10-25-11; Painful as it is to say, tornados aren’t work-related risks, folks. However, at the last minute, the Accident Fund Insurance Company of America steps to the plate!!!

A reader sent us an article about an individual severely injured in the horrific storm in Joplin, MO, earlier this year. It appears there is no question Mark Lindquist is a hero. He was a low-paid social worker who nearly gave his life trying to save three developmentally disabled adults from the storm. Both houses of the Missouri legislature honored Lindquist, the Senate resolution calling him "a true hero and inspiration to others." From our review, the Missouri Senate’s assessment is clearly accurate and we salute Mr. Lindquist for his sacrifice and heroism.

The problem is heroism doesn't pay the bills. The tornado's winds tossed Lindquist nearly a city block, broke all of his ribs, shattered his shoulder, knocked out most of his teeth and put him in a coma for about two months. Medical expenses now exceed $2.5 million and the bills remain ongoing. The main social problem we all face is Mr. Lindquist had no private medical insurance as he couldn’t afford it. He assumed workers' compensation would cover his bills, but his claim was initially denied "based on the fact that there was no greater risk than the general public at the time you were involved in the Joplin tornado" according to his company's workers' comp provider. Full disclosure--we work for that provider and have to agree with that difficult initial assessment.

That reasoning has angered observers in some quarters including family, co-workers and some lawmakers. Lindquist watched the skies darken on the evening of May 22, 2011 on his way to the Group Home occupied by three middle-aged men with Down’s syndrome. When he got there, a tornado siren began to blare. The employer, Community Support Services recently put workers through a tornado drill, so Lindquist and a co-worker knew what to do. Because there was no basement or shelter and the developmentally disabled residents moved too slowly to relocate, Lindquist and the other worker placed mattresses over the men for protection, then climbed atop the mattresses for added ballast.

The EF-5 tornado was among the nation's worst of all time. It destroyed more than 7,000 homes, including the Group Home, and killed 162 people, many of whom were at work. Lindquist's survival defies common sense. After the storm, rescuers found Lindquist buried in rubble, impaled by a piece of metal. Bones from his shoulder crumbled as he was placed on a door used as a makeshift stretcher. He was later delivered to the Hospital. His injuries were so severe his body had become swollen and unrecognizable. He fell into a coma. Debris in open sores caused a fungal infection, one that killed five other Joplin tornado victims. Lindquist overcame the fungus but remained at the first hospital for about a month. Still in a coma, he was flown to another hospital for a little over a month before being sent to a rehab center where he awakened.

His recovery amazed doctors. His right arm remains in a sling, but he has use of the hand. The eye that was temporarily blinded has full sight. He moves slowly and has short-term memory loss, but speaks well.

Critics claim the insurance company's decision is unfathomable because if Lindquist hadn't been at work, they assert he wouldn't have been hurt. Some observers feel he could have jumped in his van and fled as the tornado approached.

In our view, this is an example of deflecting fault when anything bad happens. First, in blaming doctors/hospitals and care-givers, they can sometimes be demonized regardless of the losses they take in such situations. Some folks feel there was an area-wide emergency so the doctors and hospitals should all work for free and provide all durable medical equipment, prescriptions, diagnostics and other costs at no charge. Americans want unlimited, on-demand medical care for all of our problems the moment their arise. No one sees hospitals and doctors have their own bills to pay and they can go broke.

Second, there are some folks who feel problems from such unforeseen and cataclysmic events are "the employer's fault." In this model, they double-deflect the blame from the employer to the supposedly “wealthy” WC insurance carrier and assert the carrier is to somehow “blame” for simply following the state’s rules and their underwriting guidelines. The fact workers’ comp insurance requires an event to both arise out of and occur in the course of employment is forgotten. In our view, tornados aren’t risks that arise out of employment—they are risks common to the public whether we are working or not. If insurance carriers and self-insured employers have to pay for risks common to the public, the cost is wildly higher, as can be seen in this instance.

Some folks like to blame the "government" and say taxes should always be set aside and be immediately available to pay for storm injuries and damages. Sometimes government can help and sometimes government has to pay their own bills and there isn’t much left around to cover the unexpected events that clearly arise.

There are probably thousands of survivors of the Joplin tornado who weren't working during this terrible storm and have similar stories. All of them are heart-wrenching and compelling. The question is who has to pay for the societal costs of storms. In our view, Acts of God are risks of everyday life that we all have to face and prepare for. Taxes should be set aside for such things also but we have to remember taxes aren't free either.

