Category Archives: health insurance

Workers Without Insurance?: Sign up for ObamaCare!

Enroll in ObamaCare

Worker’s compensation is not a guarantee of health insurance coverage.  At least not under Wisconsin law.  Many injured workers mistake worker’s compensation insurance for health insurance after suffering a work injury.  Not true.  Worker’s compensation is just insurance for the specific body part injured.  It is not general health insurance for any other illiness/sickenss, and it certainly is not insurance for the worker’s family or children.

There is no obligation under Wisconsin law for an employer to continue to pay health insurance premiums or provide health insurance coverage when a worker is out after a work injury.  A recent attempt to require an employer to continue its health insurance coverage while a worker is recovering failed at the legislative level.  Thus, a worker could be off work after an injury and find that their health insurance benefits have been terminated (or that the employer is not paying their premium portion…which could be cost prohibitive).

In many worker’s compensation claims, the worker’s compensation carrier sends an injured worker to an “independent” medical examiner who denies the injury or extent of disability.  The injured worker–still recovering from an injury–is then left without worker’s compensation coverage.  If the employer did not continue health insurance benefits, the worker then takes a double hit–no worker’s compensation covearge and no health coverage.  The injured worker then has limited means to obtain the necessary medical treatment.

As an attorney, we have the ability to file for prospective medical treatment and have a judge order the treatment be paid by worker’s compensation.  That process, however, could take a year or more.

The best practical route is for the worker to obtain the medical treatment through their own health insurance (and we have a claim for reimbursement to the health insurance company).  Thus, if a worker has no health insurance coverage, my advice is: get covered if you can.  In Wisconsin, that means applying for state insurance/Medicaid (eligibility based on income levels).  The alternative, is ObamaCare.

ObamaCare’s open enrollment period begin a few weeks ago and goes until February 15, 2015.  Wisconsin’s governor, Scott Walker, made the short-sighted decision to reject Medicaid expansion or create our own state exchanges, so Wisconsin residents need to obtain ObamaCare insurance on the federal exchanges.   If an injured worker has no health insurance, I strongly encourage them to get coverage.  Apply for ObamaCare right now.  Get covered.






How Safe Is Healthcare for Workers?

Today’s post comes from guest author Rod Rehm, from Rehm, Bennett & Moore.

We represent a large number of workers injured in the healthcare industry in Wisconsin.

The article that today’s blog post is based upon is an in-depth look at how one state’s OSHA office interacts with a sector of the healthcare community: hospitals. Like Iowa, but unlike Nebraska, Oregon is one of 27 states or U.S. territories that has an OSHA office at the state level

The “Lund Report: Unlocking Oregon’s Healthcare System” article talks extensively about nuances within ways that OSHA offices, whether state or federal, can measure the safety of healthcare providers like hospitals and nursing homes. 

As evidenced in previous blog posts about senior-care workers and lifting injuries, I have continuing concerns for the safety of healthcare workers. 

According to the in-depth article, “A Lund Report review suggests that in Oregon, regulators are de-emphasizing attention to hospital employee safety, despite national data showing that healthcare workers are injured in the U.S. each year at rates similar to farmers and hunters. Most Oregon hospitals have not been inspected by the state Occupational Safety and Health Division in years. And when on-the-job hazards are detected, Oregon’s OSHA office levies the lowest average penalties in the country.”

Should workers get lost as the patients are the focus of these healthcare institutions? Should regulation and inspections or fines by such groups as OSHA be the driving force toward workplace safety for healthcare employees?

It seems to me that healthcare administrators’ emphasis on profit is more important than proper concern for their employees – the nation’s caregivers. And if you or your family member is the healthcare worker who gets hurt on the job, this lack of focus on the worker is more than just a philosophical argument.

Wisconsin High-Risk Insurance Program Closing Down

I read with bittersweet thoughts that the state’s high-risk insurance program was winding down, in anticipation of the implementation of the insurance exchanges through the Affordable Care Act (“ObamaCare”).  Health insurance–or lack thereof–is crucial to the lives and health of injured workers.  In this space, I’ve written in the past about the problems faced by workers without health insurance.  

