Workers’ comp legislation introduced in House to benefit injured workers, help employers

Representatives Dave Reichert (R-Washington) and Mike Thompson (D-California) introduced the Medicare Secondary Payer and Workers’ Compensation Settlement Agreement Act (H.R. 1982) into the U.S. House of Representatives on May 15.

According to a press release, the Act establishes clear and consistent standards for an administrative process that provides reasonable protections for injured workers and Medicare. It would benefit injured workers, employers and insurers by creating a system of certainty and allows the settlement process to move forward while eliminating millions of dollars in administrative costs that harm workers, employers, and insurers.

The legislation aims to protect injured workers whose workers’ compensation claims overlap with Medicare coverage. Often, these claims are subjected to lengthy and cumbersome reviews by the Centers for Medicare and Medicaid Services to determine appropriate set-aside amounts to pay for future medical costs in which Medicare may have an interest. The delays associated with this review place unfair burdens upon the injured party.

“This is a common-sense measure to ensure that hard-working Americans are not left in limbo because of inefficient bureaucratic procedures,” said Rep. Reichert. “Injured workers must have the confidence that their heathcare claims will be processed in a fair and timely manner. By introducing this bill, Rep. Thompson and I aim to do just that: protect our hard-working citizens by making sure our systems serve them and their families.”

“The last thing injured workers should have to worry about is if needless bureaucracy is going to prevent their medical bills from being paid,” said Thompson. “This bill will make sure hard working families’ medical claims are processed efficiently and quickly, it will reduce bureaucratic headaches for businesses, and it will save taxpayers money. I will continue working with Congressman Reichert to get this bipartisan bill signed into law.”

The legislation has widespread support from groups such as the American Insurance Association, the American Bar Association, the National Council of Self-Insurers, Property Casualty, Insurers Association of America, UWC-Strategic Services and the Workers Injury Law and Advocacy Group (WILG).

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A ruling by the state Workers Compensation Appeals Board has ignited both sorrow and anger over the death of an injured worker five years ago this week.

Compounding the indignation over the details of how Charles Romano died is outrage at the meager fines—still to be issued in the case—that advocates say highlight the weakness of state oversight and the failure of state lawmakers to hold insurers accountable.

“I mourn the loss of Charles Romano and the suffering that preceded it,” says Jesse Ceniceros, board president of Voters Injured At Work.

“The facts of his case–how the rule of law in this great and wealthy state turned its back on this hardworking man–cast shame upon his employer and its insurer. His case also shows once more how powerful interests have rigged the workers compensation system against ordinary Californians. If it can happen to him, cut down in the prime of his life, it can happen to anyone.”

Charles Romano, a grocery worker at Ralph’s in Camarillo, died at the age of 47 in early May 2008, ending a five-year effort to recover from a shoulder and neck injury he suffered on the job in 2003. Frustrating that effort, as the appeals board found, were repeated delays and denials of care by Romano’s employer, part of the Kroger foods chain, and its claims administrator, Sedgwick CMS.

The ruling denied an appeal by Ralph’s and Sedgwick of their liability in the case (Romano v. Kroger, or ADJ1372133). It revealed that Sedgwick “continued to deny or delay care through the end of applicant’s life,” failing to pay even for Romano’s final hospitalization for more than 4 months after his death.

Facts of the case elicited unusually blunt and evocative language from the appeal board. The “horrifically ill” Romano repeatedly sought authorization and attention to his claims from Sedgwick, which showed only “blithe disregard for its legal and ethical obligation to provide medical care to a critically injured worker.”

Despite its determination that Sedgwick “unreasonably delayed medical care in 11 separate instances,” the board cited the limitations of state law in setting the maximum penalty of “25 percent of the delayed medical benefit, not to exceed $10,000.” The maximum fine Sedgwick faces stemming from the death is thus only $110,000.

“Adding insult to injury in the case is the trifling amount of state penalties,” adds Ceniceros. “Such fines are an affront to working people. They mock the notion of fair play and the American way. They fail to provide a deterrent to unconscionable abuses and invite multi-billion-dollar companies to treat the lives of workers as a cost of doing business. Unless state lawmakers act to fix the systemic problems exposed once again by this case, they risk being complicit in shame. The death of Charles Romano must not be in vain.”