Category: It’s COMPlicated

The use of utilization review (UR) in workers’ comp has defenders and critics. Some consider UR (insurance companies and third-party administrators, et al) to  be a basic tool to prevent unnecessary medical services and reduce costs. Others (physicians and plaintiff attorneys, et al) consider utilization review to be a cause of unnecessary delays in medical care that can result in poorer outcomes and frustration for physicians and injured workers. Finding…

Read More

Everyone agrees that workers' compensation is too complicated. But one aspect of it rises above others on the complicated scale – permanent partial disability benefits. The difficulty of finding the right balance for permanent partial disability benefits is at the heart of the differences among approaches, and it started with the grand bargain itself. The grand bargain means that benefits for workers' compensation claims aren't determined like claims based on…

Read More

Have you ever thought about whether you could live on your state's temporary total disability (TTD) benefits if you had a workers' compensation injury? It's a scary thought. The benefits in most states have formulas that begin with an injured worker's average weekly wage based on the prior 52 weeks' wages and multiply it by 66 2/3%. Then the resulting amount cannot exceed the maximum weekly wage for TTD benefits…

Read More

A 2021 Harvard Business School newsletter encouraged business leaders to take the long -term view rather than concentrating on quick returns. This is sound advice for several aspects of the medical component of workers' compensation, three of which are discussed below. First. Medical care is a major component of the total cost of workers' compensation. Policymakers have accepted that medical fee schedules help reduce medical costs in workers' compensation and…

Read More

Comments from last week illustrated the substantial difference that the choices about physicians can make in workers' compensation. This point was also made in a presentation at the recent IAIABC Forum. Dr. James Talmage, a well-known authority on medical care for workers' compensation injuries, spoke about “Working with Physicians to Achieve Return to Work.” His talk included some of the complexities of medical care that plague workers' compensation. He also…

Read More

The first edition of the It's Complicated blog began an exchange of ideas about what workers' compensation is and what it could be. The dialogue started with four questions. The responses to the questions were thought-provoking and raised even more questions. The responses are summarized below. The Definition of “Injury” The first question was basic ? what is a workers' compensation injury? ? and it had four possible answers. The…

Read More

A day rarely goes by when emails, social media, blogs, and news articles don't discuss workers' compensation – what's wrong with it, or what can “fix” some part of it. But there is no universal agreement on what “it” should be. Equally troubling, no consistent platform has existed from which the workers' compensation community can have a dialogue about issues the industry faces. The purpose of this blog is to…

Read More