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Investigators: State workers' comp system adds insult to injury

by LINDA BYRON / KING 5 News

KING5.com

Posted on July 6, 2010 at 10:37 PM

Updated Tuesday, Jul 6 at 10:58 PM

Jeremey and Suzette Jackson own Northwest Granite & Flooring on Whidbey Island. They say that the current economy is hurting their bottom line, but what's really killing them is escalating workers’ compensation rates.
 
"We're a small business, we can't really afford for the rates to go higher," said Suzette.

But the Jacksons don't have a choice. Under state law, they have to pay into an Industrial Insurance Fund that covers medical costs and lost wages for workers hurt on the job.

Jeremey demonstrated the work their lead fabricator was doing on a big tub surround when he hurt his back.

“Basically a polishing movement back and forth,” he said.

"This is the original prescription that the doctor gave him, saying that he should be off work for one week," said Suzette.  She showed us the prescription that was written nearly four years ago in August 2006. The claim is still pending.

Having an open claim drag on for years is a big deal. It means the Jacksons pay substantially higher rates for all of their employees.

"It's cost us thousands and thousands of dollars," said Suzette.

The Jacksons' rate went up nearly 30 percent in just the past year because they have an open claim in what's already considered a high risk industry. Yet they say resolving the claim is out of their control.

"I've done everything I can do. And I just don't understand why it's taking this long. I really don't and they can't give me an explanation," said Suzette.

You might think it's because the workers comp system is overwhelmed with more on-the-job injuries--but it's just the opposite. The KING 5 Investigators have found the number of accidents and fatalities on the job is dropping, yet more and more cases are taking longer and longer to resolve.

We asked Robert Malooly, who runs the State Workers’ Compensation Program, why that’s happening.

"It's a very difficult problem, there’s no clear answer, there’s no single factor,” he said.

What is clear are the numbers: In 1999, total benefits paid to injured workers totaled $879.9 million. Last year they hit $1.5 billion. That’s an increase of 73 percent.

Proof, say critics, that Washington hands out benefits far too easily.

"You will find employers who say that in every state in the country, and you'll find workers who say Washington is too stingy,” Malooly said.

The median time loss is 40 days for all injured workers.  But there is a disturbing trend for claims that qualify for long-term benefits. Those workers are staying on the state payroll an average of nine months.

The Jacksons' injured granite fabricator is one of those troublesome cases.

We reviewed his file and found that since 2006 the Department of Labor and Industries has paid the injured worker $126,000 in lost wages. The state has also spent more than $20,000 for physical therapists, doctors, specialists and vocational experts - all with the goal of getting him back to work.

But for most of 2009 his doctor was recommending a state pension - lifetime benefits. The doctor wrote that the worker has “difficulty with standing, difficulty with walking…He ambulates with a cane…and needs assistance carrying in his own groceries.”

The Jacksons were skeptical. They took photos of him on a boat docked in the marina, which they sent to Labor and Industries.

"Supposedly he can't even carry his groceries but he can pick up a 5 gallon bucket of water, dump it out bend over to fill it up and carry it back. Not a problem. And later I saw him walking out of the marina up the gang plank. No cane."

An investigator for the department of Labor and Industries did surveillance too and videotaped him working on his boat in his yard. The investigator took video of him going up and down a ladder, walking without a cane, and swinging himself into the boat.

In May, after reviewing the video, the doctor gave the injured worker the green light to work again, but in a sedentary job.

The Department of Labor and Industries is not accusing him of committing fraud. But L & I is concerned that more and more of these cases are lingering, and they need to change that.
 
"We are looking to cut the delays as much as we can. We want workers to get back to work sooner," said Malooly.

The Jacksons' injured worker was advised by his attorney not to talk to us. As for the Jacksons' Workers’ Compensation Rates, they will probably spike again next year because the longer you have a worker off the job with an unresolved claim, the more you pay. But their rates should start dropping in 2012.
 

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Comments: Displaying 1 - 15 of 32

clawman1 said on September 19, 2010 at 8:56 PM

Washington State is far behind standards other states have established. We should have the option of private workman's comp coverage and save employers money and save jobs. Many employers can not afford to hire people because of the high cost in Washington State

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kd7eer said on August 7, 2010 at 12:33 PM

Its the cost of doing business in a civilized society.

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illtop said on August 1, 2010 at 9:05 PM

L&I is calculated they are trying to wait you out Ive been on it for 2 yrs and have developed on going symptoms due to the legal harassments and so called light duty job. Which was to be as boring and not even associated with my job. I cant complain about free money right? Im better than that I want to produce and be a valued member of a team. My attorney deserves the money he didnt believe it was going to be a hard case he was wrong he has went above and beyond what he had to do and every penny I received was earned my employer did all the stalling and retaliation that the didnt stop which is against the rules. My doctor couldnt override anything if he wanted it to it was me and my lawyer in court. Its been two years and I stopped getting paid a year and half ago the so called vocational duties nope no help had to fight for that. It is a good piece but dont assume everybody is like this guy there are actually people like me that wants to work.

