California Workers Try To Secure Benefits Essays -

California workers try to secure benefits By Mary Fricker Press Democrat staff writer 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,