ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Monday, June 3, 1996 TAG: 9606030116
SECTION: NAT/INTL PAGE: A1 EDITION: METRO
SOURCE: ASSOCIATED PRESS
note: below
When she heard that nasty pop in her back and everything went black on Valentine's Day 1991, Connie Rodriguez knew little about workers' compensation in Texas.
Today, she's an expert.
Rodriguez, a nurse, suffered three herniated discs while moving a patient into a wheelchair. After three years of surgery and battles with her employer's insurance company, Rodriguez lost her benefits of $412 a week. She wound up on welfare, living in a homeless shelter.
``I worked as a nurse all my life, paid taxes all my life, and this is how my state treats me,'' said Rodriguez, 47, who now heads a group of about 300 San Antonio workers called the Association for Injured and Discriminated Employees.
AIDE is one of dozens of small groups materializing around the country to fight changes that unions say are restructuring workers' comp at the expense of the workers it is supposed to protect.
Workers' compensation, funded by employers' premiums and overseen by states, covers some 100 million people nationwide, paying out $70 billion a year for on-the-job injuries or death.
That tab represents a tripling of benefits since 1980, driven in part by rising premiums and medical bills, more complicated injuries such as repetitive stress, and the maze of insurers, lawyers, HMOs and others that must be navigated before claims are paid.
``It has a cast of characters the size of `Ben-Hur,' and we need to get it down to the size of `Cinderella,''' said Roger Fries, president of the Kentucky Employers Mutual Insurance Authority, that state's insurance fund.
Efforts to cut the cast - and the costs - have been bitterly fought by labor groups. Change, they say, has forced people back to work long before they're healed; denied them top-notch legal representation and medical evaluations; placed medical decisions in the hands of administrators and insurance adjusters; and slashed benefits.
``Have we lost sight of the fact that it is WORKERS' Compensation, after all?'' said Jim Ellenberger, a spokesman for the AFL-CIO.
Among the states that have changed workers' comp in recent years: California, Connecticut, Florida, Maine, Massachusetts, Michigan, Oregon and Texas.
From their point of view, changes rein in costs by limiting excessive legal fees and benefits; defining disabilities more strictly; and establishing state insurance funds, safety programs and administrative appeals boards that curb the number of court cases.
According to the Workers' Compensation Research Institute, a nonprofit organization in Cambridge, Mass., costs and claims have dropped in almost every reform state.
In California, the $8.5 billion in claims paid in 1993 dropped to $4.5 billion in 1995 - a savings largely attributed to the reduced number of court cases.
In Texas, the amount paid in employer premiums went from $4.08 billion in 1990 to $1.92 billion in 1994.
While the research institute praised the Texas changes, a 1995 report also noted: ``There is the inevitable question, not resolved by us, whether the system gives justice to the worker.''
Labor groups say the answer is a resounding no.
Take Connie Rodriguez. Before Texas' new laws went into effect, the San Antonio nurse said, she would have hired a lawyer to fight for long-term benefits. But with lump-sum settlements now prohibited, lawyers are reluctant to represent compensation claimants.
She was also affected by the state's adoption of the strict American Medical Association formula for evaluating injury. It assesses total body impairment and awards benefits based on the overall percentage of disability. Critics say the formula fails to take into account what kind of work claimants performed before injury.
``I could barely walk, and they were saying I only had a 12 percent total body impairment,'' Rodriguez said. ``I couldn't go back to work and bend and lift like I did before.''
``The fact is, workers around the country are getting less and less, and it's becoming much harder to collect for your broken leg,'' said Fay Hansen, a consultant for the Labor Research Association in New York.
Kentucky lawmakers anticipate being called into special session in July to consider workers' comp changes. There, the loss over two years of about 4,400 coal mining jobs, almost 19 percent of the mining work force, has fueled fears that desperate miners will try to collect compensation for black lung disease, whether or not they are seriously ill with the coal dust-caused ailment.
``The problem is when the system is so easy that someone who has worked for three years can say, `I've got a speck on my lung. Pay me,''' said Fries of the Kentucky state insurance agency.
A flood of those kinds of cases prompted nearly every major insurance company to bail out of Maine in the early 1990s.
It was a crisis that almost destroyed the state economy, employers said. Instead, said state insurance superintendent Brian Atchinson, ``We deregulated the market, set up an employers mutual and got the lawyers out of the system.''
Maine compensation payments dropped from $325 million in 1992 to $189 million in 1995.
LENGTH: Medium: 99 lines ILLUSTRATION: PHOTO: headshot of Rodriguez colorby CNB