Sorry to start 2011 off with some bad news but a decade of abusing medical providers has led to a costly workers compensation mess in Hawaii.

Here is how workers comp is supposed to work: You get hurt, you pick a good doctor, you get fast treatment and you go back to work. Until you return to work you get paid weekly benefits.

State Department of Labor rules allow you a few visits to a doctor or physical therapist immediately after your accident and then require your doctor to submit periodic written treatment plans to the insurance carrier at least seven days before more complicated treatment is to begin (X-rays, MRI exams, surgical consultations, etc.). If the carrier thinks this treatment is inappropriate, it must deny the treatment plan in writing. But until it is denied, your treatment can begin.

Those same rules guarantee that your medical providers will be paid for services up to the time they are denied in writing.

Efficient workers comp system, right? Wrong! That’s not the way our messy workers comp system presently works. If you are seriously hurt while working, here is what will most likely happen:

1. You will discover that more than half our doctors refuse to treat work-injury patients. They are tired of being pushed around by carriers.

2. Once you find a good doctor, your treatment might be delayed for several months while the carrier second-guesses your doctor by seeking a second opinion. This second opinion is called an "Independent Medical Examination," but the doctor the carrier selects may have received hundreds of thousands of dollars in business from that very same carrier over the years. This will cause you to no longer trust the carrier or your employer.

3. During your treatment the carrier may simply ignore your doctor’s periodic plans entirely. Then your doctor will have to waste endless hours calling the carrier to try finding out whether your treatment can continue.

4. Your doctor — or physical therapist, diagnostician, massage therapist — will not start treatment until having written permission to proceed from the carrier, even though that written permission is not required by the rules. This will delay your treatment by weeks or months.

Practioners wait because they cannot afford to take a chance on having to fight carriers in order to get paid, and they have little confidence that the Department of Labor will help them get paid.

5. