- ISHN GLOBAL
- EHS RESEARCH
Common Courage Press, a publisher for "an informed democracy" just released an expose on the American occupational health and safety scene. Written for the public by Lisa Cullen, a CIH and first-time book author, "A Job to Die For" weaves together the emotional toll of workplace accidents with the politics and regulatory aspects to provide a unique perspective on the current state of workplace safety and health. This is part two of a three-part series to appear in ISHN.
A national prime time television show aired a show on workers' compensation fraud, opening dramatically with footage of an old man working on a farm and a lawyer interviewing that same old man.
Announcer: This is DATELINE Monday, May 29th, 2000. Tonight. It's a crime that takes money out of your pocket, it starts with a lie.
Unidentified Lawyer: Are you able to lift anything?
Mr. Emil Mentel: A cup.
Lawyer: A cup?
Mr. Mentel: This is how I am.
Announcer: Think he's a broken old man? Here's what hidden cameras showed he was really doing while collecting money from you.
Mr. Manny Pageler: The man can grip. I see the legs working, I see the arms working.
John Larson reporting: When you first saw that videotape of him throwing that bale of hay, what was your reaction?
Mr. Pageler: I was mad.
Announcer: John Larson with lies, rip-offs and videotape.
Worst-case scenarioThe man featured in the NBC Dateline segment, Mr. Mentel, pleaded guilty to the felony charge of insurance fraud. He faked his disabilities and took advantage of both the workers' compensation system and a 74-year-old woman who gave him a job as an apartment manager. It was the worst of worst-case scenarios. What made it such good drama was the fact that Mr. Mentel was an 80-year-old man who could apparently lie without shame and toss around 120-pound hay bales. On top of that, an insurance company investigator caught the shocking behavior on videotape.
Stone Phillips explained, "Because of his age, Emil Mentel was given no jail time. He was sentenced to five years probation and community service. He was also ordered to repay the insurance company the amount paid out on the claim, more than $118,000."
Instead of emphasizing the fact that a cheat was caught, the show furthered the perception that claimant fraud is a widespread form of art. For example, after introducing Frank Meyer, from the Sacramento district attorney's office, John Larson concludes: ". . . And Meyer promises the courts will continue to go after workers' compensation scam artists."
Of course, the courts should prosecute wrongdoing, especially the intentional abuse of systems designed to help people. The real message here, however, is the threat of criminal prosecution. It is this threat that fosters under-reporting of legitimate claims and the overall shame of being an injured worker.
The rotten taste in the viewer's mouth from a truly distasteful act is blurred with anger as the state prosecutor is allowed to say, "We want to send the message that these are serious offenses, that if you commit this kind of crime and get caught, that there's a good chance you will be prosecuted."
It was like a commercial for the workers' compensation insurance industry and their anti-fraud campaign.
Hardly commonIn the middle of the segment, reporter John Larson asserts, "After all, workers' compensation fraud is quite common. The industry estimates it adds up to $5 billion a year." The American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) has heard this $5 billion claim before. The union's workers' compensation newsletter explained, "These allegations have absolutely no relationship to fact but are based on 'attitudes' about fraud (when respondents say they 'know' of someone supposedly on workers' comp even though he or she might be capable of working). A similar claim put workers' compensation fraud at 20 percent of the total of all claims in California in 1996; the truth was that suspected fraud that year, according to the state's Department of Insurance, was three-tenths of one percent!"
In the summer of 2000, an independent team of experts - J. Paul Leigh, Ph.D., Steven Markowitz,M.D., Marianne Fahs, Ph.D., M.P.H., and Philip Landrigan, M.D. - published a book titled, "Costs of Occupational Injuries and Illnesses." In it, they estimated the national price tag for fraudulent claims to be 1.2 billion dollars, roughly one-fourth of the insurance industry estimate. Conceding that $1.2 billion is still a lot of money, the Leigh team put it into perspective by explaining that it was only about two percent of all workers' compensation dollars spent in their sample year of 1994. Whether the true fraud rate is less than one percent or as high as two percent, it is hardly "quite common."
The Dateline show provoked a response from the AFL-CIO Department of Occupational Health and Safety, which wrote:
"On May 29th NBC Nightly News and its program Dateline chose again to focus on an instance of worker fraud in workers' compensation. Despite the fact that studies show that claimant fraud in this system is minimal - in California, worker fraud is less that three-tenths of one percent of all claims; and in Wisconsin, it is less than one-tenth of one percent of claims - these expos? encouraged by irresponsible allegations from the insurance industry, feed the myth that workers injured on the job are frauds, cheats, and malingerers."
A few months after the Dateline show aired, the Los Angeles Times printed, "Anti-Fraud Drive Proves Costly for Employees," and found, "Over the last decade, employers and insurance carriers have saved billions of dollars as legislatures in many states rolled back benefits, more narrowly defined workplace injuries and introduced impediments to collecting for them."
And the J. Paul Leigh team concluded, "The dollar amount of fraudulent workers' compensation claims submitted by workers pales in comparison to the amount for claims never filed and, more importantly, the overall small amount of total costs paid by workers' compensation systems. Moreover, fraud committed by insurance companies at workers' expense is likely to be significant."
The Leigh team further estimated that workers' compensation covers only 27 percent of all costs and that taxpayers that bear a financial burden of 28.5 billion dollars - close to six times the estimate of workers' compensation fraud - through Medicare, Medicaid, and Social Security. Further, they discovered that costs were borne by injured workers and their families, by all workers through lower wages, by employers with lower profits and by consumers with higher prices. Specifically, they estimated that injured and ill workers and their families absorbed about 44 percent of the costs. Now that is injustice worthy of outrage.
The other AmericaThe classic "American Dream" rests on the dignity and pride of being able to make something of oneself. We ask our children, "What do you want to be when you grow up?" because we believe that, with hard work, they can be whatever they want to be. We don't tell them that if they get injured or ill while pursuing that dream, all bets are off.
In addition to the physical pain, financial hardship and the loss of their self-image as self-sufficient members of their families and society, injured and ill workers are essentially discarded. They are outcasts. With the exception of the elderly and young, America shows little mercy for those who cannot work, those "permanently disabled" from a workplace injury or illness.
In June of 2000, at a chapter meeting of the Pennsylvania Federation of Injured Workers, an announcement was made concerning the upcoming Labor Day parade. The local chapter president thought a float in the parade would raise awareness of the plight of injured workers. The room fell silent when he asked for volunteers: only proud people march in parades. The insurance industry's campaign to root out fraud had been heard.
Tim Wagner was Executive Director of the Pennsylvania Federation of Injured Workers for five years, until it was forced to close its doors due to lack of funding. He described the indignity this way: "The America you knew before you were injured is not the America you know afterwards. The rights and privileges people think they have before they are injured dissolves afterwards. You go from being a productive member of society to being seen and treated as a bum."
When he took the organization's lead in 1995, Tim was an ordained Lutheran minister. His decision cost him his ordination and half his salary. About his choice, he says, "This is the hardest job I've ever done. Insurers have done a good job of showing injured workers as lazy malingerers. The fraud image is so powerful that even the unions and the workers themselves buy into it. People suspect their co-workers of milking the system and this pits employers and employees together against the injured worker."
Tim explains, "Most injured workers enter the workers' compensation system reluctantly but they have no other choice. Co-workers become pawns of the insurance industry when they don't support the injured. It's divide and conquer."