An intriguing story ran this year in the Oklahoman, Father Blames Oklahoma Workers' Comp. The crux of the dispute is how workers' compensation benefits are delivered. The story begins with a 28-year-old from Slidell, Louisiana. Though many will perhaps not remember Slidell, they will have driven through it. It is a little town at the confluence of Interstates 10, 12, and 59. For us Floridians, it is where we make our hard left turn to the south when headed for the Big Easy.
This young lady, Victoria Chiri, went to work in 2016 at a Girl Scout camp in Oklahoma. She is skilled at horseback riding, and she was "equestrian director at Camp E-Ko-Wah." One morning, she fell from her horse and suffered a "burst compression fracture in her lower back." She was provided medical care but has not returned to work in that capacity. She has been able to perform some work "as a photography assistant for minimal wages," apparently "at her father's Louisiana newspaper."
The Oklahoman article notes Ms. Chiri's complaints about the delivery of workers' compensation benefits. She characterized this as "slow and indifferent." Despite the "insurance-approved treatments, physical therapy, and injections," she contends that she is not recovering appropriately.
One of the most surprising allegations in the story is her contention that she is "forced to drive hundreds of miles from her Louisiana home to receive treatment." She implies (or alleges) that the Oklahoma workers' compensation system will not provide medical care in Louisiana. While Slidell may not be on the medical technology cutting edge (much of "small town America isn't), Big Easy visitors will remember that it is a short trip from there to New Orleans, and a great many exceptional specialists, clinics, and hospitals.
Another surprising contention is that Ms. Chiri has been making those trips to Oklahoma at her own expense. She contends that this is "costing her money she didn't have." Not every workers' compensation system provides transportation reimbursement to medical care appointments, but many do. Florida has provided such mileage reimbursement since the 1960s. The requirement was instituted by rule and paid $.075 per mile back then. The Florida Supreme Court upheld that rule in Mobley v. Jack & Son Plumbing, 170 So.2d 41 (Fla. 1964). Since then, the Florida per-mile allowance has of course increased and is currently $.445 per mile.
Despite the article's contention, there is evidence that Oklahoma does in fact reimburse medical mileage. One law summary says that reimbursement is a benefit whenever travel exceeds 20 miles. The Oklahoma Commission also publishes notices regarding the reimbursement rate for mileage. Possibly the reimbursement is not provided out-of-state, or perhaps there has been a misunderstanding regarding medical mileage? The issue is notable, however. According to Google Maps, the distance from Slidell to the Oklahoma state line is about 500 miles. The 2017 Oklahoma notice sets the reimbursement rate at $.535, which would purportedly reimburse over $500 for the 1,000-mile round-trip. Is Ms. Chiri not receiving mileage reimbursement because it is not due, or is there some hiccup in the process (such as how it is being requested)?
The article goes on to describe the valuation of disability in Oklahoma, as well as settlement negotiations. Recent comparisons in the national media have illustrated that state workers' compensation benefit comparisons are both complex and potentially misleading. That is because some states compensate "wage earning," others "impairment," and others some combination of factors. Determining a fair method to compensate for the permanent effects of work accidents has proven challenging. Whether the article's representations of either settlement or disability value are supportable or accurate is best left to those with specific Oklahoma expertise. However, it is an interesting read nonetheless.
Ms Chiri's father is critical of the medical treatment she has received. He contends that she has not received "nearly enough treatment." He is critical of the workers' compensation system and perceives that it is not providing what his daughter needs, "action." He expresses a common sentiment for his daughter that she "be fixed and have her life back." The article expresses a theme I hear from many patient advocates, that the provision of medical treatment is too slow in workers' compensation. Advocates often point to professional sports as a comparison and the seemingly instant provision of care in the "sports medicine" paradigm. But, unfortunately, it is worth remembering that sometimes the human body cannot be "fixed" even with the best medical care.
An Oklahoma attorney quoted in the story asserts that "Workers' compensation cases," are "rarely resolved quickly." He says “If you get it done in a year, it's a miracle.” Ms. Chiri places the blame on the Girl Scout's "workers' compensation insurance." As with any example or anecdote, one might validly wonder whether the described delays are commonplace or isolated to this particular litigation.
