I’m not sure that making the WC system more “user friendly”, as outlined in the article, will cut down on the abuse of medical care, nor get employees back to work more quickly. The proposal does sound like it will cause premiums to go up.
Increasing the comp rate, while at the same time shortening the qualification period to two weeks, will most ceratinly result in higher indemnity payments overall. Sure, the claimants will be more “satisfied” with the system. But, will the carriers who are still willing to write in Texas feel the same way? How about the employers who pay the premiums? Can you say “non-subscriber”?
The theory behind lower comp rates and long elimination periods is to discourage “goldbricking”. From a practical perspective, I don’t see how what the senator proposes will decrease the number of of lost time claims, nor decrease the durration. All I see it doing is having a minor effect on the average length of a lost time claim, but only because you will factor in all of the two week to four week lost time claims that would not be lost time claims under the four week waiting period scheme. But, averages aren’t totals.
And, to be sure, there are some bona fide complaints about the medical care under comp. However, from my experience, most claimants are disatisfied with their care under comp because: A.) They fail to understand and/or follow their doctors advice on treatment, B.) Their doctor makes them go back to work when they don’t want to, cutting off the “paid vacation”, C.) Good, competent doctors that will accept what the WC fee schedule pays, the paperwork hassles, and the delays in getting paid, are hard to find outside of metropolitan areas, D.) Once you do get to see a good doctor who treats WC patients, the patient load is such that there are longer waits for service than one should have to tolerate, and E.) Attorneys and their “comp *****” doctors can’t get clients/patients, and thus make money, unless they convince the claimant that the care he/she is getting without them is somehow deficient, and getting the claimant to voice complaints of such.
Establishing a Medical Provider Network won’t chnage these things. In fact, it may make the disatisfaction levels, especailly the imagined, worse. Claimant attorneys and union leaders will be quick to label any such provider a “company doctor”, and encourage claimants to seek treatment outside the network whenever possible. This plants the seeds of “disatisfaction”. You can bet that any regulations setting up a MPN will have various “outs” that will include claims of disatisfaction.
Somewhere along the way, we have lost sight of why there are worker’s compensation laws in place, rather than the tort system. The problem is that many workers, doctors, and attorneys still want the benefits of the tort system, with the guarantees of the comp system. But then, in their minds, they aren’t having to pay for the cake they want to both have and eat.
What is the good senator talking about?
There is NO waiting period for medical benefits and the only waiting period for income benefits is 7 days, after which
Income Benefits (TIB’s) are paid retroactively from the first day of lost time.
Perhaps it might help for our legislature to actually know what the current law provides for before they
set about to ‘modify’ it.
Chris makes some good points in this Comment. I would only add that no body of government can legislate an outcome – period. The “fix” for WC is no great big secret, treat people fairly, promptly and as you would have them treat you…make them know that their outcome is more than a closed claim. Carriers cannot really accomplish this for a variety of reasons, so only the employers, acting in concert with the employees, can “Fix” the system. Employers have too long shrouded themselves in the morale
hazard (I have WC, that’s my job, let the ins. company work this out). Bad employment practices breed bad employee populations. It is a two way street and both the employers and employees have to involve themselves in the ultimate solution to see any real longterm improvement.
You know, Texas has “mandatory” auto coverage. It hasn’t had an effect on the affordability of coverage, especially for bad risks, that I’ve ever been made aware of. And, I know that there are a lot of drivers out there running “naked”, because while the coverage is manadtory, for many it is still not affordable. Mandatory coverage hasn’t had any real impact.
There is always this assumption (based uopon the law of large numbers, maybe) that if everyone has to buy insurance, then there will be a big enough base of premium paid by risks that never incur losses to offset the increased numbers of truly horrific risks that are forced into the pool.
Well, when it comes to WC coverage, has anyone ever considered, much less studied, the idea that the “clean” risks are already insured, because they can afford it, and that by forcing everyone to get WC coverage, the only increase will be in the number of bad risks; driving losses, and thus premiums, up?
Has anyone ever done a study on just exactly which industries are chronically uninsured (non-subscribers) in Texas, to see why? Has anyone identified a carrier both qualified and willing to write WC for these industries?
Has anyone ever asked whether compulsory WC will put large parts of the some industries either out of business, force them to eliminate other benefits, or significantly increase the cost of consumer goods/services to pay the premiums?
Until we can figure out a way for good risks to afford WC coverage, and until we can figure out what an influx of bad risks will due to everyones’ premiums, we should probably hold off making it mandatory for the bad ones to get coverage.
If mandatory comp puts companies out of business, then how or why is it working in most every other state? If companies wanted to flee mandatory comp, our cities and towns should be filling up with new business and the un-employement rate about 1%- the chronic un-employed.