As this is going to press, we learned

Accident Fund Insurance Company of America announced it was changing course. "Upon further review of the case, and receiving additional information on the facts involved in this situation, Accident Fund believes the appropriate decision is to honor Mr. Mark Lindquist's claim for worker's compensation benefits," Mike Britt, president of the Lansing, Mich.-based insurance company, said. "We are committed to working with Mr. Lindquist to ensure he receives all the benefits to which he is entitled and helping him to recover from his injuries."

All we can say is God bless them for doing so and helping this hero in his time of need. Kudos from KC&A to Mr. Britt and all of his staff who are also unquestionably heroes. We appreciate your thoughts and comments. Please feel free to post them on our award-winning blog.

10-25-11; Safeworks Illinois’ 19th annual Work Injury Conference tackles Challenges*Debates*Solutions of REFORM 2011.

Last week in Champaign, IL, several hundred industry movers and shakers jammed the I-Hotel on the campus of the University of Illinois for the 19th annual work injury conference produced by Dr. David Fletcher of SafeWorks Illinois. This year’s theme REFORM 2011:Challenges*Debates*Solutions centered on the changes to the Illinois workers’ compensation system following the May 2011 reform.

Jay Tebbe, President & Publisher of the Belleville News-Democrat riveted the audience with his review of the BN-D’s investigation of the Menard prison scandal, which gained the attention of the State House and paved the way for WC reform. Tebbe stated the BN-D has a pending law suit against CMS to turn over nerve conduction velocity test results of a sample of 50 prison guard cases awarded carpal tunnel syndrome claims that resulted from infrequent turning of locks of old manual prison doors, even though Attorney General Lisa Madigan’s office has recommended turning over the results to the BN-D while CMS is being defended by private outside counsel.

The morning sessions focused on challenges and debates following the passage of HB1698. Petitioners’ attorney Kim Presbrey gave an insider look at how the new law came about following the State of Oregon WC study that alleged Illinois was number 3 in the country for WC costs. Presbrey said “Illinois is a market-driven insurance market and the failure for new reform to set up a mandated state-run insurance option to compete against the private sector to offer employers a lower cost alternative was wrong, especially in light of NCCI asking for a 3.5% increase in workers compensation rates for Illinois next year.” Presbrey noted the recent 3.1% increase came after the NCCI sought an 8.8% decrease in advisory rates in Illinois after state lawmakers adopted workers comp reform legislation last May based largely on a 30% reduction of Illinois' medical fee schedule under the new law.

A panel of industry leaders from all stakeholder point of views including medical providers, petitioners’ attorneys, respondents’ attorneys, employer/business representatives, insurance managers and labor delegates gave perspectives on what HB1698 will bring. The consensus of the panel is doctors, hospitals and other medical care-givers got the worst of the reforms. While it is well known that the IL WC medical fee schedule got reduced 30% the actual effect of the fee schedule reduction was even more drastic with the collapse of 29 geo-zips into 4 regions for the new fee schedule—up to 45% reduction in some areas, such as Champaign.

Illinois State Medical Society (ISMS) policy analyst Patrick Gallagher provided an analysis of the fee schedule cut:

Code

Desc

2011 WC Champaign

After 30% cut WC Champaign

Medicare

% Below Medicare

 

 

 

99203

off visit new pt

$157.26

$110.08

 $110.68

-0.54%



 

99204

off visit new pt

$225.41

$157.79

 $170.93

-7.69%

 

 

 

99212

off visit

$72.33

$50.63

 $44.16

14.65%

 

 

 

99213

off visit

$97.50

$68.25

 $73.90

-7.65%



 

99214

off visit

$146.79

$102.75

 $109.66

-6.30%



 

Studies show once physician reimbursement is less than 160% of Medicare that access to medical care is a real issue.

The mismanagement of workers’ compensation for employees of the State of Illinois was a major recurring topic. “Just change the locks…” was the mantra of several audience members when the discussion of the Menard prison scandal was brought up repeatedly as symbolic of the public sectors’ failure to be pro-active.

