We were exhibiting at a conference years ago when I encountered a doctor who provided a truly enlightening moment for me. He was an older gentleman, old enough to have safely assumed he could be retired. He was not; but he no longer maintained a practice with regular patients. Instead, he focused solely on Independent Medical Exams (IME).
Even though he didn’t know me from Adam, he launched into a spiel about how much he loved a certain carrier, because “all [he] had to do was write whatever they want to hear, and they’ll pay me $1,500.” What this scumbag was really telling me was that he was not at all concerned with the ethical practice of medicine in any competent form. Instead, his words told me that he was perfectly content screwing injured workers for fun and profit.
And for injured workers, the betrayal by persons they expected to help is often the biggest wound of all.
It is the responsibility of employers, workers’ comp insurance carriers and TPA’s to help workers’ when they have been injured on the job. Still, the very nature of the relationship between those entities is one where “trust” may be earned, but is not automatically given, or even expected. For doctors, whose Hippocratic oath includes “First, do no harm,” and lawyers, who are hired to specifically represent the injured workers’ best interests, it is a different situation.
When people in those positions put their own interests ahead of the injured worker, we all lose.
On January 5th, we will hold our second webinar in the new “Hot Seat” series, and the episode is intended to take this particular topic head on. Entitled “Violating Trust: Ethical Conundrums in Workers’ Compensation,” we specifically intend to talk about bad actors and the damage they can do to the recovery process.
And while bad actors exist in every sector of comp, it is the ones who are supposed to be watching out for the injured worker who can often do the most damage.
Whether it is a surgeon who performs unnecessary procedures, physicians dispensing questionable compounds, or unethical IME specialists like our earlier example, the harm done by these people extends well beyond their patient/victim. They put the entire industry at reputational peril.
The same could be said for those injured worker attorneys who settle too quickly to close the case, earn their fee and move on. Or those who should settle but don’t, as the lure of increased income outweighs the interest of the client. And are we to believe that no California Applicant Attorney was aware of what was happening in what is alleged to be the largest workers’ comp fraud case in the history of the state?
A lot of people made money in the “churn” caused by that case, which some estimate cost the system over $600 million. While we talk a great deal about the financial cost of fraud, we do not often speak of the personal damage done to the people who were supposed to be patients; but instead turned out to be merely tools in a greater pursuit of financial gain. The specific cases I refer to, which involved kickbacks for patient referrals and fraudulent bills for spinal surgeries, injured people beyond their original condition, while those purportedly protecting the interests of the injured worker made money off the process.
Injured workers’ already thrown into a confusing and complex system, look to lawyers and doctors to help them in what can be an unforgiving process. Few people automatically “trust” an insurance carrier or their representatives. However, they do trust that a doctor will not harm them, or that a lawyer hired to protect their interests will do the right thing. When that trust is shattered, the consequences can be devastating.
I’ve said it before. I’ve met many, many dedicated professionals in this industry who want to do the right thing in workers’ comp. The stats bear out that for about 85% of the cases the system essentially works for the people for which it was intended. Over the last 20 years, there have been some 75,000,000 reported workplace injuries or illnesses. That represents almost 25% of the nation’s population. If the system didn’t work at some level, there would be far more angst than what we witness today.
But still, if the system works for 85%, who wants to be in the other 15? While that second number includes the catastrophically injured and those with bio psycho social challenges, the bad actor quotient contributes mightily as well. And that should be an issue we can do something about.
Bad actors are a minority within the industry, but their impact on us extends much further than any good deed we may recognize. Bad news always travels further than its happy counterpart. When that bad news involves people who were expected to stand up for rather than screw the people who counted on them, it gains significant weight on the public stage.
It is not a condition we should easily accept or overlook.
I suspect we will have plenty to talk about at the upcoming Hot Seat Webinar. It should be interesting. If you wish to view the program, you can register for it here.