Colorado Considers Laws for Pinnacol

September 21, 2009

Colorado lawmakers proposed bills Friday to require better oversight for the state’s workers’ compensation insurer, saying they can’t ignore problems uncovered during weeks of hearings this summer.

The proposals included revamping Pinnacol Assurance’s board for better oversight, increasing transparency and accountability, banning bonuses to Pinnacol employees based on their denials of claims, and imposing stiff penalties for improper denials or delays in medical treatment.

Republican Sen. Shawn Mitchell of Broomfield proposed a bill that would make the hybrid public-private company entirely private, but lawmakers said that has little chance of passing.

Mitchell said lawmakers are trying to retaliate against the company because it refused to hand over an estimated $680 million surplus to help balance the state budget.

“Cut the leash and let it be,” Mitchell told a committee charged with recommending reform.

Committee chair Sen. Morgan Carroll, D-Aurora, suggested laws to bar bonuses to Pinnacol claims workers for denying claims or delaying medical care.

“Pinnacol is a very wealthy organization. They resent any scrutiny at all,” she said.

Critics of the company said money kept as surpluses and spent on employee perks and entertainment could have been used to help injured workers whose claims were denied.

During the hearings, company officials acknowledged that claims adjusters and medical advisers received bonuses based on profit and other performance standards. They said it would be counterproductive to deny claims to improve profit margins because customers would leave.

On Aug. 31, a dozen workers injured on the job told lawmakers they were spied upon and that their claims were unfairly denied. They included a former Durango firefighter who was injured in training. He told legislators he was forced to sell his home after Pinnacol denied him the surgery he needed to fix his back.

Pinnacol CEO Ken Ross told legislators then that he didn’t know how many of the approximately 55,000 claims filed with Pinnacol each year are denied but that it is only a small percentage.

At a Sept. 4 hearing, Pinnacol acknowledged that last year it followed about 2,600 injured workers who had pending claims and videotaped some of them. The company insists it is required and allowed to do so by state law to prevent fraud.

Ross on Friday questioned whether the committee has the legal authority to make broad changes to the workers’ compensation program.

“Questions are sure to be raised on both the impact any proposed bills will have on the workers’ compensation system as a whole and on whether the proposals are actually within the scope of the committee’s work,” he said.

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