N.Y. Agents Back Overhaul Of Workers’ Comp System

June 5, 2006

New York should increase its workers’ compensation benefits and try to deliver benefits in a less adversarial process, according to the Professional Insurance Agents of New York State Inc.

The association made its recommendations in a recent policy statement after completing a year-long study.

“New York should look at a number of areas to preserve workers’ comp as a true ‘no-fault’ system providing workers’ sole remedy for employment-related injury or illness. We should strive to preserve and enhance worker benefits, prevent work-related disability and reduce inefficiency and fraud,” said J. Carlos “Shawn” Viaña, PIANY president.

The study was overseen by PIANY President-elect David Dickson, who developed its recommendations in discussions with parties from diverse groups affected by workers’ compensation.

“We decided to look at the system objectively, with a fresh perspective,” Dickson said. “As agents, we know how insurance policies are supposed to work. Compared to other policies delivering similar benefits, such as auto insurance no-fault payments, life, health and disability insurance, New York workers’ compensation policies function very inefficiently.”

PIANY recommends that the state study several areas to save and contain costs, starting with workplace safety. Two safety-oriented programs were enacted in the state’s comprehensive 1996 workers’ compensation reform package, but were never implemented, PIANY notes. Both programs would have saved employers money on their premiums for adopting safety programs and investing in safety equipment.

The state also should tone down the confrontational nature of its system, PIANY’s report recommends. Compared to other jurisdictions, New York’s workers’ compensation system is extremely adversarial, PIANY maintains. Its adjudication structure pits insurers against claimants, which is not appropriate for a no-fault system.

According to PIANY, too many claims are controverted and the process dragged out, leaving workers feeling betrayed and employers marginalized. This leads to less-than-optimum outcomes.

The PIANY report charges there is an “extraordinary level of mistrust” that prevails among all parties associated with workers’ compensation.

PIANY also urges the state to look at cases brought under Sections 240 and 241 of the state’s Labor Law in the context of the “sole remedy” principle of the workers’ compensation system.

The PIANY study also highlights and alleged lack of oversight and transparency in the collection of data and the rate filing process and outright fraud. Significant levels of fraud occur among certain members of all groups associated with workers’ compensation, the PIANY report contends.

PIANY also believes the system could benefit from more advanced technology. “One third-party administrator that PIANY spoke with says it finds errors in approximately 60 percent of workers’ compensation billings,” Dickson reports.

PIANY also recommends that medical providers should be required to move quickly toward electronic billing for workers’ compensation claims.

The full report can be viewed at www.piaonline.org/GIA/NY/position_workerscomp.pdf.

Source: PIANY

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