ProPublica and NPR released a critical and devastating critique of the systematic gutting of the workers compensation system that has taken place over the last 20 years, with a particular focus on the reduction of benefits in California that has happened courtesy of the decision-makers in Sacramento.
Benefits are more necessary than ever for injured workers who can't get the assistance workers' compensation is supposed to provide. Although access to private insurance has improved under Obamacare, this is a benefit that the congress seeks to roll back. The federal government is also less generous with Medicare assistance. Medicare will not allow a transfer of care from any case where another insurer has liability without first being given the right to approve and modify any settlement of future medical rights.
Even if you have medicare and want to close your workers' compensation case, (or your auto accident case), you need medicare's approval to sell out your rights to future medical care in most cases, a process that takes months. Medicare requires that the estimate of your future medical care costs be paid by the insurer liable for your claim and requires that the money is 'set aside" for the estimated medical treatment. After the set aside money is spent on medical treatment, then Medicare will again allow the expense.
Where the estimate for a "set aside" is very high (according to medicare), the settlement of a case can be deterred. Many workers' compensation cases can't be closed out because of high costs of "possible" future medical care. And even though the projected costs are high, the worker's compensation insurer may in fact deny most if not all of the projected treatment under the Utilization Review process.
To compound the problem, fewer and fewer doctors are willing to treat workers' compensation patients. And even if an injured worker has private insurance, many doctors will not bill a private insurer for treatment that is possibly the liability of a workers' compensation insurer. In general, injured workers can't use medicare for treatment of a work injury without proving to Medicare that the treatment is denied, and even if Medicare or a private insurer accepts the expense of treatment, often doctors are insecure about whether they will get paid or whether they are violating the law by billing another insurer for treatment for a work injury.
Injured workers are penalized by a denial of medical care because the rules are complex and the law seems to favor a denial of care, not the right to reasonable and necessary medical treatment.
This is a worrisome trend, and the few bright spots coming out of Sacramento are not enough.