There is no provision under the Wisconsin worker’s compensation system that requires an employer to continue an employee’s health insurance while recovering from a work injury.  Also, if a claim is denied and the worker is terminated (a situation that happens all too frequently), the employee generally loses health insurance coverage because continuing COBRA premiums is too costly.  Of course, there are also the multitudes of workers that simply have no employer-provided health insurance at all.   In all of these situations, an injured worker may be faced with the situation of needing medical treatment for their injury but unable to get it without insurance.

In many of these situations, some of my clients have turned to the Wisconsin Health Insurance Risk-Sharing Plan.  If these workers were not eligible for Medicaid or Badger Care, then “HIRSP” was a potential safety net that allowed for health insurance coverage.  With some coverage, the injured worker could at least pursue some medical care.  For me, seeing that beneficial program fade away hurts.

The bright side is the hope of ObamaCare and increased access to health insurance.  Now, our governor’s short-sighted (or politically-calculated) decision to reject the expansion of Medicaid coverage may hinder this expansion–and cause some further confusion.   The key, however, is further hope.  If an injured individual is without insurance, a downward spiral can happen fast. Regardless of whether someone’s disability is work-related or not, if they are hurting, access to medical care should be a right.  



Opioid Use in Worker’s Compensation

click on the map for a larger version

Many of my back-injured clients use pain relief medication in the opioid family: Hydrocodone (Vicodin), Oxycodone (Oxycontin or Percocet), Fentanyl (Duragesic or Fentora), Methadone, and Codeine.  Many variations of opioids exist, each with a different level of potency. The worker’s compensation industry has labeled excessive opioid use “an epidemic, particularly targeting worker’s compensation.” The Center for Disease Control has noted the problem of opioid abuse as a national danger.

The CDC latest statistics show close to 40,000 drug overdose deaths each year in the United States, more than half of which involve prescription drugs. Deaths in which opioids are used now exceed deaths involving heroin and cocaine combined. The drug overdose deaths are more numerous that motor vehicle crash deaths and the numbers have gone up every year since the turn of the century. One contributing factor is that many work-related injuries are back injuries, for which doctors increasingly prescribe opioids for both short and long term to address pain. CDC medical epidemiologist Dr. Leonard Paulozzi recently noted worker’s compensation medical providers may be exceeding guidelines from the American College of Occupational Environmental Medicine regarding the use of opioids and how long they should be used. Dr. Paulozzi noted 42% of workers with back injuries had opioid prescriptions in the first year after the injury, most of them after their first medical visit, but 16% of those workers were still receiving opioids a year after the injury. He noted while opioids might be good for use as acute medication, for example within six weeks after the injury, continuation of opioids is not indicated beyond that short term use.

Prescription medication has become a bigger portion of medical expense in all States, especially if the worker becomes dependent or addicted to the opioid medication to control pain.  Opioids are generally prescribed for several reasons in worker’s compensation claims, including catastrophic injury with chronic pain and injury involving surgical treatment necessitating pain control and general pain control.

New Study Reveals Whether Workplace Wellness Programs Save Employers Money

A new study calls into question the notion that workplace wellness programs save an employer money. In a study tracking hospital employees for two years, although hospitalization for employees and family members dropped by over 40% for six major health conditions, increased outpatient costs erased those savings. The study found in the journal Health Affairs and its results help to address a debate taking place in companies around the country about how much incentive and pressure an employer can put on workers to increase healthy lifestyles by quitting smoking, losing weight, and exercising.

The flip side of the argument is that this intrusion into personal health becomes a meddlesome slippery slope and perhaps health discrimination. Many companies have wellness programs and even include gym memberships and on-premise exercise, attempting to changing employees’ bad habits. Some employers link these programs to insurance discounts or penalties.

In Wisconsin worker’s comp, an injury that takes place because of participation in a wellness program is only compensated if the program is mandatory or compensated. The additional concern for employees is that unhealthy lifestyle choices could result in potential employer’s defense to an occupational injury or exposure (obesity, smoking, diabetes) as pre-existing conditions used to deny worker’s compensation claims.

