Worker’s Compensation – Why Yes can Mean No And Vice Versa

There is a lot of talk about worker advocacy in Worker’s compensation circles. I was at a conference where a whole session was dedicated to answering the question “how did we end up at “no” as the answer to treatment in Worker’s Comp”. It was a fascinating session in which we all agreed, in a case with objective back injury findings (for example), there was no reason to do 6 months of therapy just because that’s what the “WC manual” says.

Things got decidedly more complicated when the discussion shifted to *what do you actually owe the injured employee.*

Rather than answer the conundrums raised in this sessions (even in a conference we couldn’t come up with answers!) We would simply like to look at the word…”no” versus the word “yes”.

In Worker’s Comp, allowing an employee to remain out of work is a “yes” to the employee. However, this “yes” damages the employer’s experience mod, in most states, at a rate twice as fast as allowing medical treatment. In industries such as transportation or construction once an employer’s experience mod gets beyond a certain point, they can’t bid new business and the business itself becomes damaged. The “yes” to a single employee could turn into a “no” to the rest of the employees doing their job when company goes out of business.

So, how did we end up at “no”. Its the most direct route between what happened and staying in business. Was it the right thing to do? Probably not. However, as Jim Carey found out in “Bruce Almighty”, saying yes to everything is the fast track to chaos and failure as well.

Where our conference breakout session landed was reassuring. The recommended course of action was “STOP GUESSING!” Decisions made in a vacuum are foolishness. Conducting a thorough investigation simply to add some factual information into a claim or lawsuit scenario can change the outcome from “yes Vs. no” to “truth Vs. fiction” which may be a more appropriate place to land.

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