Instead, we hear stories of companies going bare in Texas, and I see this almost daily, leaving the workers without any recourse. Most of the plantiff attorneys say they will not go after a small company to get low or moderate levels of payments since the small businesses do not have deep pockets. So the workers may be left out in the cold to get benefits.
So what is the reason for a small business to get into the comp system? I see no such benefit for the costs invlved.
Labor trumpets the benefit to workers of choosing the doctor and getting better treatment not from the “company” doctor.
If the legislature tries to go to these networks to lower costs, which they have done in other states, then the trade off may be mandatory comp for all.
Maybe you missed the gist of the article: WC here in TX isn’t working, and it costs way too much.
The reason why mandatory comp in other states isn’t, as you claim, driving businesses to start up in Texas instead is because it doesn’t cost as much in most of those states, and the employees aren’t out of work as long.
As you also point out, with the exception of a few industries (grocery stores come to mind), it is predominantly the small businesses and high risk/low profit margin businesses that are going bare. Most of them don’t have the luxury to relocate to Texas to avoid mandatory comp.
Plus, and this is a biggee, its MANDATORY. If they want to do business in the state, they have to have it. Just because its mandatory doesn’t mean its working. Look at Florida and California.
You also don’t mention the fact that many businesses fail in mandatory comp states, or just don’t ever open in mandatory comp states, due to the cost of doing business; WC premiums and lost employee productivity. It’s a bit ridiculous to assume that most of those companies will/can just pick up shop and move to Texas.
Employees that go to work for small companies in Texas that don’t have comp know that going in. In a market economy, that is one of the factors to be weighed in accepting employment at one business over another.
I am truly sorry that plaintiff attorneys won’t attempt to represent an injured non-subscriber employee just because there isn’t enough money to make it worthwhile to the attorney. I’d bet that the injured employee would be more than happy to get something over nothing. You’d think that a right-minded attorney would be willing to make that happen.
But then, maybe the attorney is making a cost/benefit analysis also. Maybe it’s okay in their mind for an attorney to claim to “defend the little guy” and demand that businesses absorb ever-increasing costs which include WC premiums, making it difficult for these businesses to make a profit. Maybe its okay for these same “defenders” to not take cases where they don’t see a big enough profit margin in it for them, because, after all, the bucks don’t stop with them, at least not if they can help it.
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I’m not sure that making the WC system more “user friendly”, as outlined in the article, will cut down on the abuse of medical care, nor get employees back to work more quickly. The proposal does sound like it will cause premiums to go up.
Increasing the comp rate, while at the same time shortening the qualification period to two weeks, will most ceratinly result in higher indemnity payments overall. Sure, the claimants will be more “satisfied” with the system. But, will the carriers who are still willing to write in Texas feel the same way? How about the employers who pay the premiums? Can you say “non-subscriber”?
The theory behind lower comp rates and long elimination periods is to discourage “goldbricking”. From a practical perspective, I don’t see how what the senator proposes will decrease the number of of lost time claims, nor decrease the durration. All I see it doing is having a minor effect on the average length of a lost time claim, but only because you will factor in all of the two week to four week lost time claims that would not be lost time claims under the four week waiting period scheme. But, averages aren’t totals.
And, to be sure, there are some bona fide complaints about the medical care under comp. However, from my experience, most claimants are disatisfied with their care under comp because: A.) They fail to understand and/or follow their doctors advice on treatment, B.) Their doctor makes them go back to work when they don’t want to, cutting off the “paid vacation”, C.) Good, competent doctors that will accept what the WC fee schedule pays, the paperwork hassles, and the delays in getting paid, are hard to find outside of metropolitan areas, D.) Once you do get to see a good doctor who treats WC patients, the patient load is such that there are longer waits for service than one should have to tolerate, and E.) Attorneys and their “comp *****” doctors can’t get clients/patients, and thus make money, unless they convince the claimant that the care he/she is getting without them is somehow deficient, and getting the claimant to voice complaints of such.
Establishing a Medical Provider Network won’t chnage these things. In fact, it may make the disatisfaction levels, especailly the imagined, worse. Claimant attorneys and union leaders will be quick to label any such provider a “company doctor”, and encourage claimants to seek treatment outside the network whenever possible. This plants the seeds of “disatisfaction”. You can bet that any regulations setting up a MPN will have various “outs” that will include claims of disatisfaction.
Somewhere along the way, we have lost sight of why there are worker’s compensation laws in place, rather than the tort system. The problem is that many workers, doctors, and attorneys still want the benefits of the tort system, with the guarantees of the comp system. But then, in their minds, they aren’t having to pay for the cake they want to both have and eat.
What is the good senator talking about?