New Trend – Penalties For Not Participating In Your Employer’s Wellness Program

A new study by AON Hewitt indicates more employers will be using penalties to prompt participation in an employee wellness program. Many employers use incentives for participation in wellness and health management programs such as Health Risk Questionnaires, biometric screenings, and smoking cessation programs. Those incentives include health insurance premium increases and other penalties, and potential reward such as premium discounts, gift or cash cards. All these penalties and rewards are aimed at an effort to prompt employees to participate in wellness initiatives.

The connection to worker’s compensation for these wellness programs is interesting. For example, biometric screenings could be used against employees who may later file worker’s compensation claims for occupational exposures. Additionally, such pre-existing conditions that are revealed in the screening programs may prove an additional barrier to employees receiving worker’s compensation benefits for a later claimed injury or occupational disease.

Employee Wellness Programs And Workers' Compensation

Injuries incurred in an employee wellness or health fitness program, event or activity may not be covered by workers’ compensation

Wisconsin-based employers like:

have found that investment in onsite training facilities pays off for their employees in terms of lower worker’s compensation claims and health insurance claims. Companies interviewed noted on-site training facilities drastically reduced the number of on the job injuries, partly from attention given to fitness and preventative health care. Many Wisconsin-based have well-established employee fitness centers. A Journal/Sentinel article referred to exercise classes, water polo, swimming lessons, bike races and even a triathlon where participants received a turkey for their efforts.

Such “wellness” programs pose some interesting issues for worker’s compensation in Wisconsin. And as a lawyer representing injured workers, I look at almost everything I read through this prism. Injuries incurred in an employee wellness or health fitness program, event or activity designed to improve the physical well-being of the employee are not considered in the course of employment. That means they aren’t covered under workers’ compensation unless the program, event or activity is mandatory or compensated. That mandatory or compensated requirement applies whether the program is on or off premises.

Our Court of Appeals, however, found compensable injury when an on-duty firefighter was injured while playing basketball at a nearby park not on the employee premises. Courts have interpreted ‘mandatory’ to include Continue reading

Path to Federalization: A National Workers Compensation System — US Supreme Court Validates

Today’s post comes to use from our friend Jon Gelman from New Jersey.

United States Supreme Court has taken a giant leap forward to facilitate the Federalization of the entire nation’s workers’ compensation system. By it’s recent decision, upholding the mandate for insurance care under the Affordable Health Care for America Act (ACA) 2009, it has set the precedent to federalize the nation’s fragmented and chaotic workers’ compensation medical delivery system.

John G. Roberts Jr.,
Chief Justice US Supreme Court

Validating Mechanism
In a 5 to 4 ruling, Chief Justice Roberts validated the individual mandate as a permissible exercise of congressional power under the Taxing Clause of the US Constitution. Under 26 U.S.C. Section 5000A. The law requires that: (a) an individual must maintain minimum essential coverage for each month beginning after 2012; and (b) if there is a failure to maintain minimum essential coverage, a “penalty” is imposed “on the taxpayer” of $695 per year or 2.5% of family income, whichever is greater. The penalty “shall be assessed and collected in the same manner as taxes.”

The Chief Justice, writing for himself, stated, “Every reasonable construction must be resorted to in order to save a statute from unconstitutionality.” If it is “fairly possible” to interpret the statute as merely imposing a tax on those who’ve failed to purchase insurance. Writing for the majority, the Chief Justice stated, that the penalty is not a tax for anti-injunction act purposes. The Court, he wrote, needs to look beyond the label when assessing the constitutionality. For constitutional purposes Justice Roberts reasoned that the penalty may be considered as a tax when: it is not so high that there is no choice; and it is not limited to willful violations; and the penalty is collected by the IRS through normal means.

Constitution of the
United States

The Court indicated that the assessment is not really a “penalty.” “Taxes that seek to influence conduct are nothing new,” the Chief Justice wrote. He reasoned for the Court that Continue reading