Imagine if you will your medical coverage. You rely on it to be there. You get hurt, you go to the doctor. If your doctor needs to send you to a specialist, you go. If you need a surgery or other procedure, you get it and move on with life, done.

Now imagine another plan you have at work that your employer pays a lot for to keep you healthy and productive and on the job should you get hurt at work. Except when you get hurt at work they doubt you and you don’t get the option right away of seeing just your doctor and you get sent to a “company” doctor.

And you can’t see a specialist without filling for a hearing. Which means most of the time you need an attorney to help you with this. The workers’ compensation carrier also sends people to follow you with a video camera to see if you’re really hurt and it can take 10 years to get a much-needed surgery.

What just happened here? Where is my beloved doctor and the great service I’ve enjoyed?

Could it be that so many people in the past cheated the workers’ comp system that now nobody gets treated fairly and all of them are suspect until proven otherwise? Why should a workers’ comp case find the injured worker waiting needlessly while they are slowly drained of life savings, going bankrupt and losing their home only to be offered a settlement years after the accident.

And this is after a lot of pain and suffering and hearings that will nowhere near cover surgery or the semblance of a previous life. And forget about going back to the same employer — the comp carriers make your employer think you are a malingerer and with little recourse they eventually fire you though illegal. How are you going to sue them when you are broke already?

Harsh Realities

You find another job and continue to work injured, that is what you do. You give up your temporary disability payments because you need more money and don’t want to end up on the street.

These are the stories of the realities that face a person making a claim in the Hawaii Department of Labor and Industrial Relations and workers’ compensation insurance system.

Mitigating further injury isn’t in the comp carrier’s interest.

The state Labor Board is short staffed and backed up and can take three months to get a hearing and six months to render a decision on a hearing. Workers’ comp attorneys stop getting paid when these things settle so it behooves them to drag it out as long as possible. Most continuances are requested for no reason other than to delay the process.

Doctors prescribe everything from physical therapy to medication in a timely manner. Each is denied by the carrier and by the time a hearing reverses it, it is too late for the physical therapy, for instance.

Imagine you have a back injury and as it gets worse, you have a fall and need knee surgery. You must go to your regular carrier to get it because workers comp won’t cover it, leaving your regular insurer holding the bag. Mitigating further injury isn’t in the comp carrier’s interest.

It wasn’t always like this. I got injured on the job in 1995. In California. I was examined, diagnosed, got surgery, physical therapy and was back to work in 18 months.

In Hawaii I had a similar injury and it is going on eight years. I still need the surgery that the orthopedic neurological specialist recoomended. I had to fight for this by filing a hearing request that said I needed surgery after the orthopedist comp doctor said my situation was too complicated and he didn’t recommend surgery. Which to workers’ comp meant I didn’t need surgery.

The neurologic orthopedist overruled that opinion. But why eight years? I have had to beat two morphine addictions and just decided to live with the pain. My attorney is overloaded with cases and does very little move my case along.

Now Senate Bill 2364 may provide some relief. There are dozens of people in the same situation. It forces workers’ comp carriers to provide service as soon as a claim is filed and not rubber stamp it with “Denied Pending Investigation.” It provides for service providers to get paid within 30 days and not 60 and provides for a $1,000 fine to the comp carrier if they don’t negotiate in good faith.

Perhaps this could be a good sign that some change is coming.

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