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starship said on July 16, 2010 at 9:13 AM

A good article but it was not follow up to the real cause of the problem. Remember the old saying "Follow the money?" Two people (not including the worker) have a vested interest in keeping a claim running for as long as possible. The attorney get 30% of all the time loss paid to the worker. The time loss check is even sent to the attorney who takes his 30% off the top and then send the remainder to the worker. The second and worst crook of them all is the doctor. The longer a worker stays injured the more the doctor makes off the state. The system also allows the doctor to OVERRIDE any other doctors opinions such as independent medical review boards or vocational people who find valid and new occupations for a worker. It is not necessarily the fault of L&I that a worker is kept on time loss. You need to follow the money and you will see that greed has invaded the system. The system need to be reformed and needs to be done at the legislature.

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sean0606 said on July 8, 2010 at 8:56 AM

Average time loss in WA is 266 days compared to national average of 70 days? If that's true, it's simply ridiculous and unacceptable. We should all be outraged by L&I's incompetency. I wonder though, if it's indeed incompetence or if it's calculated...longer the case stays open, higher the rates, more revenue for L&I? Sounds like the bigger fraudsters are within the Dept of L&I and the bogus claimants are their meal ticket.

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wcdrywal1 said on July 7, 2010 at 8:45 PM

Our company has been very lucky and has no major injuries so our L&I rates are very good, but we have still been paying a very high bill to L&I. We were hit with over a $150,000 bill from L&I due to subcontractors not paying their L&I. These were subcontractors that we check on regularly with the state and even have the paperwork to prove that the state said they were in good standing! Come to find out after a few years of work they never paid their L&I. So the state stuck us with their bill. We of course fought this and were on our way to WA Superior Court but the cost of the attorney's fees were sinking our business.Our case was going to be the precedent case for this issue, but we were forced to take a payment plan the state offered. Our industry has been attached by L&I and several others in our business have been hit with the same bill. L&I has made millions off of this kind of penalty!This story needs to be covered too!

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smallbusinesses said on July 7, 2010 at 7:56 PM

Excellent job KING 5 and LINDA BYRON. It's about time someone in the media started to challenge this state's casual attitude towards its spending practices. Loved this piece and love the stuff on the State ferries. Just goes to show, we have incompetence in state government and plenty of people in line to profit by it. Any state that has three way insurance, the businesses benefit. Anyone that says otherwise is uninformed. Competition lowers the price. Monopoly, as it is now, inflates the price, and what incentive does a claim investigator for the State have to close a claim? Absolutley none! In fact, if they were more diligant, we'd have too many L&I employees and have to cut back to save the taxpayer money! What a concept. Malooly never did give a clear (honest) answer, and casually cast the blame back on King 5, saying if you asked any state you'd get the same answer. Bureaucrats like him are a good reason we're going bankrupt as a state.

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pixelater said on July 7, 2010 at 6:16 PM

tika01, while I respect your opinion I disagree about the cost. I agree 100% with the rest of your post. Currently the State is totally lacking of fraud investigators. In one of our cases we had clear pictures of the claimant doing things he supposedly could not do because of a back injury. ** Not only would the state not investigate, our pictures were dismissed as unacceptable. ** We were told that we would have to hire a licensed private investigator to gather information and submit it to the state and then the state would consider the evidence. We did what they asked and still had to have our attorney send the state a letter asking that they make a decision or face legal action. The claim was finally closed. The claimant to my knowledge never paid back a dime. ** If after reading this you think I am disgruntled with the State, you would be correct. We need L&I insurance to protect all working individuals, but it is in serious need of an overhaul

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tika01 said on July 7, 2010 at 5:46 PM

I have done my research and I have owned 2 business in WA state. I have reviewed research not backed by the BIAW or WA State Trial Lawyers Association. I have looked at as much independent research as I can find and it suggests the costs will go UP for employers. As much as I loathe LNI, the bottom line is that it is cheaper. If you do the research, you will see, employers will pay more unfortunately. What needs to be revamped is the way the laws are administered and claims manager training. We need more investigation into fraud on the part of worker's and doctors and they need to more liberally investigate fraud and prosecute not ONLY when there is a large financial sum involved as a deterrant. This list goes on, but privatizing is not cheaper for the employer and not better for the worker. Oh...and voc rehab is the ONLY party who IS regularly audited. They actually receive MORE money if they recommend MORE services for the worker. The problem is NOT the voc.

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speakthetruth said on July 7, 2010 at 5:45 PM

What is that doctor thinking, to recommend that the man have a sedentary job?

