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Following a workshop on the issue last week, the House Insurance & Banking Subcommittee this week is expected to vote on workers’ compensation reform.

The Florida Justice Association supports responsible reforms to provide statutory and rate reforms that return workers’ compensation back to its stated purpose: To help injured workers get healthy and back on the job.  establishing a more equitable framework for the state’s workers’ compensation system and a competitive and transparent rate-making system.

FJA member Kim Syfrett prepares before a committee meeting at the Florida Capitol.

Advocates for injured workers explained the importance of four pillars to lawmakers including:

  • Develop a transparent rate-making process that allows for meaningful competition.
  • Permit some element of patient choice in medical care.
  • Develop a mid-level tier for providing benefits once the doctor determines the employee has reached Maximum Medical Improvement.
  • Ensure that injured workers have proper access to the court by maintaining a reasonable standard for attorneys’ fees.

Speaking up for injured workers, the Florida AFL-CIO shined a light on how the reforms of the early 2000s “radically altered” the system in favor of insurance companies by slashing benefits including providing no retraining opportunities for workers to return to their original job where they were injured

“The workers’ compensation system is really quite brutal for injured workers and their families. When workers are injured, they are forced into an alternate medical system where insurance adjusters make the decisions,” said Rich Templin legislative and political director with the Florida AFL-CIO. “The workers’ compensation system has no medical choice. You cannot choose your doctor. You are assigned a physician by the insurance industry.”

Richard Chait, representing the Florida Justice Association, urged the committee to take a hard look at the rate-making process to bring costs under control. He added that the insurance industry’s problem with attorneys’ fees is, in effect, self-inflicted.

“What we have here is this perceived pandemonium. But what concerns me is when anyone comes before this committee or any subsequent committee and suggests that we have a crisis now because of attorneys’ fees and because of the rate-making process, what they’re essentially admitting is they have a business model where they’re building in the intention of denying benefits,” Chait testified. “Provide the benefit, you don’t have to pay the attorneys’ fee.”

As lawmakers consider this important issue in the coming days, the two issues below are critical to formulating a healthy workers’ compensation system:

(1) Maintain Carrier-Paid Fees
True reform must contain carrier-paid attorneys’ fees which would only apply when benefits are wrongfully denied, and the injured worker secures the services of an attorney to prevail. The workers’ compensation law does not contain a civil remedy for bad faith as is found in other insurance statutes. The carrier-paid attorneys’ fee serves as the replacement for this bad-faith remedy.

If carrier-paid attorney’s fees are removed from the law, an alternative bad-faith remedy would be required, or the entire workers’ compensation law would be unconstitutional, and the exclusive remedy which prevents the filing of a civil lawsuit would disappear.

Everything is about how people are treated after they’re found guilty. This affects only those found guilty. Guilty parties.

(2) Promote Efficient Delivery of Benefits/Maintain Current 30-Day Provision
Current law provides a safe harbor for the carrier which allows 30 days to pass after the filing of a formal claim before they would be obligated to pay attorneys’ fees if an injured worker’s benefits were wrongfully denied. Proposed legislation amends current law to allow the carrier 60 days. This is an unnecessary change and further compromises the injured worker, because the carrier receives notification of the need to provide a benefit immediately after the authorized physician makes the recommendation for medical treatment or other benefits.

By extending the obligation to 60 days, the injured worker encounters further delay. Ordinarily a carrier who is going to provide benefits does so within the last five-to-seven days before a fee would become due. The 60-day provision places an unnecessary burden on the injured worker and exposes them to the risk of waiting another 30 days before receiving the recommended benefits. The 60-day provision compromises the injured worker and his or her employer and impairs recovery which interferes with quick a return to work.

Kim Syfrett 6:20 says extending 30 to 60 days) is in direct conflict with many cases and would harm efforts to get the injured worker the treatment they need to get better. She adds that the 30-day deadline helps speed up care for injured workers, which is the purpose of the system

“If you are injured on the job, you’ve gone to see your doctor (and) your doctor needs an MRI. Oftentimes we’re dealing with a situation where it’s not necessarily denied, we’re just don’t know why it has not been authorized,” Syfrett said. “The only option that an injured worker has is to file a petition. That then places the ball in the insurance company’s court to come up with a response as to why they’re not giving that MRI.”

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