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The February 21, 2020 edition of the Houston Chronicle featured the plight of Stephanie Albers, a 54-year-old flight attendant who suffered a neck injury on the job. The headline was gripping:
In crippling pain from on-the-job injury, Houston flight attendant finds getting help ‘impossible’
The accompanying story was a scathing indictment of the Texas workers’ compensation system and, more particularly, workers’ compensation insurance companies. The problem? It's grossly misleading.
Albers was injured when air turbulence threw her into the air and back to the floor, reportedly damaging nerves in her neck. She recounts an exhausting, two-year struggle to obtain necessary treatment which, she says, has been routinely and improperly denied by her comp carrier. According to her husband, Dwight Albers:
She’s in pain every single day, and they’re dragging their feet, doing this dog and pony show, all this administrative stuff . . . In the meantime, she’s not getting any better.
According to the Chronicle, Albers’ experience is all too common:
In Texas . . . injured employees who file claims through the [workers’ compensation] system enter an endless maze of denials and appeals that blocks their treatment, recovery, and return to work. For many, the process is so exhausting that they rue ever filing a workers’ compensation claim.
The Chronicle neglects to mention that preauthorization is not required for most pain medication or treatment and, therefore, the insurance company could not “block” treatment even if it wanted to do so. TheChronicle does not explain that, even where medication or treatment requires preauthorization, the decision to approve or deny it is fast-tracked and must be made within three days, nor does it mention that the preauthorization decision must be based on evidence-based treatment guidelines adopted by the TDI-DWC, not the whim of the carrier. TheChronicle does not explain that if the carrier denies preauthorization the worker is entitled to review by an independent review organization. TheChronicle does not acknowledge that insurance companies have a disincentive to block a worker’s recovery and return to work because to do so would increase their exposure for income benefits. And theChronicle cites no evidence whatsoever for its assertion that “for many, the process is so exhausting that they rue ever filing a workers’ compensation claim.”
It gets worse. According to theChronicle, an injured worker who has a dispute with her insurance carrier may as well just give up because changes in the law “have left a workers’ compensation system that makes . . . fighting against insurance companies effectively impossible.” Although the Chronicle acknowledges that the TDI-DWC provides a dispute resolution system to resolve benefits disputes, it dismisses that system as being rigged in favor of carriers:
But experts say the dispute resolution process is hopelessly stacked against workers, leaving them with only one real option: Don’t get hurt at work.
The Chronicle does not identify the so-called “experts” on whom it relied for that indictment of the dispute resolution system, nor does it cite to any statistics or other evidence to support it. TheChronicle also does not mention that injured workers are routinely represented by legal counsel at Benefit Review Conferences and Contested Case Hearings, and it neglects to note that ombudsmen from the Office of Injured Employee Counsel are available to assist injured workers at no charge in those proceedings.
We don’t have a subscription to theHouston Chronicle, but if we did we would cancel it.