free enterprise.
3) My experience as an employer and an injured employee is that w.c. is not trying to get out of paying an injured worker benefits. Simply trying to determine if it is work related. The employer has alot to do with that as well. If we say it was work related, then it was and no questions are asked. If we aren't sure - no witnesses or whatever - then an investigation insues. Sadly, that takes some time. However, again, an employer can push procedures along and drs. appts. going through the proper channels. I know this because I have done it.
4) Lastly (for now anyway) is the issue of videos. Yes, they are done more and more now. But,....... only because of the fraud that is so prevalent now. We have had two cases of fraud from injured employees. Yes, they were injured, but when they got better, they lied and said they weren't. Please understand I am not saying that about anyone on this board. I just had a single level PLIF and understand all too well the misery of severe, debilitating back pain. However, there are those that do lie and unfortunately, that has marred the entire system.
We had a total disability claim - 100% disabled - deemed unfit to do any type of work at all shingling his house immediately after his case was paid and closed.
We had another partial disability claim - 35% impaired who could absolutely not do the work we do ever again recently start applying for jobs with our competitors.
So, if video survailence (sp) is available and at our fingertips - you bet, we will do it if there is probable cause. Doing so has saved us two other fraudulent cases.
The mis-nomer is that it is not coming out of the employer's pocket - WRONG! Of course it is and when you are a small business like ours, that hurts - bad! As I stated earlier, our premiums are 50% higher than our competitors.
5) Okay, this is lastly - re: pre-existing conditions. In Colorado, if we hire a person with, say, Rheumatoid Arthritis and this job exacerbates that condition and renders the person partially disabled - we just bought that disability for that person. Likewise for DDD - with or without back pain prior to the job injures due to the DDD an unstable back - we buy that as well.
I sincerely hope I did not make any enemys with this thread as I enjoy this board and the interaction. I just needed to say these things.
Thanks
------------------
gbr
JDD
2 Discograms
4 Level failed IDET
4 Confirmed torn lumbar discs, 2 full thickness
Issues now with c-spine & thoracic
Fusion of L5/S1 scheduled 3/5/03
Fusion successful - feeling better all the time
[This message has been edited by go*big*red (edited 04-25-2003).]