What Should an Injured Worker Expect from The Workers’ Compensation System After His/Her Injury?

The way the worker is first introduced to the WC system is generally through the Concentra, Urgent Care, Clinic route.  I can state within a reasonable degree of accuracy that my clients find this initial treatment deeply off-putting and most of my clients have already heard stories about the company clinics as they call them.  The stories come from their co-workers, rumors or possibly from false or exaggerated stories that paint clinics in a negative light.   

But if “the proof is in the pudding” then after a few visits at these company clinics the struggle to get quality treatment becomes a reality.  It is difficult for my clients to break out of the clinics to a more specialized doctor.  The clinics are quick to return my clients to work without specialized testing or specialized care.  This creates an atmosphere of distrust on the part of the injured worker.  “Why can’t I just go to my family doctor for decent treatment” they say so often. 

This begs the question: “Why is Georgia one of the only holdout states for eliminating the panel of doctors? Why is it so difficult to expand the panel to a much more reasonable number of doctors, giving the worker an opportunity to possibly have confidence in the medical care they are receiving.  Do we, as lawyers, have our own family doctors who are there for us when we are needing treatment?  Too bad the workers’ compensation system locks the injured worker out of this choice.  

Clients ask me to represent them when they are dissatisfied with the medical treatment they receive.  Many of them seek fairness because they perceive the system as weighted against them.  I am surprised at how many company clinic doctors openly state to their WC patient that the doctor’s “options are quite limited because the claims adjuster doesn’t allow various treatments or testing.  “Our hands are tied” the clinic doctor says all too often.  How can this instill any confident from patient to doctor?  Again, if my family doctor told me that she could not order a certain test because my insurance company said no, what would I do or say?  It would not be pretty, I assure you. 

I am always amazed at the lengthy delay in obtaining appropriate treatment for my clients.  I handle both workers’ compensation and auto injury cases.  It is amazing how slow the workers’ compensation system is to obtain routine treatment.  Part of the problem is that I cannot get an adjuster on the phone to talk about needed treatment (even from the insurance/panel doctors).  Nurse case managers are generally following orders from the adjusters so they do not speed up the process.  I also found that insurance defense lawyers find a way to slow the process down.  Using a WC-205 PMT Conference has been great in limited factual circumstances.  All in all, if a study were to be done regarding the lengthy of time it takes for an injured worker to travel through the medical system in a non-controversial, uncontested case, it would be 3 or 4 times the length of a group medical or auto claim.  

Workers get quite frustrated with the extensive delay at many turns of the case.  We do not realize how much of a bad reputation workers’ compensation claims have become.  I speak to a number of injured people weekly who say they are going to take FMLA leave and get treatment from their PCP doctor and use their group insurance to pay for the treatment just to avoid the workers’ compensation system. 

 It is sad that this less than savory reputation of the workers’ compensation system is so bad.  But as lawyers, why should we care? Most of us on the injured workers’ side have adequate business income and settlements/mediations are good for us.  The defense bar is an always expanding group of lawyers that welcomes litigation.  And the adjusters….. well, how many of us have seen the revolving door at the insurers and TPA’s and rarely see the same adjuster more than once or twice.   

Legislation that could help balance the workers’ compensation system is most difficult to achieve.  The WCCL fights against the overwhelming advantage of the employers, insurers, self-insurers, and all those also have interests adverse to the worker, and they usually prevail. 

It is argued that our system is “well-balanced, profitable for insurers and fair to all.”  Really?  This is not so.  The worker suffers more than anyone else.  And they have achieved little power or influence to change or to even modify the system to a small degree.  

I find it amazing how many doctors pay more attention to the wishes of the insurers with little desire to treat the worker as their priority, let alone fairly.  Why is this so?  It seems that the volume of injured workers funneled through the system are treated like cattle.  The orthopedic doctors at most large ortho clinics have received their marching orders from the insurers: return everyone to work, irrespective of the extent of the injury.  Full duty is the mantra.  Follow it or the insured will take your clinic off the panel of doctors.  And we all know that the doctors have created lucrative practices from implementing this policy.  But on the worker’s side, the familiar faces of the doctors who treat the workers fairly is small and constantly under attack. Sad but true.