Unfortunately, about 10 days before the conference, Governor Quinn’s office pulled a speaker from IDOT who was supposed to discuss highlighting model programs IDOT had implemented to promote worker safety and save money for the Illinois taxpayers. In response to this censorship by Governor Quinn’s office, Illinois Chamber President Doug Whitley said: ”It is of course disappointing, but not surprising that the Governor’s office did that. The State is missing the boat and failing the taxpayers by not devoting the resources and efforts that a private employer would pursue. The pursuit of seeing the State’s WC program privatized will be a part of the Illinois Chamber’s next campaign to build support for another round of WC changes in 2013.”

The afternoon’s session featured solutions being touted to further help with WC cost control. Dr. Charles Bush-Joseph managing partner for Midwest Orthopaedics at Rush (MOR) spoke about the formation of Preferred Provider Program (PPP) networks Illinois employers can offer injured workers as their first option of care before choosing to opt out of the PPP system and then utilize their final choice of treating provider. Dr. Bush-Joseph touted a smaller elite PPP network that would be based employee assurance of quality. He believed it was important to have independent or community-branded providers in the network and providers needed the skill-set in dealing with injured workers by understanding the nature of the work environment. He also felt effective providers must engage in efficient communication with all stakeholders.

We did receive a draft copy of the PPP “opt-out” form and we would be happy to email it to anyone who wants it. We were told it may make the IWCC website today or later this week. If you want a copy, send a reply.

Dr. Fletcher gave an overview of the AMA Guides and the physicians new Permanent Partial Impairment (PPI) ratings that arbitrators now have to consider when arriving at PPD awards, along with other enumerated factors.

Dr. Fletcher wrote this article and it was briefly edited for space and content. A DVD of the conference is being produced and our readers may contact Dr. Fletcher for more details at their website: www.safeworksillinois.com or via email to dfletcher@safeworksillinois.com.

10-25-11; Can the State of IL and the City of Chicago appoint “Attendance Czars” to attack spiraling WC costs, questionable claims and absenteeism?

We continue to reel on the news these two nutty government bodies have annual workers’ compensation costs that will respectively exceed $100 million dollars for each every year. The State of Illinois has a budget deficit expected to top $8 billion or about 25% of its budget while the City of Chicago is now pushing for a deficit expected to be as high as $800 million or about the same percentage of its budget. If you aren’t certain, the State of Illinois has about eight times the number of workers the City of Chicago has so if the numbers for the City are accurate, and we have no reason to doubt the Chicago Sun-Times who published the $100 million number, the State’s comparative annual payout at the rate the City is blowing WC money would be $800 million.

The City of Chicago’s WC numbers indicate they have the highest per-employee WC payout on the planet. One out of every ten City workers has a pending WC claim. We don’t think anyone on this Earth is even close; if any reader is aware of one, please send it along. We are certain any private company with one WC claim for every ten workers would be out of business in a year.

Why do these two government bodies throw away so much money and stick out so badly? Well, we feel the main problem is the old-line politics that got them to this situation. In a setting where everyone is working in a political patronage army, the overall goal is electioneering. The government job is a far second place to winning elections. The folks at the State of Illinois and the City of Chicago who are in charge of WC programs have been running them badly for decades—the programs act as a perk for their workers and the workers’ attorneys who donate heavily to keep it all going. You may ask, what about civil service protections and the Shakman decree that were designed to take the politics out of State and City politics? Well, they sort of worked and sort of didn’t. Lots of folks on both sides of the political fence in this state still feel pressure to participate, donate and win elections. Civil service safeguards are sort of a joke in this state--as we just saw at the Illinois WC Commission, civil service protections were quickly and brutally stripped from lots of hard-working and long-time arbitrators who were summarily canned for doing nothing wrong other than holding the same job titles as two or three miscreants. The State of Illinois and City of Chicago both have “reform” leaders who haven’t truly touched the main issues that have led to monster budget deficits and lots and lots of borrowing.

The Main Problem Causing Hundreds of Millions in Government Waste

What do we think is wrong with these governments and their programs—in a word, attendance. In our State and City governments, lots of workers don’t have to show up. We are told thousands of workers for both government bodies are ���missing in action” every day of every year. How can that happen--one way to maximize lost time is to get “hurt” at work—one can have an infinite number of workers’ compensation claims, if you know the ropes. We are advised lots and lots of state and city workers file lots and lots of claims and take over whatever season they want at their whim to return to protected jobs whenever they want. As a cookie, they then seek a nice tax-free WC settlement in a forgiving system that punishes and penalizes anyone who gets in their way.