In one specific cited example, Ms. Chiri sought a medical procedure to alleviate symptoms. It would "sever nerves" in her spine. That procedure was later ordered by an Oklahoma judge, but the decision was appealed. It is likely that appeal remains pending at this time; appellate review can sometimes take longer than it requires to initially bring a case to trial. The argument against the procedure appears to be centered on the employer's perceptions that her recovery has been sufficient to accommodate a return to work. Ms. Chiri contests that perception, arguing she has since worked only in the shelter of her father's Louisiana business.
Ms. Chiri's story is not uncommon in some respects. People get injured, unexpectedly, and often while doing something with which they have extensive experience or even expertise. There is no "accident exemption" for the experienced or even for the careful. Though some contend that accidents are more common among new hires or the inexperienced, accidents happen to everyone.
It is also not uncommon for injured workers to migrate to family. Life is a complex series of commitments and challenges under the best of circumstances. And, when those are exacerbated by an injury, bodily dysfunction, and the commitments of therapy and recovery, it is not unheard of that workers seek to be in some supporting environment. Moving home to family is often that environment. But, that move home to family may distance a worker from the injury location and initial medical care providers.
Ms. Chiri returned home to Slidell. Then, about a year after her fall, she "slipped into a deep depression," and "attempted suicide." She reportedly took "a combination of medications prescribed for her back injury," but was timely discovered and saved through medical intervention. That aspect of the story also bears some consideration. When people suffer major life events, some effects may be apparent (broken arm and cast; abrasion, scar) and others may be less readily discernible.
Another interesting aspect of the story is health insurance. Ms. Chiri reportedly does not have health insurance. Time and again, I have recently been told that although Obamacare mandated health insurance, a significant population (millions of Americans) nonetheless did not have coverage. Until very recently, the federal government said that health insurance was mandatory. The story reports that Ms. Chiri's father also does not have health insurance. Certainly, if he had a policy it would not likely cover her as she is 28 years old, and the dependent inclusion of Obamacare ends at 26, according to healthcare.gov. But, how is it that "mandatory" did not mean what so many thought it meant (that everyone would have health insurance)? How is it that some people were fined for not having such coverage, but it appears others blithely ignored the requirement?
During the recent National Conversation regarding workers' compensation, a great deal of time was spent discussing Maine's requirements (June 2016) for treatment. There, a health insurer cannot deny treatment because of allegations that injuries are related to work. In Maine, the group health carrier has to provide care under its contract (policy), and may later be reimbursed if the injury or illness is determined to be workers' compensation. That requirement exists elsewhere and has been discussed in still more states. Such a requirement might help some who struggle with delays in workers' compensation medical care, perhaps those involved in disputes regarding occupational causation.
Of course, such a requirement only benefits those with health insurance. And, according to the Centers for Disease Control, over 28 million Americans do not have health insurance, despite the "individual mandate" in place until recently. As an aside, what was done with the at least $10 billion in penalties from this 28 million person (minimum penalty $347.50 times 28 million). Of course, the Maine solution would not assist those like Ms. Chiri, or her father. But, it would perhaps help the (at least) 177 million Americans who do have such coverage? It is an idea that will perhaps be discussed further in other states.
Ms. Chiri's is an informative story. It highlights that workers' compensation is defined by state laws, and various states may have similarities but also distinctions. It raises questions as to whether a program does not provide certain benefits, like medical mileage, or whether there are merely obstacles to obtaining them (informational or otherwise). There are questions of "medical necessity" and extent of recovery, as well as issues regarding the emotional impact of both physical injury and the process of recovery. And, it reminds us that accidents can happen to anyone, even when they are skilled, experienced, and careful.
In all, it is an illustrative story of workers' compensation. It is worth reminding everyone that it is only one side of that story, and it is always appropriate to listen to both sides before forming conclusions. But, it is worthy of consideration for the potential implications that it suggests and reminds us about this system in which we strive.