There is NO waiting period for medical benefits and the only waiting period for income benefits is 7 days, after which
Income Benefits (TIB’s) are paid retroactively from the first day of lost time.
Perhaps it might help for our legislature to actually know what the current law provides for before they
set about to ‘modify’ it.
Chris makes some good points in this Comment. I would only add that no body of government can legislate an outcome – period. The “fix” for WC is no great big secret, treat people fairly, promptly and as you would have them treat you…make them know that their outcome is more than a closed claim. Carriers cannot really accomplish this for a variety of reasons, so only the employers, acting in concert with the employees, can “Fix” the system. Employers have too long shrouded themselves in the morale
hazard (I have WC, that’s my job, let the ins. company work this out). Bad employment practices breed bad employee populations. It is a two way street and both the employers and employees have to involve themselves in the ultimate solution to see any real longterm improvement.
My 2 cents.
One solution to bringing rates down is not being openly discussed: mandatory comp coverage.
You know, Texas has “mandatory” auto coverage. It hasn’t had an effect on the affordability of coverage, especially for bad risks, that I’ve ever been made aware of. And, I know that there are a lot of drivers out there running “naked”, because while the coverage is manadtory, for many it is still not affordable. Mandatory coverage hasn’t had any real impact.
There is always this assumption (based uopon the law of large numbers, maybe) that if everyone has to buy insurance, then there will be a big enough base of premium paid by risks that never incur losses to offset the increased numbers of truly horrific risks that are forced into the pool.
Well, when it comes to WC coverage, has anyone ever considered, much less studied, the idea that the “clean” risks are already insured, because they can afford it, and that by forcing everyone to get WC coverage, the only increase will be in the number of bad risks; driving losses, and thus premiums, up?
Has anyone ever done a study on just exactly which industries are chronically uninsured (non-subscribers) in Texas, to see why? Has anyone identified a carrier both qualified and willing to write WC for these industries?
Has anyone ever asked whether compulsory WC will put large parts of the some industries either out of business, force them to eliminate other benefits, or significantly increase the cost of consumer goods/services to pay the premiums?
Until we can figure out a way for good risks to afford WC coverage, and until we can figure out what an influx of bad risks will due to everyones’ premiums, we should probably hold off making it mandatory for the bad ones to get coverage.
If mandatory comp puts companies out of business, then how or why is it working in most every other state? If companies wanted to flee mandatory comp, our cities and towns should be filling up with new business and the un-employement rate about 1%- the chronic un-employed.
Instead, we hear stories of companies going bare in Texas, and I see this almost daily, leaving the workers without any recourse. Most of the plantiff attorneys say they will not go after a small company to get low or moderate levels of payments since the small businesses do not have deep pockets. So the workers may be left out in the cold to get benefits.
So what is the reason for a small business to get into the comp system? I see no such benefit for the costs invlved.
Labor trumpets the benefit to workers of choosing the doctor and getting better treatment not from the “company” doctor.
If the legislature tries to go to these networks to lower costs, which they have done in other states, then the trade off may be mandatory comp for all.
it will be an interesting session.
Robert,
Maybe you missed the gist of the article: WC here in TX isn’t working, and it costs way too much.
The reason why mandatory comp in other states isn’t, as you claim, driving businesses to start up in Texas instead is because it doesn’t cost as much in most of those states, and the employees aren’t out of work as long.
As you also point out, with the exception of a few industries (grocery stores come to mind), it is predominantly the small businesses and high risk/low profit margin businesses that are going bare. Most of them don’t have the luxury to relocate to Texas to avoid mandatory comp.
Plus, and this is a biggee, its MANDATORY. If they want to do business in the state, they have to have it. Just because its mandatory doesn’t mean its working. Look at Florida and California.
You also don’t mention the fact that many businesses fail in mandatory comp states, or just don’t ever open in mandatory comp states, due to the cost of doing business; WC premiums and lost employee productivity. It’s a bit ridiculous to assume that most of those companies will/can just pick up shop and move to Texas.
Employees that go to work for small companies in Texas that don’t have comp know that going in. In a market economy, that is one of the factors to be weighed in accepting employment at one business over another.
I am truly sorry that plaintiff attorneys won’t attempt to represent an injured non-subscriber employee just because there isn’t enough money to make it worthwhile to the attorney. I’d bet that the injured employee would be more than happy to get something over nothing. You’d think that a right-minded attorney would be willing to make that happen.
But then, maybe the attorney is making a cost/benefit analysis also. Maybe it’s okay in their mind for an attorney to claim to “defend the little guy” and demand that businesses absorb ever-increasing costs which include WC premiums, making it difficult for these businesses to make a profit. Maybe its okay for these same “defenders” to not take cases where they don’t see a big enough profit margin in it for them, because, after all, the bucks don’t stop with them, at least not if they can help it.