Hold on, hold on, one might say. That can’t happen, can it? Shouldn’t both government bodies be investigating these dubious WC claims and looking for lost time documentation and sending out surveillance operatives to insure they aren’t stealing from the taxpayers? Well, we have advised you both the State of Illinois and City of Chicago have hilariously comical WC claims adjusting programs. The State of Illinois claims adjusters have more than 1,500 claims each—in comparison, most private WC claims handlers are able to track about 150 litigated lost time claims before pulling their hair out. If you think 1,500 is a lot of Illinois WC claims, try to imagine the City of Chicago has a single adjuster managing over 3,000 claims!!! No one person can manage and investigate literally thousands of workers’ compensation claims. It is almost a miracle to imagine they can keep any of it straight—we bet a detailed audit would show lots of overpayments and double-payments at every level.

On the other end of the matrix, if you can argue your injuries or surgeries arguably prevent you from coming back to work at your initial job title, right now, the State and City of Chicago won’t bring you back to alternative work. We call this “inverse absenteeism.” This is literally the best of all worlds for the government workers and a nightmare in runaway costs for taxpayers. In August of this year, we reported about a story from George Pawlaczyk and Beth Hundsdorfer of the Belleville News-Democrat about a State of Illinois worker who underwent CTS repairs and then could no longer work as a court stenographer. When the State couldn’t/wouldn’t bring her back to another job, the State's Office of Workers’ Comp Claims Mismanagement provided this excuse for now owing her several million in benefits: "If and when possible, one of the primary objectives of the state's workers' compensation program is to return employees safely and quickly to productive work." However, they also apologized to note "Re-employment for injured workers is subject to union bidding rights, veteran's preference and other laws, and all hiring must take place within those laws." We consider that excuse to be balderdash when you understand how much those comical and supposedly unalterable “rules” cost all of us. We think “workers’ comp rules” should also be a part of the mix.

The BN-D team also reported claimant got an additional $122,000 from the IWCC for “loss of trade.” In addition to the monies listed above, this claimant will also receive $1,482 per month in occupational disability from the State Employees Retirement System. Her total for workers' compensation and retirement disability is $57,633 per year, none of which is subject to tax. In our view, she is getting more tax-free dollars in “retirement” than her salary! The projected lifetime cost of the combined benefits is $1,671,357.00. Adding the $122,000 in “double-permanency” and the $248,966 already paid, our State is going to be out about $2,042,323.00 not including medical bills. Right now/today, the claim value would drop from over $2,042,323 back to $122,000, a savings of about $1.9 million, if they offered her a reasonable job right now—the State can cut all of this off if and when they ever get the message and offer her a reasonable job. All of these benefits for a woman who testified under oath she can and will work. No one seems to care about “inverse absenteeism” other than the taxpayers.

We are telling everyone who will listen our sources advise us the State of Illinois is paying about 400-500 lifetime total and permanent disability claims. Some of those workers can and should be brought back to work. We don’t know but we are confident the City of Chicago probably has several hundred similarly situated individuals living off “double-dipped” lifetime WC and retirement benefits. Can someone send a FOIA request to find out how many and what they are getting?

Our Thought—Attendance Czars for State of Illinois and City of Chicago Claims

Noting the City of Chicago has an “Inspector General” for outside vendors and general corruption in city government. The stated mission of the City of Chicago Office of Inspector General is to root out corruption, waste and mismanagement while promoting effectiveness and efficiency in municipal government. The Office asserts it is a watchdog for the taxpayers of the City and has jurisdiction to conduct investigations and audits into most aspects of City government. We assert no one is watching spiraling workers’ compensation costs or claims mismanagement in either State or City government.

We are telling them and everyone who will listen their workers’ compensation program needs to be audited with a focus on attacking lost time at the beginning of claims. Getting folks back to work to avoid “lazy-lot” T&P’s has to be addressed. Private WC brokers or the top-notch managers at IRMA should be consulted for their thoughts and comments. They need someone to attack and prevent “non-accident” accidents. They need to start considering what folks in the private sector do to avoid claimants who file numerous claims and act unsafely so as to cause the claims.

We truly don’t care if the Attendance Czar is a part of the Inspector General’s Office or another payroller. We just feel someone, somewhere has to take a look at how much taxpayer money is being overpaid to city workers as a result of absenteeism, uncontrolled WC costs and obvious mismanagement. Something should be done to stop it while there are still folks in this State and City who can afford the rising taxes and tolls.