Farmers Insurance Group Fined $1 Million in Settlement

http://www.insurancejournal.com/news/west/2006/01/24/64475.htm
January 24, 2006
Farmers Insurance Group has been fined $1 million following settlement negotiations about how the company handled consumer claims. Advertisement
Farmers, consisting of Farmers Insurance Exchange, Fire Insurance Exchange, Mid-Century Insurance Co., and Truck Insurance Exchange, agreed to the settlement to resolve a California Department of Insurance enforcement action. The action covered approximately 1,000 violations of the California Insurance Code and Fair Claims Regulations covering the period from Jan. 2, 2002, through Aug. 8, 2004. An investigation by the Claims Services Bureau of the California Department of Insurance found violations arising from some 350 claims handling complaints filed by consumers from 2001 to 2004, according to the commissioner's office.
The majority of the complaints and violations cited in the December settlement involve claims handling delays; failure to commence investigation of a claim within 15 days; failure to properly notify policyholders of the need for additional investigation time; failure to pay a claim within 30 days after liability was accepted; and failure to respond to the Department within 21 days of receipt of communication from the Department.
The settlement includes an additional $125,000 to be paid if Farmers does not adhere to terms of the agreement and improve its claims handling practices, the department said.
http://www.insurancejournal.com/news/west/2006/01/24/64475.htm

Texas / South Central News

Texas Division of Workers' Comp Reorganized into 4 Program Areas
February 9, 2006

Texas Commissioner of Workers' Compensation Albert Betts announced organizational changes at the Texas Department of Insurance Division of Workers' Compensation effective immediately.

Major reforms of the Texas workers' compensation system approved by the Legislature in House Bill 7 last year removed statutory divisions within the workers' compensation system's administration.
The new structure aligns the functions of the Division into four program areas overseen by four acting deputy commissioners who will report directly to Commissioner Betts.

"After careful consideration of our strategic mission and customer needs, I think the new organizational structure will allow the Division to better administer the workers' compensation system and to better serve our customers," Commissioner Betts stated in a news release. "It is my expectation that there will be no disruption in customer services as we make this transition."

The four new Division program areas are: Compliance and Regulation (Teresa Carney, Acting Deputy Commissioner); Dispute Resolution (Heidi Jackson, Acting Deputy Commissioner); Field Services (Brent Hatch, Acting Deputy Commissioner); and Workplace and Medical Services (Allen McDonald, Acting Deputy Commissioner).

Under the new Division structure:
--Workers' Health and Safety, Return to Work, and Medical Review's rule and guideline development function will be part of the Workplace and Medical Services program.--Field Operations and Records Archiving and Management will be part of the Field Services program.--Income and Medical Dispute Resolution will be part of the Dispute Resolution program.--Self-Insurance will be part of the Compliance and Regulation program.

The creation of the Division of Workers' Compensation within TDI also created opportunities to consolidate certain functions. Commissioner Betts and TDI Commissioner Mike Geeslin have agreed to transfer the Division's legal enforcement functions to TDI Legal and Compliance and to transfer responsibility for all workers' compensation criminal fraud investigations to the TDI Fraud Unit.

Source: Texas DWC

WHAT IST THE STATUS OF INJURED WORKERS IN TEXAS?

My letter in Public Comment to the Work Comp Division of Texas

Firstly, as a native born Texan, and as a provider who started providing care to injured workers in the old TWCC system in 1990, I appreciate this change to give input on proposed rules, and hope that the DWC will indulge me in commenting on those rules already passed. I find that the comments I have may specifically be related to proposed rules for which the comment cutoff date is in March, but also, wide sweeping observations and comments on the system proposed by HB7, and as it is being adopted via rules.



Firstly, I believe I may represent a large number of Workers Compensation providers in saying that over the past sixteen (16) years, there has been a continuing degradation of the system.



When I initially practiced in Austin and later in Tyler in the early 1990s, treating doctors had the benefit of being able to refer injured workers to a wide variety of medical specialists in the city/ town they were practicing.



I can recall in Tyler, in the early 1990s, being able to send a worker to many neurosurgeons in the city for evaluation, and the practitioners were happy to receive such patients. I could also send injured workers to orthopaedic surgeons, or neurologists, and although the system has never been perfect, it was workable.



