by brettb on February 8, 2010
A battle between the the White House and the U.S. Chamber of Commerce over workplace injury reporting makes clear the goals of the Chamber: the Chamber of Commerce does not want the public to know just how many musculoskeletal workplace injuries there are each year or for the government to do anything about those injuries.
As reported by the online news magazine Politico, the Bureau of Labor Statistics estimates that nearly a third of the 1.1 million workplace injuries in 2008 were musculoskeletal (MSD) in nature – like carpal tunnel syndrome, strains, sprains, spinal disk herniations, and problems caused by repetitive movements and stress.
But this is only an estimate because musculoskeletal workplace injuries are recorded the same way and in the same column as any other workplace injury. The changes proposed by OSHA would create an additional column for musculoskeletal workplace injuries on the forms that employers fill out when someone has a work-related injury or illness. And this would mean better reporting of these injuries. Better reporting means that the government and the public wouldn’t have to estimate the number of these injuries because they would know.
But if we all knew just how many musculoskeletal workplace injuries there were, then it would be pretty hard to oppose the ergonomic safety rules that workplace safety advocates and Democrats have been trying to get in place since Bill Clinton’s administration.
And here lies the heart of the matter: the Chamber views new ergonomic rules as potentially costing business millions. But this view is short sighted. Musculoskeletal workplace injuries already cost business and the economy, which means the public, millions and millions in lost productivity and medical care, not to mention what these injuries do to the individuals and their families.
The changes in reporting and ergonomic rules proposed by OSHA and the White House have been fought by the Chamber for nearly a decade. When Republicans controlled Congress the Chamber was successful at using legislative maneuvers to put off the changes and new rules. However, with Democrats now controlling both houses and the White House it is not likely that the Chamber and business groups will be as successful.
by brettb on February 5, 2010
The New York Times has an interesting article today on what an injury victim or patient should do when they believe an insurance claim for medical treatment has been wrongly denied. And while the article has some good recommendations it fails to capture the whole picture.
Let’s set the scene: let’s assume that you are involved in a personal injury accident in San Francisco – an automobile accident or car wreck, a trucking accident, maybe a fall – something of that nature. And you and your doctor decide that you need a certain procedure. So, your doctor schedules it but then you both are notified by your health insurance company that your claim for the procedure or treatment has been denied. Now what do you do?
According to the Times, one in fourteen claims just like the one I described above is denied. Now it’s true that often claims are denied for legitimate reasons – meaning the procedure or treatment is not medically necessary or is simply not covered in the insured’s policy. But what the Times article does not detail is that many insurance companies employ people to do nothing but comb over their policy holder’s past medical records looking for any reason at all to deny coverage.
We reported on one such example ending in a $37 million dollar jury verdict against the insurance company here on San Francisco Injury Law Answers recently (click here for the post).
The article encourages patients and injury victims to appeal the denial. And that is good advice. The Times article insinuates that many appeals are won and provides a quote from a health official in Kansas indicating that 53% of appeals in that state are won. What the article does not indicate is how many claims that are denied are appealed. My guess is not many and for good reasons; the appeals process is long, costly, takes an enormous amount of resources, and a certain amount of education and ability to understand the process and move the system forward. Insurance companies know this.
They know how hard appealing a denial is, they know how costly it can be, and they know that a certain percentage of folks simply will not be able to appeal even if they want to, which is one reason such a high number of claims are denied.
The article’s advice to policy holders including patients and injury victims is worth repeating:
1. Read your policy carefully.
2. Take your time and be careful before you act.
3. Do lots and lots of research.
4. Persist. In other words, go the distance and don’t give up if you are denied a second time.
5. Seek the help of a professional.
And I will add one more piece of advice that the Times does not include: if you feel that you have been wrongly denied a claim by your health insurance company and that the denial was done in bad faith – contact a personal injury attorney. Good luck.