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pixelater said on July 7, 2010 at 2:55 PM

To those that say cost will go up, I wonder do you own a business and have you done the research? What this initiative is trying to accomplish is give businesses an alternative, a choice. L&I would still exist, in a competitive arena. Business will have choices, in a competitive market price generally evens out or goes down. In several western states that allow private L&I insurance businesses have seen their cost go down. *** The initiative does not seek nor will it change the standards of state industrial insurance. Current state standards will have to be met by all companies offering L&I insurance in the state of Washington.

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stateneedshelp said on July 7, 2010 at 1:56 PM

I find it very troubling that this artice puts out inaccurate information regarding worker time loss in our state. The average worker time loss in our state is actually 266 days compared to a national average of 70 days. Our neighbors to the south, Oregon, have an average time loss of 73 days. These facts can be easily verified by contacting the appropriate agencies. Our state will never be able to attract business / jobs that are labor intensive due to this huge inequity. Combine this with a state business & occupation tax ( B & O) that taxes businesses on gross revenues and not on profits and you have a formula for disaster when it comes to repairing the damage caused by the recession and creating job opportunites for those who want and need to work. I think we can all agree that we need a fair and balanced system that falls within the national avwerage.

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hotdamsel2 said on July 7, 2010 at 12:36 PM

Gee talk about costs, they need to put a limit cap like they already have for health care provided for the vocational assistance received, which isn't really any help at all. My husband hurt his foot and as had 2 surgeries on it in the last year, and was getting ready to be released for permanent light duty at his job and the place of injury. LNI was in negotiations for a job for him and one day he goes in to work and is fired. Their reason, they said they didn't have a light duty job and after they told LNI they did....... yeah so go figure. You will always have BS claims and legitimate ones who want to return to their original place of employment and get these voc counselors that must get paid bonuses for how many clients that they can turn away for retraining......but yet paid thousands of dollars for virtually no help at all.....investigate them, the counselors and see all the claims they turn in and at full dollar amount......

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tika01 said on July 7, 2010 at 12:21 PM

I help employers with LNI claims for a living and have for over 12 years. Those who have indicated Initiative 1082 will be more costly to employers are correct. Statistics have proven this with other states. As much as LNI frustrates me, it is still less expensive. I see claims just like this every day and can confirm that LNI gives out benefits WAY too easily. Most of the time no questions asked. Worker's don't even need a lawyer because the claims managers will often make the argument for the worker. They do not help the employer at all and in fact when claims managers go through training, they are given next to NO information regarding employer impact. There are ways this employer and others can reduce their costs and better control their claims. I highly suggest if you have problem claims you find someone to help you. Expenses are often minimal for these services and can prevent increased premiums.

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kent_t said on July 7, 2010 at 12:17 PM

no doubt some of those doctors are crooked as the fraud claims.

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ksquared said on July 7, 2010 at 12:10 PM

This sounds like the doctors are participating in these frauds - if so, they should be penalized. Either charged with fraud or sued.

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kent_t said on July 7, 2010 at 12:02 PM

My rate jumped to 4.50hr after one bs back injury claim that dragged on for four years. That injury didn't keep that guy from snowboarding one winter where my son ran into him at Crystal, but it did keep me from staying in business. I can only imagine how many small businesses closed shop due to similar stories.

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collegeguy said on July 7, 2010 at 11:29 AM

The problem is more with the Doctors and the injured. I was injured on the job with a torn bicept tendon and considering my job required that I used my bicepts constantly, I ended up not doing my job for 3 months but I was able to do other work around the plant. As soon as I could do my job again, I was back to work. If the injured were all honest, the system would be fine. But there needs to be a point where an independent doctor examines the injured worker and not just the PCP that they are seeing already. Doctors can only work with what they are given by the patient. But when there is clear proof in the form of video or photos showing the worker is doing activities that they should not, they should loose their L&I benefits without question. The BIAW's plan will not fix this problem and will lead to higher premiums than what businesses are paying already because you add in the element of greed.

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helen2 said on July 7, 2010 at 10:48 AM

There's another side to this no one has mentioned - medical conflict of interest and incompetence. There's a backstory here of professionals (vocational therapists etc.) who benefit from the system - it's ripe with conflict. Someone should examine that. The Jackson's could have been spared grief and expense if someone had seen that the man got comprehensive treatment to begin with - one week isn't enough for back problems, but that physician probably had no idea about current alternative treatments. A patient with chronic pain will do their old recreational stuff just to keep from going crazy.