Denials and disputes, though they occurred, were nothing like they are now. In that early part of the decade, denials were the exception. Now they seem to be the rule. As a result of the increase in paperwork, problems getting paid, and the increasing unreasonable actions of insurance carriers,

more and more during the 90s, providers of all specialties, began leaving the Work Comp system as providers. They could not be blamed. It left the more hardy of us who were willing to put up with increasing amounts and types of paperwork, and problems getting paid, in order to sincerely help injured workers.



But, as the system got more and more broken, more and more complex, and as the obstructionism by the insurance carriers became more and more problematic, more and more left the system.

Actually, this outcome should not be in any way a surprise, but should in fact, be seen as the logical extension of the unreasonable number and types of stumbling blocks which were increasingly being

placed in the path of participating providers.



In the year 2005, I was seeing a percentage of my patient load as workers comp patients. I daily was faced with frustrations which made the decision to continue in the system, increasingly difficult, but I was even more frustrated by the physical , psychological, and emotional impact of the unfairness of the system on injured workers, many of whom were having their family fall apart because of having their case and care disputed and denied unreasonably, having no money, not being able to get their problems taken care of because of ongoing and unreasonable denials which smacked of bad faith on the part of the carriers.



I can recall one lady who was literally knocked down and was being run over by a fully loaded forklift, and for months, all the carrier would allow as a compensable injury, was "bilateral scraped ankles".

Unfortunately, I have horror story after horror story like this where care, diagnostic testing, referrals to specialists, were not done because of improper and ongoing denials by carriers.



To the extent that these carriers were the proximate cause of a frustration of care and diagnosis, and deterioration of function, as well as great amounts of pain and suffering for the patient and their family, this is a public disgrace.



As bad as the system was in 2005, the few tools the worker could on was the ability to choose their own doctor, not selected by the company or the insurance carrier, and to get a lawyer to help fight their ongoing battles.



Thus, just as I thought things would not get worse, I was proved wrong by the appearance of House Bill 7.

As I read the Bill early on, it became clear that the Bill seemed, in most respects, to be stacked in favor of the employer and insurance carrier, and squarely against the willing provider and worker. Perhaps this was a reflection of the humorous version of the "golden rule", i.e. those who have the gold make the rules.



The proposed functional unit of the new system was the creation of these "health networks" and these networks would certainly be comprised of doctors who were accepted to, and arguably favorable to, the interests of the employer and carrier.



There was a good reason that under the "old rules", a doctor the worker was sent to by the company, or one who worked for the company, could not be a treating doctor unless they saw the patient for more than 60 days with good cause. The obvious reason is that there may be, and I believe often is, a conflict of interest and allegiances, with more weight being paid to "cost containment" and less to patient care.



The act of making a worker choose from a list of doctors selected by the insurance company, in a work comp system, really strips workers of one of the most important tools they had for getting good care, and fair care, and that is the free selection of any willing provider on the ADL list.



Many workers feel powerless to oppose these changes, Injured workers often, due to chronic pain and other problems, already are clinically depressed, and depression itself can be like a cancer against empowerment and motivation.



At this point, another important point is with regard to the emergency rule adoption with regard to physical therapy and occupational therapy. After talking with friends and acquaintenances in Tyler, Longview, and elsewhere in the state, one disturbing trend SEEMS to be occurring.



Chiropractic doctors are experiencing what at times appears to be almost a pattern and practice of automatic denial of requests for preauthorization. My MD friends in various cities , who, although they report occasional denials, en masse, seem to be having great success in requests for preauthorization.



This , on its face, appears to be establishing a pattern and practice by carriers of almost automatic denial of Chiropractic requests for preauthorization, and a selective discrimination against this class of providers and against this profession. I do not make this observation casually nor without consulting with other providers. I am finding most if not all Chiropractic doctors I have talked with, are of like mind with regard to this concern and these observations.



Of course, in this as in the other problems I have discussed, although the providers become victims, the ultimate victim is the injured worker who is denied care, denied referrals, denied proper testing, or if not outright denied, put off so long that it allows his or her condition to get worse, needlessly.



