Health Coverage Could Replace Workers’ Comp
The State Compensation Insurance Fund, a state-run nonprofit that insures half the businesses in California for worker injuries, has warned that it will stop accepting new customers shortly and that rates are scheduled to jump about 25% in the next 18 months. Here is one employer’s story:
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The young man had been a problem employee from the beginning. He left the hospital job he had held for two years to be a retail clerk for our company, which had more flexible hours. He said he was going back to school. His first week, he requested permission to leave early to sign up for classes. Subsequently, his attendance was spotty: He was sick, he had an extra class, there was a family emergency. His manager accepted the excuses but warned him he might not successfully complete his probation period because he was undependable.
One night, alone in a storeroom, the worker claimed he heard a pop in his back as he picked up a box. He wrote a note to his manager and left. The manager called him the next day. The worker said he thought he would be fine but had to rest his back. Two days later he was asking for medical help.
We filed a report with State Fund, and the young man went to a doctor. He returned with a paper that said he should stay home for one week and then return with limited duties; no lifting, no bending.
When he returned to work, we accommodated his limitations. A few hours into his shift on his first day back he told a co-worker he was going on break. He walked out of the store and never returned. The next day, he called the manager, claiming that he had had a splitting headache and had gone home and fallen asleep. The manager told him that things had not worked out and he was being terminated. He had barely worked 10 full days in two months.
A month later, our former employee had an attorney and a date for a hearing before a workers’ compensation hearing officer. The employer was not invited to attend. We were told later that the young man was being given $90 a week in tax-free disability benefits. The State Fund representative handling our claim explained that the question was whether the former employee would receive permanent disability. She said the injured worker had promised to see one of her doctors. He had already missed two appointments.
Apparently there are doctors who accept the word of the worker and doctors who don’t. When it comes to pain -- backache, carpal tunnel, headaches -- all you have is the word of the sufferer. My representative told me that she hoped to settle the case relatively cheaply, which to her meant for less than $10,000. The system presumes the worker is truly injured. We learned that our worker told another employee he had a previous workers’ compensation claim and knew how the system worked.
Our company, with about 40 people, had not had a claim for several years, yet our rates have doubled within the last two years. That was before the employee filed his claim.
The State Fund led a long and difficult fight a decade ago to change the system when stress claims were rampant. Such claims are now virtually nonexistent. At one time, we had three employees from the same store suing for stress, all seeing the same doctor and represented by the same lawyer.
Most of my employees have full medical benefits, and my company pays about 80% of the premium. If they are injured on the job, why can’t they be covered under their existing medical insurance? Although our governor is preoccupied with other budgetary matters, he might find a pile of money that could be used differently if he addressed some of the problems in the workers’ compensation system.
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Karen H. Mason is corporate secretary of a small business in Los Angeles.
