“You work that you may keep pace with the earth and the soul of the earth. For to be idle is to become a stranger unto the seasons and to step out of life’s procession.”
— Kahlil Gibran, author
Although still far from perfect, employees working in Hawaii who are injured on the job have the benefit of an extensive safety net for medical benefits, and compensation for wage loss during periods of disability.
Available benefits
Under workers’ compensation insurance, injured workers in the state, as appropriate, are entitled to up to 15-20 visits for each of the following services within the first 60 days, without prior authorization: physician care, physical therapy, occupational therapy, acupuncture, massage therapy, naturopathy and chiropractic. X-rays and medication, including effective topical creams, are also not subject to prior authorization. After 60 days, authorization becomes necessary for most of the above services. Authorization is also always required for any consultations, additional diagnostic studies and surgery. The exception is emergency care. Injured workers are also entitled to compensation after treatment is completed if there is permanent disability, and have the right to occupational training if they cannot return to their baseline work.
Manakai o Malama Integrative Healthcare Group and Rehabilitation Center typically offers most of the above services and has treated tens of thousands of injured workers during the past 20 years. The clinic utilizes a measured, team-based approach to care. Manakai recently moved into the heart of Kakaako and is now in the Gold Bond Building (Gateway Building) across the street from John A. Burns School of Medicine and immediately adjacent to SALT.
Unfortunately, workers’ compensation benefits are not available to those who work in the gig economy, which relies on barter, cash transactions and temporary, part-time and freelance work. The succession of COVID-19 stimulus and relief packages that augmented and extended standard unemployment benefits drove many to discontinue traditional employment and instead pick up government benefits while working on the side. Although the boost to usual unemployment benefits has tapered, many remain as gig workers to enjoy flexibility and independence despite the lack of job security. One trade-off is that, if injured, gig workers do not have the benefit of the rich safety net of workers’ compensation medical care and wage-loss benefits.
Hawaii’s unemployment rate spiked to 22.6% in April 2020 as COVID-19 gripped the economy and dampened tourism. During this period, many clinics that had previously treated injured workers were forced to close.
Today the official unemployment rate is back down to 3.5%, close to the pre-pandemic level of 2.2%. A healthy economy maintains an unemployment rate of 3% to 5%. Anything below 3% is considered a tight labor market, which limits the ability of businesses to find staffing and drives up labor rates. Throughout the islands we see restaurants closing or reducing hours and limiting available seating. Can you believe that Zippy’s Hawaii Kai has reverted to takeout only? Retail outlets large and small are also closing, including the Walmart on Fort Street Mall.
The 20% physician and 12% nursing shortage in Hawaii continues to hamper access to health care, and lack of support staff slows down the time it takes to get medical appointments, authorizations and procedures. Increasingly, we are seeing injured workers who have no primary care providers. Fortunately, Manakai has recently brought on four additional family medicine and primary care providers who can quickly accommodate new patients. With so many struggling to access general medical care and for those who have deferred care during the COVID-19 years, often there are concurrent general health problems that must be addressed to optimize recovery for injuries sustained on the job. Consider diabetes, high blood pressure or cardiac issues. However, workers’ compensation does not itself cover primary care.
Several years ago some of the physicians who see the greatest numbers of injured workers in Hawaii met at my home. Together we founded the Work Injury Medical Association of Hawaii. The mission of WIMAH is to engage workers’ compensation insurers, legislators, physician colleagues and other stakeholders in an effort to ensure fair treatment for injured workers. We meet again next week. There is still much to be done to ensure that workers’ rights are protected.
Compared with many other states and nations across the globe, Hawaii has an impressive and robust safety net for its injured workers.
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Ira “Kawika” Zunin is a practicing physician and medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center: manakaiomalama.com. Submit questions: info@manakaiomalama.com. His column appears the first Wednesday of each month.
