Delays in workers’ comp system hold up treatments
By Philip Walzer, The Virginian-Pilot | |
McClatchy-Tribune Information Services |
A family dog jumped to greet him. Hockman, 28, twisted toward it. Seconds later, speared with pain, he sank to the floor of his home in
It was the fourth time Hockman had dislocated his kneecap since
The aftereffects of the work accident weren't solely physical. It snuffed his dream of following his father and two brothers into a career in law enforcement. But "determined to get my life back," Hockman continued working and pursuing a bachelor's degree.
The setback in October revealed his perseverance.
While lying on the floor, Hockman matter-of-factly prodded the kneecap back where he thought it should go. He put on his leg brace, limped to his car and drove to
Then came a different type of obstacle he's found much harder to surmount -- roadblocks in the workers' compensation system that's designed to help Hockman and others rebound from workplace injuries.
Dr.
The reason: The company representing the insurer for Hockman's former employer had only recently approved the surgery. It hadn't yet authorized post-operative physical therapy, which Brown considered crucial for Hockman's recovery, despite repeated requests from Brown's office and Hockman's lawyer,
"How is this right by any logic?" she wrote in a
Workers' compensation is a century-old system to recompense workers for on-the-job accidents and subsequent medical attention.
But the Hockmans, echoed by other employees, lawyers and even the former head of Virginia's workers' comp system, say the intended safety net is pockmarked with cavernous holes, leaving workers vulnerable to another kind of free fall: Restitution and care can elude them for months, even years.
"Delay, delay, delay: That's what the insurance companies live and die for," complained
"And at the end of the day, there's no penalty," said Bennett, who said he's handled hundreds of workers' comp cases in 39 years.
The delay in Hockman's knee surgery was the latest in a long-running series of obstructions on his road to rehabilitation and reimbursement.
It took nine months after the 2007 accident to get approval for cognitive therapy to assess psychological impairment, his mother said. And she said the family usually waits six months to a year to get repaid for tolls, mileage to medical appointments and other expenses. The Hockmans'
State law does not mandate deadlines to resolve workers' comp disputes, said
The problems go beyond delays.
"Virginia is one of the most restrictive states in terms of what injuries are actually covered," said
Virginia covers injuries only if they were caused by an "identifiable incident or sudden precipitating event," Diamond said. The way she explained it, if a mover wrenches his back after carrying several TVs but can't identify which one triggered his injury, he might not qualify for workers' comp.
In June, for instance, the commission ruled against a family seeking repayment of medical, funeral and other expenses after a drywall installer fell down an elevator shaft at a building where he was working and died. "There is no evidence of what the claimant was doing at the time of the injury," it ruled, "and thus no evidence that he was engaged in any work activity at the time of his injury."
The
The insurer for Hockman's former employer is
"I certainly can appreciate their frustration," Szablewicz said of workers such as Hockman. "On the other hand, we have the obligation to afford due process to both sides. We can't just summarily decide something."
He said the commission is working to reduce the timespan from filing to resolving claims, partly by promoting the option of mediation. Ninety-two percent of cases brought to mediation were resolved last year, Szablewicz said. But
Employers' insurance premiums for workers' compensation in
"What is our state's strategy for achieving prosperity?... Will we support business at the expense of working people? Or can we find a more moderate path to shared prosperity that is both pro-business and pro-worker?"
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Workers' compensation developed across
At the time, workers went to court if they wanted remuneration for on-the-job injuries, said
"The courts were mostly stacked against them, so it was hard for them to win any judgments," he said. "But every once in a while, a sympathetic judge or jury gave them a pretty big award." The inconsistencies left both employees and bosses disgruntled.
The system that evolved varies from state to state. But it generally prohibits litigation, shielding businesses from costly lawsuits. For workers, it is intended to provide timely payments under a no-fault philosophy: It's not supposed to matter if the employee's negligence caused the accident.
Nearly every state requires employers to carry insurance to pay for workers' lost wages and medical costs.
The image of workers' comp has been tarnished by accounts of workers receiving payments while they're "recuperating" on the golf course.
"There clearly is some gaming of the system," said
Rapaport, a partner with the Clarke Dolph law firm, said 90 percent of his work involves representing employers in workers' comp cases. The process has been speeded by the commission's move to online records, he said, and his cases usually are resolved in six months.
The Hockmans, though, said they've encountered delays well beyond that.