I assert that this situation cries out for a statistical analysis of the denial of preauthorizations for care received by the various providers, and broken down with regard to provider type, i.e. rate of success or approval of requests for preauthorization for MDs, DOs, and DCs. I believe that the outcome would be statistically significant that there is a differential handling of these requests based on provider type.



Of course, it would also be informative to assess the rates of denials based on the insurance carriers to see if some are being more blatant about discrimatory practices toward DCs than others.



Since it would take too long to make specific comment of a detailed nature on each and every proposal listed on the site, I want to make this chance at public comment, address a system so broken, that it may soon see a massive departure of even the most hardy and dedicated of providers.



Firstly, here we are at the end of the first week of February, 2006. To my knowledge, NOT ONE of these functional units of the "new system", i.e. the "health networks" have been formed. This is a positive thing for patients, because it means they have a little more time to have the luxury of picking their own provider instead of having a panel of insurance approved docs thrust on them as their only choice.



Secondly, in this time of transition, it seems that few people know exactly how things are to be done.

As all the proposed rules of HB7 have not been adopted, we are in a time where providers, and I think many DWC employees themselves, are not certain what rules apply. This confusion makes an already confusing system even more difficult to navigate.



Thirdly, there needs to be a method of input about problems with the methods and examinations of designated doctors. As HB7 proposed to put even MORE power and responsibility for determination of various aspects of a worker's case in the hands of this list of doctors, I submit that there are "bad apples" who are not fair to injured workers, some owing to their past allegiances and alliances, and even some with present alliances or connections, with insurance carriers. There are many good and fair designated doctors, but just a bit of thought would indicate that designated doctors are like apples, some are good, some are bad. There needs to be a method of review in which, if a designated doctor gets several independent ongoing complaints by treating doctors, that their past decisions can be independently reviewed, and if they are found NOT to be acting fairly in evaluation of patients, they can be quickly removed from the designated doctor list. Treating doctors arguably know their own patients better than a doctor that sees them for perhaps 5 to 10 minutes, and the treating doctors who see a certain pattern to decisions of designated doctors that differs radically from their own perception of the case, need to be able to have direct input to DWC to initiate closer scrutiny of any designated doctor who seems to establish a pattern and practice of siding with the carrier and against patients in their determinations, especially, if they have a history of making quite low percentages of impairment.

Given the foregoing, I honestly believe that the DWC needs to poll ADL doctors to assess their satisfaction with the system, to gain some feeling as to their perception of the worst problems in the system, and perhaps, invite comment from them as both feedback and direction.



Lastly, it is sad that with all the bad changes initiated by HB7, it is surprising that this bill did not correct one of the most obvious problems with the Texas Workers Compensation system, and that is that Texas still, does not require all employers to be subscribers. As you know, Texas ALONE in the nation, allows employers to opt out. This needs to be corrected, because workers for companies who are not subscribers, often are injured without recourse, since many attorneys will not handle non-subscriber cases, and all too often, these workers have no insurance.



My final comment is that, in my sincere estimation, HB7, if implemented as it is constructed, will sound the death knell for worker's rights, and for the Work Comp system in Texas, and will generate a mass exodus of providers from the system.



I believe that, the emergency rule with regard to preauthorization, should be allowed to end and not be made permanent, and that the other injurious changes from HB7 should not be implemented, HB7's provisions are to the system as cancer is to the body.



Respectfully submitted,



John R. Baker,B.S., D.C.

Longview Texas


Respectfully submitted,

John R. Baker,B.S., D.C.
Longview Texas

What is the BOTTOM LINE for Work Comp ?

THE BOTTOM LINE IN WORKERS COMPENSATION IN TEXAS
Sometimes I surf the net looking for breaking news in the Work Comp arena, and what I am struck by is the fact that apparently, especially in California, what the media likes to tout is "falling costs". In one article
http://www.shns.com/shns/g_index2.cfm?action=detail&pk=WORKCOMP-01-04-06 "SACRAMENTO, Calif. -- In a dramatic turnaround, the cost for insurance and medical treatment in the state-run workers' compensation system fell precipitously in 2005, bringing long-sought financial relief to beleaguered California employers. Insurance rates slid to the lowest levels since early 2002 and employers are poised to receive further reductions that will average about 15 percent in the coming months. At the same time, hospital costs were down 4.6 percent while outpatient surgery expenses tumbled 45.1 percent, studies show.
"Costs are definitely coming down drastically," said Christine Baker, executive officer of the state Commission on Health and Safety and Workers' Compensation. "A lot of good things have happened. Other states are going to look to California."
But some critics, led by labor leaders and attorney groups, say the cost-cutting measures enacted by the Legislature in 2003 and 2004 have gone too far and are cutting benefits and compromising medical care. They vow to step up pressure this year on lawmakers and Gov. Arnold Schwarzenegger to reverse some key changes."

