UR: Money Talk, Injured Workers Walk

As my college buddy ZQ used to say, “JT, money talk, bullshit walk.” In workers’ compensation and Utilization Review (UR), “money talk, injured workers walk.”

In workers’ comp, UR is the process where medical treatment recommendations for workers’ comp injuries are either approved or denied.  If they are denied, the UR denial may be appealed to Independent Medical Review (IMR).  The overwhelming odds are that IMR will deny the treatment, too.  The cost of going through UR/IMR is about $600 per review.   Since July 2013, there have been an average of 15,000 IMR reviews per month statewide.  Do the math.   That’s $9 million per month in appeal costs.   Since July 2013, that’s $468 million!

So, why would the workers’ comp carriers keep such a costly process?   Because since 2013 they have saved $1.6 billion, with a B, in medical costs after appeal costs are deducted.  If you had to spend a dollar to earn three, wouldn’t you do it?   That’s why the workers’ comp industry denies treatment: they are making a killing doing it, and injured workers suffer.

When the Legislature passed UR/IMR in 2013, they raised benefits, saying that any savings from UR/IMR will be passed on to injured workers.   Ok, what about the $1.6 billion in savings since then?  Where’s the benefit increase?   Anybody?  Bueller?  That’s right, benefits have been frozen since 2013.  If there are no benefit increases, how about changing UR/IMR laws so that injured workers can get medical treatment?   Yea, right, do you think the workers’ comp carriers will give up their toy that has saved them $1.6 billion?  If a legislator tried to advance a bill that would do this, you can bet that the insurance industry would use some of that money to shut it down. Money talk, injured workers walk.

Is there any hope to help injured workers by turning around workers’ compensation laws?   Maybe a new governor will help if he or she is not blinded by the money with either new legislation, or new regulations.  Next year will be interesting.

 

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