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Politics

Workers' Comp Changes Might Get Scuttled

March 28, 2019 - 9:30am
Cord Byrd
Cord Byrd

A push by Florida’s business community to tackle the state’s workers’ compensation insurance laws could be poised to fail again this year.

As legislators near the midway point of the 60-day session, the possibility is fading that groups representing major corporations, retailers and small businesses can win changes to the complicated system designed to provide health benefits to injured workers.

A House panel this week unanimously approved a proposal (HB 1399) that could result in a 5 percent reduction in the workers’ compensation insurance rates paid by employers.

Much of the savings would be derived by changing how insurance companies reimburse health providers. The bill, if it became law, would tie payments to rates established for Medicare, a proposal opposed by some health providers.

But business lobbyists say the legislation is missing one key feature they desperately crave: caps on the fees charged by attorneys representing injured workers.

Caps are part of a Senate workers’ compensation bill. But there wasn’t enough support this week in a Senate committee to pass the bill, according to people involved in negotiations.

The Florida Chamber of Commerce, Associated Industries of Florida and the National Federation of Independent Business, among others, want lawmakers to reinstate fee caps that were ruled unconstitutional by the Florida Supreme Court in 2016.

“This (House) bill does good things,” said Kimberly Fernandes, a lobbyist for the business-backed Florida Justice Reform Institute who said her group was “happy” to support the measure. But Fernandez said her group believes the Senate bill “does more.”

The House bill would allow insurance companies to depart from state-set rates and reduce rates by 5 percent.

FCCI Insurance Group lobbyist Tom Koval told the House Insurance & Banking Subcommittee that allowing companies to deviate from the approved rates could lead to predatory pricing and insurance company insolvencies.

The approval of the bill by the House panel came a day after the Senate Banking and Insurance Committee delayed action on a Senate workers’ compensation bill (SB 1636).

While the Senate bill would cap attorney fees at $150 an hour and limit overall payment to $1,500, there weren’t enough votes on the committee to pass the measure, committee member Tom Lee, R-Thonotosassa, said.

Workers’ compensation is meant to be a self-executing system that provides health benefits and lost wages to injured workers and protects employers from lawsuits.

While the system is generally set up to avoid lawsuits, disputes about injured workers’ benefits often lead to legal fights, which is when attorney fees come into play.

Workers’ compensation has long been a divisive issue in Tallahassee because of the breadth of its impact, touching disparate interests including injured workers, employers, health-care providers, insurance companies and workers’ attorneys.

Lee said the Senate committee didn’t have time to digest the complicated issue before taking up the bill.

“It puts you in a very awkward situation of having to move quickly on a bill that has massive consequences for the general population,” Lee said, noting it’s not just workers’ compensation but also other insurance issues that can befuddle legislators.

“To try to jump into these things on the fly is very dangerous,” Lee said.

Reinstating the workers’ compensation fee caps has been a priority for business groups since the Supreme Court struck them down. The groups argued that without caps, insurance premiums paid by employers would skyrocket, hurting the state’s economy.

Following the Supreme Court ruling, the state approved a 14.5 percent increase, which was largely attributable to eliminating the fee caps.

But since that initial increase, Florida Insurance Commissioner David Altmaier approved a nearly 10 percent reduction in rates for 2018 and an overall 13.8 percent decrease in workers’ compensation insurance rates for 2019.

Rep. Cord Byrd, a Neptune Beach Republican who is sponsoring the House workers’ compensation bill, told members of Insurance & Banking Subcommittee this week that the Legislature erroneously interfered in the free market when it agreed in 2003 to pass the fee caps that the court ultimately found unconstitutional.

“I think sometimes government has been more of a player instead of a referee,” said Byrd, an attorney who has practiced on both sides of workers’ compensation cases.

“As a practitioner, someone who has done both sides, philosophically I am opposed to caps,” he said. “I think we need to trust our judges.”

Comments

As a injured worker in the state of Florida, after losing everything from the legal games, Optum is able to play with my health and well being, to my employer who supposingly was not able to fire me because of my injury. ( that's a joke that every employee believes till they are let go. Then the story begins, not one anyone cares to listen to and I'm sure not the only one, oh wait I'm just another drug seeker working the system because I get to live a much better life now, so my story don't get heard. Changes are needed, however no one is or wants to listen.

Perhaps basic knowledge of what really happens in this complicated system is important. I have had the opportunity to represent the employer/carriers in this State and the injured worker. A carrier never has to pay an attorney's fee to the Claimant's (i.e. injured worker's) attorney except when they 1) wrongfully deny a benefit that they should have paid and 2) after they have received a good faith effort to resolve the matter without litigation (usually 5-7 days) plus an additional 30 more days on top of that to do the right thing. This doesn't even include the time when the carrier already has had the written recommendations from the doctors but have done nothing to get that moving forward. Keep in mind, there are many very good adjusters who do the right thing and get the case moving forward properly. I am only talking about when litigation is prompted here. Guess who selects the injured workers' doctor for them (95% or more of the time)? You got it...the carrier. Here's a common scenario: disputes commonly happen when the carrier selected doctor recommends care. The fight often begins when the carrier simply decides to deny the care or do nothing. I think most would agree, that's not "quick or efficient" right? Remember, the denied care was recommended by the doctor the carrier selected for the injured worker to begin with! Fights happen over prescription medications, physical therapy, a consultation with another specialist, a diagnostic study or....God forbid, a surgery. Let me pose this question...if you were searching for health insurance for yourself, your spouse or your children....and you found coverage but with this added stipulation...you don't get to select your doctor, the insurance carrier gets to pick the doctor for you...would you take it? I would guess most people would be insulted that choice of medical care is removed from them and would keep searching for better insurance elsewhere. Heck, even a PPO plan has a list of doctors a participant can choose from! Oh, and before you try to pipe up and say...well the employer had to pay for the wc insurance so it's only fair that they should get to select the doctor...Well, I would doubt you would feel that way if the injury happened to you or a loved one and you or your loved one had to experience the Florida Workers' Compensation "system" first hand. The injured workers gave up their ability to seek damages in circuit court for (often) permanent or lifelong symptoms due to an injury they didn't want. One last thing, carriers like to say...well, if the injured worker wants a change in doctor they simply have to ask for a change. Well, guess who gets to select the choice in doctor (97% of the time)? You got it...the carrier. Ever heard the phrase: "The fox guarding the henhouse?" Fees aren't the problem. It's either mishandling of a claim or failure to provide benefits that are properly due which prompts litigation. Even when given the chance to correct their bad decision (usually 35 days or more) or behavior, the carriers often don't. Fixing that problem would greatly reduce litigation to begin with.

Explained very well from what I have seen in the system. The Drs. the carrier chooses also know where their bread is buttered so to speak, They often don't have the injured workers best interest at heart. Their judgement is very tainted against the best treatment of the injured worker.

In Florida, the insurance industry will get what the insurance industry wants. (And, it's always been that way.)

Ooops!... There's the "Ole lawyer bump in the road" again..! ( If every third lawyer instead became a carpenter,.. they'd even give Jesus a "bad name"! )

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