In another article we read this"Groups want insurance rates scrutinized
By Michael Sorkin
ST. LOUIS POST-DISPATCH
02/03/2006
High gas prices have forced many motorists to drive less, and the result has been fewer accidents. Two consumer advocacy groups say the payoff should be lower auto insurance premiums.The Consumer Federation of America and the Center for Economic Justice are asking regulators in Missouri, Illinois and elsewhere to conduct hearings into whether auto insurers are reaping windfall profits from the change in driving habits.So far, neither state appears eager to investigate.States vary in how much they regulate insurance rates. For example, Missouri is considered a weak-regulation state."

MONEY IS THE BOTTOM LINE FOR INSURANCE AND EMPLOYERS
In other articles, the focus is the same...MONEY, MONEY, MONEY.
And, I find that this focus is, in a sad way, probably important for the media coverage on workers compensation, because it seems like that is at times, THE ONLY CONCERN.

So, if that's the way it is, and if insuranc companies really are running the system (protestations of politicians to the contrary), why not just do away with Workers Comp and pass legislation in which no worker has any right to sue any employer, PERIOD. Just imagine the kind of headlines about monetary savings THAT would generate.

But you see, as a treating doctor, I try to work to heal the aftermath of the broken bodies and limbs generated by shoddy work conditions, constant wear and tear on body parts, or work that biomechanically, could not be better designed to cause injuries.

Workers nowadays are treated like cogs in a machine. If they get worn out or broken from the constant overuse, they are treated like trash and thrown away. It is quite correct to draw this analogy because of the way the workers report they are treated.

THE INJURED WORKER BECOMES THE ENEMY
Another good analogy is that when a good worker, and by that I mean someone who does more than their fair share of work, never complains, works when they are sick, is loyal, and usually, has worked at a job for several years, when they get injured through no fault of their own, suddenly they are treated differently.

People often quit talking to them, quit being friendly with them, decrease contact with them, and suddenly, they are not only isolated, but become treated like they are the enemy.

There is a great deal of pressure put on workers at some companies, NOT to report on the job injuries. They are often told that the other workers will miss some sort of bonus related to time without injuries, and the clear attempt is to get other workers to pressure them NOT to report an injury so that everyone will not miss some little monetary reward.

And, in a clear violation of rules, workers are often told they MUST see the "company doctor". Sometimes this is a doctor who is actually employed by the company, but more often than not, he or she is a doctor that the company knows is sympathetic to their side of things, and will usually minimize the diagnosis of injuries, both in severity and extent, and will send the person back to work as soon as possible (if they take them off work at all).

Until House Bill 7, if workers had ANY hope of getting anyone on their side, it was through their right to choose their own doctor. Well, insurance companies weren't really happy about this. Doctors not under their thumb or influence might actually order proper testing such as EMG/NCVs, MRIs, CT scans, CT myelograms, arthrograms, etc..

Of course, this affects the "bottom line" and thus, clearly, something had to be done about that. So, What to Do, What to Do?

The answer of course was to create a pseudo PPO system in which entitites called "health networks" would be created and the worker would HAVE to select what in effect, would become a number of company doctors. In fact, because some people ("shudder") already had a good treating doctor, it was mandated that after the implementation of the Act through RULES to be adopted by the newly appointed commissioner, a work comp patient would be taken away from the doctor they felt comfortable with, and who was familiar with the course of the worker's problems, and force them to pick from one of the doctors "in network".

Clearly, this would benefit "cost containment", a fancy way of saying, keeping more money in the insurance company's bank accounts, and spending less on patient care.

