New York Workers Compensation Alliance

The "Dean" of the New York Workers' Compensation Bar and Author of Larson's New York Workers' Compensation Handbook (LexisNexis 2006), Edward Pitts, responded to the 12/21/06 Letter to the Editor of Larry Gilroy, the crusading anti-worker insurance broker who has been sending essentially the same insurance company spin to multiple upstate newspapers.   I wonder if Mr. Gilroy ever sold his clients AIG workers' compensation insurance? Is it possible Mr. Gilroy himself has contributed to the high cost of workers' compensation in New York State? Thankfully, Governor-elect Spitzer has proved in the past that he knows how to deal with the "unseemly" insurance industry. Here's Ed's persuasive and educational response:

Workers’ Comp Reform must Continue to Protect Injured Workers

The Post-Standard published a commentary by Utica insurance agent Larry Gilroy on December 21 that congratulates Governor-elect Spitzer on his leadership in the area of workers’ compensation reform. I agree that Eliot Spitzer has a historic opportunity to reform workers’ compensation. I hope, however, that he will not accept at face value the arguments put forth by Mr. Gilroy, NYCAN, or the NYS Business Council. They simply are not telling the truth about workers’ compensation.

I am a board member of the Workers Compensation Alliance (WCA). The WCA is composed of workers’ compensation attorneys and advocates from across New York State committed to *protecting the rights and dignity of injured workers. These attorneys are in the trenches attending workers’ compensation hearings on a daily basis. They know first hand the troubles facing injured workers. Collectively, members of the WCA represent over 200,000 currently injured or disabled New York residents.

In addition, the WCA publicly fought for the passage of the recent “9/11 Rescue Workers” law and leaders of the WCA spoke at recent New York State Senate Labor Committee forums and State Assembly hearings addressing workers’ compensation reform.

It is true that benefits paid to injured workers in New York are the lowest in the nation while per claim costs are among the highest. However, without any objective evidence NYCAN claims that a major reason for the high costs is the fact that New York still protects the most seriously injured workers from poverty. Without directly saying so, NYCAN claims that the only way costs can be controlled is to cut off benefits for persons who are so severely injured that they're permanently unable to return to work at their pre-injury wage. Not only is this untrue, it's unfair to every hard-working New Yorker.

If Upstate New York businesses want to be more profitable, they need to attract and retain skilled, hard-working employees. It’s grossly unfair for upstate employers to claim they can only be competitive if their hard-working employees give up insurance benefits they have been guaranteed under workers’ compensation since 1914.

More than a quarter of a million employees are injured at work in New York every year. Of these, the vast majority return to work shortly after being injured. Even those who are more seriously injured return to work as soon as possible. Only a small minority of all injured workers (about 13%) are so seriously affected by their injuries that they have a permanent loss of wage earning capacity. About half of these permanently injured workers have returned to work but are unable to earn as much as before their injury. For these hard-working employees permanent partial disability benefits provide the only protection between them and bankruptcy.

Now NYCAN wants to deny these seriously injured workers their permanent partial disability benefits so that insurance companies can increase their profits. But wait a minute, doesn't NYCAN claim if PPD benefits are limited that workers’ compensation premiums will decline? No, they don't, because there is no evidence that such a limitation will actually result in a decline in premiums. Credible nationwide studies of the cost drivers in workers’ compensation show that even when payouts to injured workers and medical costs decline, premium costs continue to increase [see National Academy of Social Insurance “Workers’ Compensation: Benefits, Coverage and Costs (July 2006)”].

In fact over the past decade the number of persons injured at work in New York has declined as have the number of workers’ compensation claims, the number of workers’ compensation hearings and the average cost of payments to injured workers. Why, then, have premium costs remained high?

At least one explanation is insurance company profits. New York is unique in that premium rates for workers’ compensation are largely controlled by the insurance industry itself. A good start in controlling workers’ compensation costs would be to abolish the New York Compensation Insurance Rating Board (CIRB) and force insurance companies for the first time to tell the truth about their profits.

Another reason for New York's high premiums is the terrible job almost all commercial carriers and self-insured employers do in managing their workers’ compensation claims. Workers' compensation claims take longer to resolve and involve more unnecessary litigation than other types of insurance claims.

