August 2016

Even though women have been in the workforce for many years, there are many that claim the workers comp system is biased against them. There’s a lawsuit happening in California right now that states women’s rights are not being properly acknowledged as defined by the Equal Opportunity Employment Act, and we’ll look at some of the claims so you have a better idea of how gender works in the world of workers comp.

Male Doctors, Male Opinions

When the vast majority of practitioners determining a woman’s condition are male, people claim that women can’t receive fair treatment when it comes to truly diagnosing their level of disability. This is a class-action suit which includes a woman who has breast cancer which she was found to be caused by her two and a half decades serving in law enforcement. During that time, she came up against hazards like narcotics and other toxins while on the job. After she had her breast removed, she had applied to be put on permanent disability but her claim was denied. Her doctor had verified her breast cancer was caused by unsafe working conditions, but through a guide used by the AMA in California, it was determined that this did not qualify for permanent disability. She continues to work in her job, but her lawyer states that she has multiple physical and emotional problems due to her cancer. Her duties remain essentially unchanged after undergoing surgery. In contrast, if a man has his prostate removed, then they could be classified as being up to 20% impaired (meaning that they would at least have accommodation made for them, if not placed on perm disability.) The AMA guide also diverges from the VA, which classifies someone who has had a mastectomy at up to 80% impaired.

Tips for You

If you’ve followed workers comp (or the world) at all, you already know that inconsistencies are part of the deal. People view situations very differently, which leaves the law wide open. In this case, it’s clear that those who have filed against the policies want a reevaluation of how women are treated so that they may work safely and be compensated fairly should something happen. If you employ women, it’s helpful to be aware of gender difference, but that doesn’t mean you have to obsess about them. If you’re using your own sound sense of judgment, you’ll likely be fine, but we caution you against stereotypes. No matter what state you live in, this California suit will likely affect you as more people may start to see cases of discrimination in front of them. Whether that’s based in fact or not will be determined by the courts.

Any kind of insurance is a double-edged sword, and it often feels like each party is on the wrong side of the deal. Those who have insurance feel like they can’t get a break when they need help, and those providing the insurance often feel like everyone has their hand out for everything under the sun. Add into this that there are a select subset of the population taking up most of the available healthcare resources and the insurance fraud that occurs on a regular basis, and you can see why it can make the case of pre-existing conditions even trickier. We’ll look at what you need to know in the case of workers comp.

The Straight Facts

Obviously, you do not want to preclude a perfectly capable employee just because they have typical problems like a heart condition or knee problems. However, there have been cases where this has been known to cause disputes. Employees may blame something related to their condition by something that happened at work, and while you aren’t required to pay out for this, the burden of proof will now be put upon you to come up with evidence that their working was not responsible and that their pre-existing condition was. You are only held responsible if their condition worsens due to being on the job. For example, if someone has a back condition and there is no reasonable accommodation to get them ergonomic equipment, then you may be found at fault.

What You Can Do

Documentation is highly encouraged for all employees, but be extra careful for those with pre-existing conditions. Have employees sign off on forms that acknowledge the steps you’ve taken to reduce the likelihood that they will be injured on the job. Also, try not to take any chances. If you have someone with a knee injury who really shouldn’t be lifting heavy objects, then don’t ask them to fill in if that’s not within their job description. Too often the needs of the moment outweigh the needs of the future. If you make too many risky moves though, then chances are you’re going to land yourself in some type of hot water. Especially considering that back pain is extraordinarily common, it’s a pre-existing condition that simply can’t be taken lightly.

Additional Considerations

Each state has their own specifications regarding pre-existing conditions. For example, if the original injury was not from on the job, then insurance may deny the claim. The same goes if it can be proven that a worker operated outside their doctors orders. Any type of lie made by the employee is the best way to build a case that their claim is fraudulent.

With change in the air and the politics of the 2016 election polarizing people to extreme views, it’s helpful to understand that radical opinions about anything often have a ripple effect. The Republican party was galvanized by the ideas that liberals have simply failed to step up to the plate, that hand-outs have become too prevalent and that the common person has lost their sense of trust for the government. Now, you’ve likely already noticed that they’re not screaming about workers compensation, but the active people who want change in this sphere take it upon themselves to start using the discussion to their advantage. We’ll show you some recent events that have happened so you can get a sense of the underlying principles of what’s happening within the charged conversations.

From Michigan to California

Disability leave, workers comp, pensions: they may all be covered by an employer. It stands to reason that this could cause some overlap, but how exactly it is meant to overlap can feel a bit murky to decision makers. A Michigan judge recently ruled that it was possible for GM to use disability pensions as a supplement to workers comp costs to help cover the cost of injured workers. This decision was challenged because, while it’s legal for GM to do this, they had previously agreed not to when it came to union workers. While this case may seem specific to GM, it does signify a change and a precedent when it comes to coordinating the two measures, and of course shifts the burden of payment around to different budget lines within the company. In California, comp cases are being decided based on subtle language, which increases the fears of both lawyers, insurance companies and employers. Simply not having the correct contract language could spell big trouble for everyone.

New Ideas, Possible Changes

No one knows how the wind will blow exactly, but there is evidence to suggest the new ideas could weave their way into workers compensation rates. When people on one side live in fear, like currently it may seem like employers do with rates going up and major fraud cases making headlines, there may be a tide shift away from rights to employees. This will hopefully increase personal responsibility and lower rates across the board. However, workers comp, like everything in our political system, has to be all about keeping a balance. Being aware of what’s going on can help you understand where the tipping point is and when it’s crossed. The more you can deduce from national discussions (especially during these upcoming critical times), the better you can keep your wits about you when it comes to going forward.

We take our local insurance people for granted. Perhaps we think that everyone in interchangeable, or that it’s just easier to stick with what we know. These are short-cut thoughts that we often discover are all wrong after it’s too late. While there is something to be said about the grass not being greener on the other side, we’ll tell you what to look for when it comes to an insurance agent and workers comp. Whether you’re looking for a new one or evaluating your old one, keep these tips in mind.

Begin With Questions

It’s your job to ask this person lots of questions. No matter how kind-hearted an agent may be in their personal life, their professional motives are often a little different. The more coverage they sell you, the more they make. This is not to say that extra coverage won’t be handy or useful later on down the line. After all, settlements and extended medical care can get very expensive. However, when you ask questions, you get a better sense of the person’s character. It doesn’t even necessarily have to be about insurance. Chances are, you know little about insurance and have little time to study up. What you’re looking for in their answers is how extensive they are. Do they tell you the bare minimum or are they pretty open with in their conversations? Can they chat with you for 15 minutes about your children but gloss over important parts of what they’re selling? Often people are blinded by sincere attitudes, but the person will tell you a lot right off the bat both in what they say and what they don’t.

Check Their Reaction Times

Cheaper rates are appealing, but they often come with customer service that’s about as cutthroat. It’s an extremely frustrating experience to not be able to get ahold of someone. If the insurance agent lets emails go by for days, doesn’t call back when they say they’re going to, or is just plain never at their desk, these are causes for concerns. In this day and age as service falls by the wayside to save a buck, we accept these types of inconveniences as just a part of the deal. However, in the midst of an insurance claim, time can be tight. Delays can cause uncertainties for you which can eventually lead to mistakes.

Hopefully, you’ll only need to fulfill your legal obligations when it comes to your workers comp insurance. Having a rigorous hiring policy, enforcing safety tactics and ensuring that you’re watchful on the job is what will be the strongest determining factors as to whether or not you have to call your agent for anything but having to renew your policy.