The cost of being injured in the current system for the injured worker is horrendous. In the system that was in place prior to the passage of HB7,
workers who were actually getting money while they were offwork, were limited to about 70 percent of their BASE salary.
http://www.tdi.state.tx.us/wc/information/benefits.html
"Definitions
The following terms are defined:
Average Weekly Wage (AWW) is the average amount of weekly wages you earned during the 13 weeks immediately before your work-related injury or illness occurred. Income and death benefit payments are based on your average weekly wage."

More on this , ibid.
"Amount of Temporary Income Benefits
Temporary income benefits equal 70 percent of the difference between your average weekly wage and the wages you are able to earn after your work-related injury. If you earned less than $8.50 per hour before you were injured, your temporary income benefits for the first 26 weeks of payments will equal 75 percent of the difference between your average weekly wage and the wages you are able to earn after your work-related injury.
The amount of temporary income benefits is subject to maximum and minimum benefit amounts. For example, if your average weekly wage was $500, and your injury or illness caused you to lose all of your income, your TIBs would be $350 a week:
Your average weekly wage $500Minus your wages after the injury - 0Lost wages $500
70 percent of $500 (.70 x 500) equals $350
After an injury, your doctor may release you to return to work at modified duty; i.e., changes made to your regular job, or a temporary or alternate work assignment. You may still be entitled to TIBs if your employer provides the modified duty at reduced wages.
For example, if your average weekly wage prior to the work-related injury was $500, and you returned to work doing a modified job after the work-related injury and you are now earning $200 per week to work only 4 hours a day, your temporary income benefits would still be $210 a week.
Your average weekly wage $500Minus your wages after the injury - 200Lost wages $300
70 percent of $300 (.70 x 300) equals $210
By returning to work, you are able to receive a total of $410 per week. This includes the wages you are able to earn ($200) plus the TIBs ($210) paid to you by the insurance company for lost wages.
When TIBs begin and end
You become eligible for TIBs after you miss eight (8) days from work. Remember, disability refers to your inability to earn an income, not to a physical handicap. You have disability if your work-related injury or illness causes you to lose all or some of your usual pay. Benefits are not paid for the first week of lost wages unless disability lasts for four (4) weeks (28 days) or more.
TIBs end at the earlier of:
the date you reach maximum medical improvement (the point that your work-related injury or illness has improved as much as it is going to improve), the date you are again physically able to earn your average weekly wage which would be the same wages you were earning prior to being injured on-the-job, or
at the end of 104 weeks."

And if you were making a great deal of money a week at your job, there is a maximum amount of TIBS you will be paid, and I believe, it maxes out at 500 dollars a week.

DENIAL , DISPUTE, AND MORE DENIAL
I've started working in the Work Comp area around 1990 or so. In the past , now, almost 16 years, I've seen the system spiralling down and down, in a mad race to the bottom. When I first started, sure, occasionally you would get a dispute or denial, but it was not a regular occurrence. And at that time, in Austin and Tyler, you could find a large number of willing providers who were participating. In Tyler, you had a lot of neurosurgeons and orthopaedic surgeons who would see WC patients. Now in Tyler, there are NO neurosurgeons who see WC patients.

Good doctors are leaving the Work Comp system in droves! Earlier, the main gripe was the paperwork that one must complete. Later, payment became the issue because it was relatively low, and took a while to get.
Now, the big issue is compensability. The insurance carriers seem to be acting in solidarity to uniformly deny and dispute that an injured worker had a compensable injury (i.e. caused by their on the job duties or accidents on the job).

It is so bad that a lawyer told me last year, of a case where two office workers were working one day, and THE WALL FELL ON THEM. The position of the carrier was that the wall falling on them did not hurt them at all, and that any injuries they claimed were pre-existing. Sadly, I have scores of similar stories of patients I have treated where reason seems to have flown out the window, and no matter how clearly the link between something that happened to the worker on the job and their injuries, the carrier puts up a stonewall defense. They ain't paying.

To my understand, there is a duty of the workers comp insurance carrier to exhibit "good faith and fair dealing" toward the worker, but time after time, it seems that they are acting in bad faith and unfair dealing!