Finally, I believe a major cost driver for upstate employers is the absence of a premium-rating plan specifically tailored to the costs of insurance in each geographic area of the state. If New York adopted a regionalized premium policy such as is already in effect for automobile and health insurance, I believe upstate premium costs would decline.

The Workers’ Compensation Alliance has proposed a package of reforms to Governor elect Spitzer designed to reduce premium costs while preserving necessary benefits to the most seriously injured workers. We can only hope that he will get all the facts and consider all alternatives before deciding on any reform.

*Edward Pitts is a Syracuse attorney who represents injured workers. He is the author of the leading legal text on Workers’ Compensation, and past president of the Injured Workers Bar Association.

CIRB may set the rates based for the policyholder and propose the premium rates but the Insurance Department actually has the final approval factor of the CIRB proposed rates.

As for rising cost of premium is abit misleading since the CIRB listed approved manual rates which declined for a total of -51% since 1994. 2005 was the first major increase in manual rates of 5%. This year the Ins Dept rejected another rate increase which will leave the rates unchanged.

CIRB does provide an important service for the businesses in NY such as reviewing all the policies issued by the carriers to make sure they are getting the appropriate credits and classification rates.

There is "NO DATES or SENATE COMMITTEE SET UP FOR
FRAUD AGAINST INJURED WORKERS and the CORRUPTION that our WC TOLERATES KNOWINGLY.
There is NO ONE to investigate IMES' or SELF INSURERS from BAD FAITH Claims like mine and so many others.
WE NEED HELP ! Many of us went to college to get a great career just to have it taken away by INSURANCE MONGOORS. I was told there are "NO" laws to STOP the Bad Faith , FRAUD from IMES' and the SELF INSURERS.
Does anyone care what is happening to us. Trying to survive on welfare or social security like I . When I was entitled to benefits. I have been on social security and MEDICARE since 2001 , I was 45 y/o. How PATHETIC.
Does anyone care that people lose everything they have worked their ENTIRE LIFE FOR ! Some are in so much pain emotionally and physically they COMMIT SUICIDE.
CORRUPTION and Workers' Compensation REFORM needs to be first and foremost on the AGENDA.The "INJURED WORKERS like I that was refused care , delayed, and benefits, medical NEED YOUR HELP. NOW !
If a worker is disabled for life then either permanent partial disability or Permanent Disability MUST be PAID. That was the law since 1914. Or I submit that I will campaign that injured workers just SUE their employers because workers comp. corruption and allowed FRAUD from IMES' and self insurers will take your life.
I would love to speak as an advocate for Injured Workers if you would like to hear our HORROR STORIES. PLEASE HELP US. I ask that you ALL look at the PROFITS these INSUERS are making from the SUFFERING HARD WORKING INJURED WORKER and premiums from employers. We need someone with COURAGE to step up , just like Attorney General spitzer did. GREAT JOB !
WE NEED AN INVESTIGATION into our allegations. We need OUR LIFE back with some benefits we are entitled too.
Dear GOVERNOR ELIOT SPITZER,Lt. Governor and all elected Senators, 2007 IS HERE, TIME TO GET TO WORK !
I and other "INJURED WORKERS and DISABLED people" helped vote you in office. It was "YOU" that had the COURAGE, STAMINA, and proved to be a tenacious and "HONEST" compassionate man that went after certain insurance companies for what they were doing to the hard working people. It is now that those hard working "INJURED" people like myself need you to stand strong and let all know that you will NOT support any disabled people , or hard working "INJURED WORKER" from New York to end up on the welfare role, Nor allow them from having to go on Social Security and medicare at age 50 like I or any age for that matter. This was do to a corrupt workers' comp. system with corrupt IMES' , INSURERS that are lawless and , Governor Spitzer you are well aware of.
Governor Spitzer I was poor all my life and worked since I was 11 y/o ,I always wanted to be a nurse. At age 36 with three years of very hard work for a nursing degree I full-filled my life dream. I was injured at work in the critical care unit lifting men. Herniated two discs that flattened my spinal cord. My employer , their insurer and the workers' comp. system ignored my pleas and my neurosurgeons URGENT request for neck surgery. Finally over a year went by and a domino effect of many more medical problems( I was healthy before this work injury) and many hearings later and visits to fraudulent pathetic IMES, my medications stopped, medical refused the LAW JUDGE ordered my surgery.
I now SUFFER with many spine, nerve , muscle and CHRONIC PAIN 24/7 because of all the delays, refusals and negligence from ALL forementioned.I wanted to reopen my case because my neurosurgeon found after a horrific myelogram that nerves above my 2 inch plate put in to decompress the spinal cord are now being compressed.According to an IME this is not related to my work injury.My neck surgery was paid by the insurer and the Law Judge ordered it but the nerves above the sight or muscle and nerve damage and PAIN is not related according to a very well PAID fraudulent IME. My case was closed even with many expert doctors evaluations. There is a law that IMES' have to be somewhat consistant with expert or injured workers doctor. I was "REFUSED DUE PROCESS" and no one gives a ....I live solely on social security $853.00 a month. I cry all the time because I miss my career , my patients and my health that I had.
GOVERNOR SPITZER I know you would not tolerate this corruption. I am a critical care nurse and will always be, but I can't tolerate the pain that the system left me with literally totally disabled and without medical care, medications to control my pain,nor any monetary benefits, NONE!. Emotional and physical Pain, like so many others. My case was wrongly closed I should be drawing WC for life. If one's work injury caused by the delays, refusals and negligence of the employer, their insurer or WC then "INJURED WORKERS" are entitled to benefits for life according to the agreement and laws for WC made in 1914. These laws are there they are just NOT being followed. I am ENTITLED to benefits but I will never see a dime and I am a critical care nurse , I knew what they were doing to me.
I pray everyday that you will set the fraudulent IMES' and the EMPLOYERS,WC SYSTEM and INSURANCE mongoors straight.
If I may suggest a panel of trusted people that can follow or study a state that received an "A" in a study that was done and rated on their WC System. IOWA got an "A". I would be glad and willing to speak to you or anyone you choose with suggestions on what needs to change. Appoint me to the Board I will gladly put the system in the right direction.Thank You for your time.
I BEG YOU TO HELP US and STOP the INSURERS from CAPITALIZING off our "PAIN and SUFFERING". Read the studies the insurers PROFITS ARE HUGE from INJURED WORKERS.
I TRUST you Governor Spitzer Lt. Governor David Paterson and all elected senators.
Sincerely,
Donna Gilman RN(disabled by a WC System

