A voice of the worker

Risk & Insurance, Jan, 2004 by Peter Rousmaniere

At its fall 2003 research conference, the 20-year-old Workers' Compensation Research Institute unveiled a ground-breaking survey of claimant satisfaction with medical care. The results are alternatively reassuring and disturbing.

The WCRI is the only independent research body in the country with an all-inclusive broad view of workers' comp systems. Its meticulous, somewhat scholarly demeanor masks the ambitions of the board and Richard Victor, the executive director, to be the eye, ear and voice for the workers' comp field. At this conference, it gave voice to the worker.

It is reassuring that a survey team can efficiently construct a credible profile of worker experiences with injury and recovery--recalling events as long as three years past. Regulators and insurers can adopt the model any time. The WCRI reported how 3,000 lost-time injured workers in four states not only graded their medical care, but also reported how they recovered physically and vocationally.

Claimants in low workers' comp cost states were more satisfied than those in high cost states. In the highest cost state, California, claimants were the least satisfied. Yes? So much for how well that grossly overstuffed pinata of a workers' comp system serves claimants.

Many injured workers never succeed in returning to the wage levels they had achieved before their accidents. The data suggest that the vast majority with less than an eighth grade education do not get close to where they were pre-injury. They account for much of the injured workforce in states like California and Texas, maybe due to the large Hispanic workforces there.

We cannot blow away this recovery failure by quibbling with the messenger. The sampling method was sound. The team carefully checked out other studies. The lead researcher, Peter Barth, with 30 years in the field, at first did not believe it. "It's an indictment of all of us," he told me.

Let's put this in middle class terms. It is as if 70 percent of professional workers who experienced a job loss in 2000-2002 will not regain their income levels for years, maybe forever.

The out-of-work engineer in Austin has career recovery tools such as education and social mobility. The Hispanic construction worker in El Paso may have neither. His or her most attractive path may be to join the cash sub-economy or snag a social security disability award, or maybe do both.

Juan Hermosa (let's call him that) is going to fashion his own risk management solutions if the workers' comp system does not find them for him. A million Hermosas will turn the most attractive paths into highways.

The roll of workers with very limited vocational options will likely grow even as the Austin engineer regains her or his footing. Professional America is a gated community. Low-skill jobs become scarcer and, relatively at least, meaner.

Workers' comp, this busy microcosm of risk and insurance, is an unending call and response between exposure and risk management. But the workers' comp system can respond only so much on behalf of this worker group. The California system's tableau of generous legal and medical benefits for claimants is a mirage. The concept of voc rehab has largely failed as a major solution. What may help are better incentives for the employer to retain the worker from day one of the injury and through, if and when a permanent award is made.

It may also help to view the low-skilled injured worker as a cohort with millions of other individuals facing bleak prospects to find jobs at livable wages. Barbara Ehrenreich's biting book, "Nickel and Dimed," presents the worker who is condemned to the margins for life, injured or not. Some people such as Robert Schiller of Yale have proposed a global income insurance solution, sort of an AFLAC for working people with inadequate income.

Maybe we should reframe this problem as an exposure not of workers' comp but of society.

Peter Rousmaniere writes monthly for Risk & Insurance. He can be reached at riskletters@lrp.com