When Workers’ Comp Doesn’t Work

Patrol Car WreckageEmployees who are injured on the job are typically entitled to medical care to help them heal and get back to work, along with financial compensation to support them during their recovery. Law enforcement officers and firefighters are often eligible for specialized benefits, due to the highly physical and dangerous nature of their jobs. While workers’ compensation systems vary depending on state and local laws, one common thread seems to be that — much like public employee retirement systems across the country — these programs are frequently under attack by municipalities and special-interest groups pushing “reforms” that claim to save taxpayers money. The result, however, is a dysfunctional system of roadblocks and red tape that delays or denies the care desperately needed by first responders who just want to return to serving and protecting the public.

As we have previously detailed, public safety members place themselves in harm’s way every day. They heroically respond to critical emergency situations, face violent attacks and undergo repeated stresses and exposures that put them at a higher risk than the general public for cardiovascular disease, cancers and other health problems. In addition to smoke from fires, needle sticks, communicable diseases, blood and other bodily fluids, first responders can be subjected to hazardous materials even in places you might not immediately suspect. Earlier this year, the L.A. Times reported that more than 100 LAPD officers and civilian employees filed workers’ compensation claims over respiratory issues caused by unsanitary conditions at Southeast Community Police Station, including black mold and pigeon feathers and droppings in ceiling vents. And most recently, officers around the nation have been sickened by dangerous levels of carbon monoxide in their police vehicles — including several who passed out while driving and crashed — prompting a federal investigation into possible defects in Ford Explorers. Another hidden health menace for police is cumulative trauma and progressive degeneration from repetitive actions and carrying the weight of gear, including back problems caused by gun belts and vests (recognized by the state of California as an automatic workers’ comp injury for officers with more than five years on the job), elbow and shoulder injuries from handcuffing uncooperative suspects, and knee and back injuries from pivoting in and out of their cars many times per day.

With all these threats, it’s no wonder that one in three LAPD officers files a workers’ comp claim every year, according to the City controller. Injuries sideline nearly 15% of the Department’s workforce and cost nearly $100 million annually. The numbers are higher than in other jurisdictions, leading critics to paint a picture of lazy employees filing excessive claims and taking up to a year off work while milking the system for their full, tax-free salaries. But a 2016 NBC Los Angeles investigation found that while the overall percentage of LAPD workers’ comp claim denials was low, the number of cases being sent for review had doubled in the past several years, from 3,200 to 6,400 — delaying treatment and thus the injured officers’ return to work. “If you wanted to design a painful, lengthy, expensive system you couldn’t have done a better job than the one that the state has right now,” Controller Ron Galperin said.

When injured officers turn to the workers’ comp system, many encounter a bureaucratic labyrinth that hinders, rather than helps, their recovery. The rising price of health care, combined with headlines about high-profile fraud cases, have prompted workers’ comp programs to limit access under the guise of preventing abuse of the system and containing costs. In California, reforms instituted by Senate Bill 863 in 2013 have saved nearly $800 million — great for insurance companies and employers, but often at the expense of injured employees and the doctors trying to care for them. Instead of appealing denials of treatment before a judge, injured workers now have their appeals reviewed by a private, for-profit corporation that employs anonymous doctors who have never met the patients in question, are not even required to practice medicine in California, and make their decisions based on a partial review of the worker’s medical history, according to a standard set of guidelines.

This process, called “Independent Medical Review” (IMR), seems designed to advance the interests of the insurance companies, not the patients. Last year, an NBC investigation found that injured California workers contested almost 600,000 denials of medical treatment between 2013 and 2015, and those denials were upheld by IMR doctors nearly 90% of the time. While supporters claim these numbers mean the system works because the decisions made earlier in the process were correct, it’s difficult not to think about the thousands of lives affected by these frustrating denials of care. With a workers’ comp program like this, it’s hardly surprising that even the survivors of the San Bernardino terror attack have encountered difficulties in receiving the treatment they need.

“First responders have a heck of a time getting proper treatment promptly,” says LAAPOA President Marshall McClain. “The cities, counties and even state put our police and firefighters through the wringer when they seek care. There are too many stories of officers and firefighters getting hurt in the line of duty and being betrayed by the system, in many cases left without a paycheck while trying to heal. These delays and denials of care are causing their conditions to get even worse, leading to needless suffering, costing taxpayers millions and ultimately decreasing public safety by keeping officers off the job. Most law enforcement officers love what they do, are committed to their careers and don’t want to let their colleagues down — they don’t report on-the-job injuries frivolously and don’t want to be away from work unless absolutely necessary. But our jobs are dangerous and our injuries are genuine. It’s in everyone’s best interest to resolve them quickly and efficiently.”

Fortunately, there are some positive developments in raising awareness and hopefully putting the focus back on improving health care for public safety officers. In May, the U.S. Senate passed the Law Enforcement Mental Health and Wellness Act of 2017, which, if passed by the House and signed into law, would identify existing mental health and wellness programs and develop model policies that could be adopted by state, local and tribal law enforcement agencies. And in July, Vermont became the first U.S. state to pass a law granting workers’ compensation to first responders for mental health issues, such as PTSD, that result from their on-the-job experiences. More states have been crafting similar legislation and hopefully will follow suit.

LAAPOA urges lawmakers to look out for our community heroes by ensuring that they get the care they need after risking their physical and mental health in service to the public. “It’s the least society can do for those who put their lives on the line while keeping our cities and country safe,” says McClain.