I hear you. I have had a third back injuy thathas done me in for life. I cannot take care of myself, my home. I cannot rememmber many things because of the constant pain and medications to help control the pain. Th etwo earlier back injuries I went back to work and worked 60 to 80 houlrs a week. I did this not only because I loved my job but I pay all the bills in my household. It's just me responsible for everything. I have been very fortunat in that I have a very good attorney Mr. Edward Pitts of Daly and Pitts who have stood by me through everything. I was also fortunate after many years of actually finding a doctor who knew what was truly wrong with me and now I have a medical help in place to see me through. As you say the pain is unbearable. I take many medications ansd they don't even touch the pain anymore. My mobility sucks. I aamd totally incontinent from herniated discs. I have needed surgery since my last injury of April 2005 and to date have still not had any. THIS NEEDED SURGERY THAT HAS BEEN PUT OFF, IS NOW RESPONSIBLE FOR LEGS THAT GO SEAD ALL THE TIME, LEGS THAT SWELL IF I AM ON MY FEET LONGER THAN 20 MINUTES,BLURRED VISION, INVOLUNTARY MUSCLE SPASMS THAT OCCUR ANYWHERE FROM THE BOTTOM OF MY FEET RIGHT UP INTO THE BACK OF MY HEAD. tHE PHYSICIANS KNOW THIS IS DUE TO CRUSHED NERVES AND OVERALL NERVE IMPINGEMENT FROM MY NECK DOWN INTO THE COCCYX. I WILL SAY PRAYERS FOR YOU. WE ARE ALL OUT HERE AND TRULY UNDERSTAND YOUR PLIGHT. TRUST ME YOU ARE NOT ALONE. KEEP THE FAITH AND KEEP FIGHTING THE FIGHT. I PRAY YOU FIND A GROUP OF INDIVIDUALS TO HELP YOU AS I HAVE BEEN HELPED AND CONTINUE TO BE HELPED.