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jayemdub said on July 7, 2010 at 9:10 AM

We took pics of an employee, on L&I for a 'knee injury', playing softball, hitting home runs and running bases and sent them to L&I. He also had a jacked up truck and could jump in and out of it just fine. Not only did the claim continue, this employee got surgery on the other knee as well! Fraud division admitted to us that this guy was not on the up and up, but health care providers continued to write him up as 'injured and partially disabled'. His claim went on for over 2 years and our rates went thru the roof! I want employees covered for injury but this system is badly broken and in immediate need of an over haul. Come to find out - this guy had filed L&I claims on 3 other employers! He would work a few months and then claim 'injury'. The state knew this and still allowed him to do this. Employers need to access L&I records before hiring to weed out the 'professional L&I claimants'.

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sean0606 said on July 7, 2010 at 9:02 AM

Fraudulant claims in L&I? Say it ain't so. 11 years in construction business, ive had 4 employees file an L&I claims, 2 legit claims and 2 bogus claims. It's funny how the 2 legit claims who had serious injuries with shattered bones and punctured organ are back at work in less than 2 years, yet the 2 frauds who were both temporary non-skilled laborers doing light duty clean up are STILL collecting after 31/2 years. Their injury of course is "back pain", almost impssible to disprove...one was a 19 yo ex-baseball player who admitted to back problems from his playing days and knew that was his last week of employment who claimed hurting his back while picking up piece of trim wood weighing 2 pounds at most. My rates skyrocketed forcing me to lay-off few good employees and hire sub-contractors instead. So, if half of the claims are fraud in my books, i wonder what percentage of the L&I claims are fraudulant and what it's costing them and us. L&I, enablers of lazy frauds.

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puyallup_leon078 said on July 7, 2010 at 7:35 AM

They do need to police the system better. I know someone thats been on L&I for 7 yrs and he`s just hanging in limbo.

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scott_bellevue said on July 7, 2010 at 7:13 AM

L&I is rife with fraud. People like the one in this article who are caught lying about injuries should be put in prison for fraud, then sued in a civil court for damages. In fact, I don't know why this business hasn't already sued both the state, and the worker claiming injury. You don't need a criminal conviction to file a civil case for damages.

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formernewsie said on July 7, 2010 at 7:08 AM

Sure you can always find a few bad apples, but this story has no balance ... what about the vast majority of the people who get hurt at work and depend on the system when they can't work and aren't getting paid.... -- wasn't workers comp originally set up so that business wouldn't go bankrupt when one of their employees got hurt on the job and sued them? King 5 makes it sound like a tax on the business when it is really set up to protect the business. This stinks of sensationalism ....and .....how'd they get access to the medical records of the guy who got hurt?.... aren't their laws against that?????

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aziza said on July 7, 2010 at 6:56 AM

Scott04? We also need your opinion of the West Virginia coal mining disaster that killed numerous workers earlier this year and the current BP disaster in the Gulf that took 11 worker's lives and reflect on how the capitalist corporate fat cats LIED to the government and circumvented their way around regulations by cutting safety procedures / responsibility all to use capitalism to gain profit on their bottom line? That's a bonus input.... we're waiting.

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aziza said on July 7, 2010 at 6:51 AM

scott04? Do tell us how this capitalist system benefits us? I want you to start with the capitalist fat cats of wall street who essentially robbed the treasury of trillions of taxpayer dollars. Then I want to hear your take on the Pledge's history which was composed by a socialist author who had advocated for state separation from the union. Go ahead... enlighten us...

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pixelater said on July 7, 2010 at 6:13 AM

L&I is rife with fraud. In the last 15 years my company has had three very similar cases to this story. All three cases went on for years, even though we had proof that these individuals with back injuries were riding quads, cutting firewood, clearing land and racing stock cars. *** Higher rates not only hurt the business owners, but the other employees as well. Under the current system the employer is allowed to pass along a certain percentage of L&I cost to the employee. Higher cost means more money from employees. *** With private L&I insurance the employees will have no out of pocket cost. Private insures will have to meet state standards in order to cover employees in Washington state. There will be less fraud because a private company will be watching over the dollars spent, not some lackey for the state that just shows up for a pay check. Less fraud equals more money for employers and employees alike.

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skime said on July 7, 2010 at 5:47 AM

And who is going to manage my health care?

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framed said on July 7, 2010 at 5:36 AM

Pretty typical of K5, find a few examples to represent the position they are selling rather than showing both sides of an issue. Why are they not showing the comparison to other states? Of course claims have gone up 70% in 11 years, the claims reflect medical costs. Medical costs are out of control, that is why we just had a national debate on the subject. Maybe we should all move to West Virginia or Alabama.

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scott04 said on July 6, 2010 at 11:45 PM

do tell us how this socialist system benefits us eric! I remind you, our country is capitalist

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layindownthelaw3 said on July 6, 2010 at 11:28 PM

Injured people are wising up and not settling before they are well.

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eric1972sea said on July 6, 2010 at 11:17 PM

The timing of this story is suspicious being the BIAW has an initiative to end the states current system that does not allow private companies to compete and offer workmen's comp insurance in WA. Did the BIAW pay King 5 to run this story??

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