Although Einstein never said, “Insanity is doing the same thing over and over again and expecting different results,” that doesn’t make it any less true.
I learned that lesson recently in my first (and hopefully only) encounter with the workers comp system – as a claimant, rather than counsel.
It all began with a “routine” false alarm in our center city high rise office.
Since 9/11, we have all been motivated to walk down the fire escape stairwell, no matter how often the alarm sounds.
In fact, we have had several real evacuations, when noxious chemicals spread through our ventilation system.
At least I am only on the 6th floor. At our last building, I once hustled down from the 29th floor when I saw smoke spewing out of an air vent.
This time, however, I tripped and fell at the bottom of the fire tower. In my mind’s eye, I was jostled by someone behind me, or in the crowd milling around the ground floor exit.
Those behind me in line, however, told me I suddenly went down, for no apparent reason.
Although I remember feeling something trip me, I could not find any uneven surface in the fire tower exit during our next false alarm evacuation.
I distinctly recall falling in cartoon-like “slow motion” – with a clear expectation that a major hit would occur – and that nothing I could do would avoid an impact.
Instead, I recall a detached curiosity about how badly I would be hurt.
First my rear end hit the ground.
Next came my right elbow.
Finally, the back of my head slammed into a concrete wall.
(It all happened in a fraction of the time it took you to read this.)
To my surprise, I seemed fine – but not so well that I didn’t agree to an EMT ride to a hospital emergency room.
Fortuitously, it was the one time where all my doctors were on staff. By the time I arrived, the ER doctors had all of my medical records on their screens – as well as my health insurance information.
Fortunately, everything checked out fine. After a detailed neurological exam, I was discharged, with instructions not to use my brain.
Huh? Apart from life functions, I am an attorney, and compulsive reader.
Nonetheless, I stayed awake on the train ride home. I even skipped the newspaper that night.
The next morning – I never considered commuting to work – I rested in a dark room, listening to calm music. “Alexa, play quiet soothing music.”
Nine months later, I see no evidence of my fall and concussion – except for the large pile of dunning letters and collection notices.
But the letters sent to my home were not the worst of it.
Since I fell at work, the claims (above the amount paid by my health insurance) were supposed to be paid by our workman’s comp carrier.
We got calls at home, in the evening and on weekends, asking for the same information I had previously provided to our comp carrier’s adjuster in the days immediately after the accident.
Even worse were the repetitive questionnaires from the three collection agencies hired by the hospital and doctors’ offices to collect the bills that the carrier had not paid, months after the accident.
Spoiler alert – they all requested the same information I had previously provided to the carrier’s adjuster.
I didn’t understand the problem until months later, when we had a conference call with our health and liability insurance brokers, who identified what had happened.
By receiving immediate medical treatment from my own doctors – in an emergency room – paid by our group health insurance, I apparently bypassed the normal workers comp system and carrier.
(I still don’t know how I could have understood that “in the moment,” while waiting to be examined, concussed, in the hospital ER. No one from the carrier to whom our firm business manager had reported the accident contacted me.)
As a result of that conference call, I finally understood that the comp system works differently than normal health insurance.
In addition, our brokers found the real culprit – the same hospital that sicced collection agencies on me, had received but not responded to the comp carrier’s requests for information about the claim.
Although I give kudos to the brokers who identified the source of the problem (and ultimately got the bills paid), they are not blameless either.
They had also been involved in the claim from the beginning, and did not realize the source of the delay arising from the incorrect classification of a comp claim as a medical claim.
Even worse, the time-value of all the time I spent on calls and surveys, at my hourly rate, was well into the five figures – a several times multiple of the actual medical bills.
It had become such a frustration for me that I asked one of our brokers if I could bill the comp carrier for my time in responding to all its demands. The broker was not amused.
Notwithstanding all of the dark humor this incident generated, on reflection it revealed a far more troubling truth to this corporate attorney of almost 38 years.
If I, with my legal training and experience, was unable to get my claims resolved and paid, how would a non-lawyer injured at work fare in the systems?
Not well, I am afraid, based on my brief experience of “how the other half lives.”
That putatively injured worker probably doesn’t keep an organized file of correspondence and records about the claim, as I am used to doing with legal matters at work.
(One broker told me that file was key to the brokers’ resolution of my claims, although one is still open nine months after my fall.)
Perhaps that is why I see a constant stream of television ads for local workers comp attorneys – emphasizing their humanity (in marked contrast to what I experienced from the comp insurance claims system).
To paraphrase one such ad, “We can do better.”
