One million times a year, California workers seek help from their employers for
an on-the-job injury. Most believe the state's workers compensation laws --
created at the turn of the century and overhauled four years ago -- will be a
safety net. Instead, many will step into a world where, at perhaps one of the
most vulnerable times in their lives, they will wander for years with little
help. This is a world where doctors can earn $500 an hour writing reports,
lawyers can earn $100 an hour arguing about benefits that are set by law, judges
can make $85,000 a year and insurance chief executive officers can be paid $2
million a year. All while hundreds of thousands of injured workers -- among them
school teachers, laborers and office workers -- face years of frustration and
delays to get medical care and $39 to $490 a week. That's the California workers
compensation system. And it is damaging lives. ''This system chews people up,
and I don't like it,'' said Edward C. Woodward, president of the California
Workers' Compensation Institute, the research arm of the insurance industry.
''This would be a scandal anyplace else in the world.'' After 1993 legislation
made the most sweeping changes in workers compensation in 20 years, The Press
Democrat conducted a 12-month investigation to see how well the reorganized
system is serving California workers injured on the job. It found a system that
serves the powerful voices of employers, insurance companies, doctors and
lawyers, while workers remain unheard. Among the findings: * Benefits are the
lowest in the nation for six out of 10 workers with a permanent injury. Overall,
benefits are so low that California ranks 45th out of 50 states. * Injured
California workers must go to court to get benefits 20 percent of the time,
double the rate 12 years ago and more than four times the national average. *
Insurers mishandle half their claims. In one of every five cases, the insurer
won't properly notify workers of benefits, and in one of every six cases workers
won't be paid all the money they're owed, according to state audits. * Fraud is
overstated. While some insurance companies claim one out of three workers lie
about their injuries, or 33 percent, the actual number of fraud cases sent to
prosecutors is less than 1 out of 100, or less than 1 percent. * The state has
one information counselor for every 20,000 workers comp cases, symptomatic of a
bureaucracy that greets half of worker calls with a busy signal and can't even
say how many claims are filed each year. * No state agency regularly monitors
claims to see, for instance, whether insurance payments are received on time or
whether injured workers are receiving appropriate medical care. Conflict and
confusion To assess how claims are handled, The Press Democrat conducted the
first-ever media analysis of state computer data, analyzing 26,400 North Coast
workers compensation claims covering six years, as well as another 77,800 cases
in central and southern California at the Santa Barbara and Long Beach appeals
boards. It found that conflict and confusion are imbedded in a system that is
taking longer to resolve disputed cases every year, while the number of disputed
claims is increasing faster than the growth in the work force. One out of five
injured workers will spend almost three years struggling with claims adjusters
and doctors and lawyers to get the benefits they are guaranteed by law. The
nature of claims is changing as well, moving from warehouse to office with a
growing number of cumulative strain injuries such as carpal tunnel syndrome,
which are more difficult to assess and harder to quantify. ''I wouldn't want to
be an injured worker in this system, due in huge part to the inherent
complexity, subjectivity and inefficiency,'' said Doug Widtfeldt, vice president
of the Association of California Insurance Companies. ''Delays and disputes are
an endemic problem.'' The California program -- funded by employers and run by
insurance companies, or employers who self-insure -- covers 13 million workers,
almost twice New York or Texas. Every year, it costs employers roughly $8
billion, pays insurance companies about $1 billion in profits, pays doctors and
medical providers $2 billion for medical care, pays workers $2 billion, and
spends the rest on administration. And it makes everyone unhappy. Worker's comp
in California is an equal-opportunity headache. Employers worry about costs.
They resent workers who take advantage of the system. They resent insurance
companies that make generous profits. They wonder how they can possibly compete
with companies from other states and nations where workers compensation is
cheaper. Insurance companies feel caught between two masters: One their
customer, the employer-policyholder, who demands cost controls; and the other
the injured worker, who is desperate for quick assistance. They chafe under a
mountain of often-conflicting regulations piled on them by state legislators.
Doctors and other medical professionals resent claims adjusters who second-guess
their treatment recommendations. They worry that they won't get paid. They
despair over the paperwork. Lawyers resent the ever-tightening legislative
screws that regulate their services and their fees. "No one trusts anyone
in this system," said Gregory Vach, an employer representative on the state
Commission on Health and Safety and Workers' Compensation. Complicated,
adversarial Nearly everyone agrees there are too many laws, too many options,
too many deadlines, too many conditions, too many forms, too many paths, too
many participants, too many delays. ''We have evolved a system that is so
complicated, so complex, that it can't be understood by the participants, by the
practitioners, or even by the experts and technocrats,'' Woodward said. ''If
those of us who study it full time can't understand it, what chance does an
injured worker have? Not much.'' It pits each player against all the others,
which experts say forestalls solutions. ''We have to agree there's a serious
problem, it's systemic, and quit trying to blame each other for a system we're
all being victimized by,'' Woodward said. True, many of California's injured
workers will sail through the program without difficulty. For the 600,000
workers a year who have a minor injury, go to a doctor for treatment and don't
miss work, workers compensation often works as it was intended. 'Short end of
the stick' But many of the 400,000 workers a year who miss time from work or
have a permanent disability will have a different experience, including the
200,000 -- among them, 5,000 on the North Coast -- who will have to litigate.
They will discover difficulties in many subtle and surprising ways. "The
injured worker is getting really the short end of the stick when it comes to
what needs to be done in this system," said David R. Caine, a workers comp
expert for the California Chamber of Commerce and past president of the
California Self-Insurers Association. Many will slam into a wall of suspicion
and distrust that will paralyze them with shame and frustration and delay their
recovery. Some will lose their jobs, their homes and their families -- not to
mention their health -- because of delays and low benefits. Eventually, many
will have to turn to taxpayer-funded safety nets such as State Disability
Insurance, Social Security, food stamps and Medicare to get by. "Daily I
watch workers' worlds crumble in front of them as they fall further in
debt," said John Frailing, last year's president of the California
Applicants' Attorneys Association, an association of attorneys for injured
workers. That wasn't how it was supposed to be. Workers compensation was
historically a compact between employers and employees that grew out of the
Industrial Revolution. Injured workers gave up their right to sue their employer
-- and the uncertain outcome of litigation -- in exchange for prompt, certain
but modest benefits, including medical care and a stipend while they were out of
work. Broken bond In general, workers compensation benefited both employers and
employees, and it revolutionized workplaces in industrialized societies around
the world -- protecting employers from lawsuits, encouraging them to keep safe
workplaces and guaranteeing workers prompt care without litigation. But for many
California workers, the compact has broken down. Employers still are protected
from civil lawsuits and expensive jury verdicts. But many injured workers will
not get prompt, guaranteed benefits without litigating through a special workers
compensation court system. The 1993 legislation, which climaxed four years of
overhaul efforts, had the primary goal of reducing costs to employers and
raising benefits for some workers. Since then, average employer costs have
fallen 34 percent. ''The people I represent, fully insured employers, are
relatively happy,'' said Jim Contreras, vice president of the California Small
Business Association. ''The employers have stepped up to the plate and won some
victories.''