The commission annually sends notices alerting workers that they can get cost-of-living increases in their payments, Szablewicz said.
She has wondered whether the fact that they live in
The Hockmans contacted politicians on both sides of the border -- and aisle. But in this case,
Diamond, the former chairwoman of the commission, said delays are common.
Hand, working for a
It took more than two years, Hand said, to win approval for his spinal-fusion surgery, and he still endures monthslong delays in receiving payments and other treatment.
"They've got no bite," he said of the commission. When insurers "don't do what they're supposed to do, they don't do anything to them."
Szablewicz said he could not talk about specific cases. The commission, he said, unfairly gets blamed for delays by workers who haven't followed all the steps, though the Hockmans and Hand said they and their lawyers have been on top of the paperwork.
Requests to reschedule workers' comp hearings come equally from both sides, Szablewicz said, and the commission offers the option of "expedited" hearings in some situations.
But
On
"The Insurer has informed the Commission... that it has agreed to medical treatment," the agency said in a letter. "In light of the above, it appears that this issue has been resolved and the Commission will take no further action unless requested by the parties."
But nothing had changed.
Despite the assurances, the Hockmans said, the doctor still had not received authorization for the therapy. He was no closer to treatment.
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Six days after the high of
He was working part time at the
An impatient customer was waiting to pick up a dishwasher. The platform lift wasn't available, Hockman recalled, so he climbed a pole on the side of the racks. He stepped on a box that collapsed and fell headfirst 7-1/2 feet to the concrete floor.
He doesn't remember much about the fall. His mother remembers the fear that crept through her when she got to the hospital. "I'm feeling the back of his head, and it was squishy. He wasn't making a lot of sense. It just wasn't him."
Hockman had suffered a brain hemorrhage. He underwent a craniotomy, in which part of the bone from his skull was removed, and spent three days in the neurological intensive-care unit at
He's been able to work since his accident and continue his studies at ITT Tech, taking online classes. But in addition to the recurring problem with his left kneecap, his symptoms have included double vision, the inability to lift more than 30 pounds and occasional trouble finding the words he wants to say.
The most debilitating consequence has been the series of fierce headaches that plague him, usually twice a week. They get worse in the summer.
A recent one lasted from 5 in the morning till 4 in the afternoon. When they're particularly intense, he lies in his bed with his eyes closed and the blinds drawn. Others he can work through.
His father, Larry, a former investigator with the
Hockman also planned to join the family tradition. At
"It definitely killed my spirit for a while," Hockman said.
Then he realized loss prevention was just a different shade of his original goal.
"I can't become a police officer or a Secret Service agent, but this could be my alternative," he said. "It's in criminal justice, and I can contribute to it and do my own thing." Hockman took a civilian job at the Navy Exchange in
Hockman graduated from
The Bible in their living room is open to a passage from Isaiah that sustains the family: "Yet the Lord longs to be gracious to you; therefore He will rise up to show you compassion. For the Lord is a God of justice."
"God wants justice for us,"
_____
The good news came in a roundabout way on
His mother wasn't sure what got the ball rolling. "I think the commission is pretty much tired of me," she said.
Her hope was shadowed by a cloud of wariness. "The day they roll him into the operating room is the day I'll believe it'll happen," she said. "But this is the most optimistic I've been since October. Hopefully, everybody will stick to their word and answer their phone calls."
They did.
Brown, who declined to be interviewed, performed the two-hour arthroscopic procedure on Hockman's left knee on
He was off work until
Hockman was eligible for workers' comp payments for his time off. They amounted to two-thirds of his salary -- not at the time of his recuperation, but at the time of the initial accident at
He received all he was due, but the first check didn't come until
As he recovered, Hockman finished his online coursework for his final classes at ITT Tech.
On
A gaggle of supporters -- including his parents, a brother, sister-in-law, niece, nephew, grandmother and aunt -- shared the moment with him. Hockman strode sure-footed across the stage at the
A few relatives teared up, but Hockman remained steely-faced. "Mister Serious," one of them joked.
It was an evening, he knew, to relish his triumph over adversity. But even there, his accident from 2007 intruded.
For most of the day, Hockman had suffered a low-grade headache. It didn't go away during the ceremony.
Maybe that was fitting, he said afterward. "I had to get all of my assignments done and finish all of my classes, even with the headaches."
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