THE PSYCHOLOGICAL TOLL
One thing I see is that these injured workers not only have broken bodies, but they develop psychological problems secondary to their injury and inability to work. Most of the workers I see have family members who are definitely affected by what happens as a result of the accident.

One commonly seen problem is the development of clinical depression. This can be generated for various reasons. Chronic pain itself (usually 6 months or more) has been associated with the development of clinical depression in the injured worker. Another side effect is that often, the immune system may be affected (i.e. immune function may be suppressed). See http://64.233.179.104/search?q=cache:wV3cKxWe4xkJ:meagherlab.tamu.edu/M-Meagher/%2520Health%2520Psyc%2520630/Readings%2520630/Stress%2520readings/Maier%252094.pdf+chronic+pain,injured+worker,dperession&hl=en&gl=us&ct=clnk&cd=2

See
The social consequences of occupational injuries and illnesses
Allard E. Dembe, ScD *http://www3.interscience.wiley.com/cgi-bin/abstract/85512964/ABSTRACT?CRETRY=1&SRETRY=0

Also see http://www.universityhealthsystem.com/pain-management/pain-chronic.html

Also, in citing the possibility of the "wounded worker syndrome", we see this :
http://www.guideline.gov/summary/summary.aspx?doc_id=8385&nbr=4693&ss=6&xl=999
"
Acute pain is a sign of real or impending tissue damage and usually disappears with healing, although the experience may still be different based on personal factors.
Chronic pain exists when the patient continues to experience pain even after the injury has healed. Early detection of potential chronic pain patients could help in determining treatment approach. Pain is not remembered, but the fear of pain is.
Note: In workers' compensation cases, providers may need to shift focus from a "cure and relieve" to a "functional restoration" paradigm. Too much effort may be going into responding to complaints of pain rather than encouraging "coping" strategies and the desirable outcome of "working" with pain. There is a possibility of a "Wounded Worker Syndrome," which is a chronic pain condition characterized by failure of an injured worker to respond to conventional healthcare measures, and prolonged disability with continued absence from the workplace. This "Wounded Worker" chronic pain syndrome is facilitated by a healthcare system that encourages and supports the injured worker in his "sickness" role."

I find the assertions in this last sentence troubling to some degree, because it smacks of "blame the victim". It is NOT the worker's fault they are injured. It is NOT their fault they are in chronic pain. Pain does NOT stop just because a bone knits together or a muscle tear heals. Soft tissues heal by deposition of scar tissue, fibrosis, and it is known that fibrotic, scar type formation, is less elastic than normal tissue, and hence can decrease range of motion of joints associated with that muscle group, and that tissues with fibrotic infiltration tend to be more tender and painful than normal tissue.

http://www.chiroweb.com/archives/12/22/17.html
"Inflammation is a natural consequence following injury. The inflammatory response, which is the body's initial attempt at healing, can become the culprit in perpetuating future pain and disability if left unchecked, as this leads to random scar tissue formation and fibrosis."

And, ibid "Because connective tissue heals by proliferation of neighboring fibroblasts, scar tissue is the normal result. This tissue is usually less elastic, weaker, and more prone toward exacerbations with use or stress resulting in future chronic pain and disability. Immobilization prevents the formation of strong scar tissue in the important direction by avoiding the strains leading to proper orientation of the fibrous tissue.
Poor healing leads to altered biomechanics that result in aberrant neural reflexes, scleratomal, or myofascial pain syndromes forming the vicious cycle that we are well aware of and see in our offices. Additionally, areas adjacent to the restricted segment may become hypermobile due to a compensatory reaction which can result in additional degenerative changes of the disc and facets. Scar tissues in muscle can result in a phenomena of super sensitivity, a result of the excess proliferation of nerve fibers around the region of the scar."

Of course, the insurance carrier does not like the above, because it interjects objective, physiological, and morphological reasons for the pain and depression of workers. It interferes with their ability to promote their "blame the worker" stance.

It's funny, but in the criminal justice system, even an alleged murderer is supposed to have the "presumption of innocence", but with what I am seeing, and with the percentage of denials and disputes I am seeing, it seems that in the work comp system in Texas, the carriers seem to hold the a priori notion that the worker is lying or malingering from the beginning.

