June 30, 2016
Oklahoma Option Supreme Court Litigation and PCI Report on Cost Shifting
Comments attributed to PartnerSource President Bill Minick
Option success: “The Oklahoma Option has been very successful in providing more information to workers on their rights and responsibilities, improving disability benefits for injured workers and achieving better medical outcomes. It has also dramatically reduced the number of claim disputes between employers and workers, and reduced costs for employers and taxpayers, which supports creation of new jobs in a struggling Oklahoma economy.”
Who has filed amicus briefs with the Oklahoma Supreme Court: “The fact that Oklahoma trial lawyers want to see more injury claim disputes is no surprise. The fact that Property Casualty Insurers Association of America (PCI), American Insurance Association (AIA) and The National Association of Mutual Insurance Companies (NAMIC) all want to avoid competition with an effective alternative to workers’ compensation is no surprise. But it is amazing that Oklahoma and national trial lawyer groups have compromised these workers’ compensation insurance companies, getting them to rush to the side of a claimant that is clearly seeking coverage for a non-work-related condition. This is an affront to all of their policyholders and agents who are calling for change and innovation within workers’ compensation systems.
“If they have their way, the result will not work to the advantage of either injured workers or employers. Insurance premiums will rise, outcomes and benefits for workers will deteriorate, and calls for a federal takeover of state workers’ compensation systems will only grow louder.”
The facts of this case: Public court documents show that Ms. Vasquez:
- Had been previously diagnosed with a degenerative neck condition
- Was receiving ongoing treatment under her group health plan for the exact same symptoms
- Had scheduled a follow up appointment with her physician before the work-related event
The Dillard's Oklahoma Option plan paid substantial benefits while Ms. Vasquez's claim was being reviewed. As part of a full and fair review of her claim as required by law, highly credentialed physicians determined there was no on-the-job injury.
“This is a textbook case of a worker being treated fairly, having received substantial occupational injury benefits during a period of evaluation, with her lawyers attempting to gain additional, no-cost coverage for a pre-existing, non-work-related condition. The Oklahoma Workers’ Compensation Commission did not find any harm to the employee or any wrongdoing by the employer, which demonstrates how desperate these trial lawyers and insurance companies have become to find any opportunity to challenge Oklahoma’s 2013 legislative reforms.”
For more on the facts of this case, highlighting system abuse that Option programs help address, see https://www.partnersource.com/option-insights-vol-ix-june-2016/feature-story-do-facts-matter-oklahoma-constitutionality-case/.
Cost-shifting: “PCI and others are investing a lot of time and money attempting to show cost-shifting away from Option programs are using obvious, material mis-statements and exaggerations. They are making an apples-to-oranges comparison (1) without using any Option program claims data; (2) without acknowledging the fact that the Option’s active communication with employees, improved disability benefits and better medical outcomes have reduced claim disputes and lowered costs for employers and taxpayers; and (3) without disclosing the fact that traditional workers’ comp has completely excluded coverage for 14 million American workers and has its own benefit limitations and exclusions.”
For a full response to PCI’s cost shifting report, see https://www.partnersource.com/option-insights-vol-ix-june-2016/feature-story-pcis-cost-shifting-myth/.
Positive innovation: “We believe that market competition, and accountability and personal responsibility from employers, employees and medical providers, will always be met with criticism and roadblocks. Nevertheless, we will continue to work with all private and public sector leaders to develop more effective workers’ compensation systems and improve the lives of injured workers.”
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Media contact, Karen Carrera, firstname.lastname@example.org or 972-207-1935