As a treating doctor, I see time and time again that a worker who reports an injury, becomes treated as a liar and a troublemaker ab initio (from the beginning).

And, if you have been a loyal worker at a company for 18 or 20 years, and get seriously injured on the job, and people start trying to talk you out of filing a claim, if the company tells you that you HAVE to see the "company doctor", and you go see him or her and they tell you that you have a simple sprain/strain and send you back to work without taking x-rays or doing a thorough examination, and you find that you CANNOT work due to your pain and injuries, you have to file work comp. But then, you become the enemy.

Many ladies who become injured in industrial settings suddenly find that their friends no longer call them at home or want to socialize with them.
This can be devastating to some people, especially those who are more socially oriented than others and who depend on their friends for emotional and psychological support.

Some workers not only develop clinical depression, but also develop post traumatic stress disorder (PTSD). They may begin having nightmares which relive their accident, or being in similar circumstances that share some common element with the events of the accident, may spontaneously cause a type of flash back of the accident and bring on a repeat of the trauma in their mind. This is similar to the type of PTSD flashbacks that soldiers serving in Viet Nam have reported.

WORK INJURIES CAN DESTROY FAMILIES
One thing also is clear. When a man is the main breadwinner for his family, and becomes seriously injured, he may face many problems at home. One major problem is the devastating effects of loss of income.

It is bad enough if he is getting his Temporary Income Benefits (tibs), which are only 70 percent of his average base (and if a family was just making ends meet at 100 pecent, you can imagine the effects of losing 30 percent of their income), b ut if , as more people are experiencing now, if their case is disputed, they are getting ZERO. Most blue collar families
are just a paycheck or two away from having real financial problems.

This puts several stresses on the injured male worker. First, if he sees his role in the family as the provider and protector, and now he is very limited in his ability to move , and is unable to provide like he was, and suddenly, his wife and children are having to do without, this is a big attack on his self esteem, and his manhood.

Depending on his specific injury, he now may be unable to engage in sexual relations with his spouse as he did before, and this can cause tension and feels of low self worth.

He may now be unable to play ball with his children or participate in the types of family activities he did before, and then, with the chronic pain, he may indeed develop clinical depression.

The less he can exercise, the more deconditioned he becomses, he often may gain a lot of weight, and the stresses of not being able to pay bills, feelings of betrayal by the company he has worked so long and so hard for, and the worry about whether he will ever be able to work at that job again, create a boiling pot of stress.

As a doctor, I've seen these forces, both on injured men and injured women, escalate to the point that their spouse leaves them, or in some cases, they may begin to contemplate suicide (at which point it is imperative to get them to see a mental health professional, if the possiblity of suicide is real and imminent).

THE ULTIMATE VICTIM IS THE WORKER
The bottom line may indeed be money, but the one AT THE BOTTOM, is the worker. The Texas Work Compensation system, under House Bill 7 and the Rules adopted by the Commissioner, is entirely, in my opinion, slanted in favor of the employer, and AGAINST the worker.

In the mad rush to slash spending and to put "cost containment" in place, it is the health of the worker, and the well being of the worker , that is sacrificed so that a few bureaucrats and executives at insurance carrier offices, can claim a few percent of payment reductions.

The question of course must be put to the people at the carriers and the employers, and yes, the DWC (division of work comp) of the TDI.

What price health of the workers? What price the future of injured worker's families ? Do you give a damn about the average hardworking Joe Blow who gets hurt on the job ? Judging on the system you are creating, I say NO!

Injured workers are also potential voters. Injured workers are also people who buy products. Injured workers need to protest their unfair treatment to their representatives at the State Level (even if you don't think it will do any good, you need to do it). Injured workers may decide to boycott the products of companies that treat them poorly. Injured workers may decide to initiate bad faith lawsuits against insurance companies, and adjusters, who act unreasonably, and fail to exhibit "good faith and fair dealing". Injured workers may file complaints against the medical licenses with the Texas State Board of Medical Examiners when a "company doctor" fails to take x-rays when they seem to be indicated, or if they feel the doctor has acted against their best intersest, and in the best interest of the employer, by sending them back to work too soon, in a time when they may actually be injured further.

The time has come for workers to speak out, or , if they don't to continue being victimzed by a system in which money makes the bottom line.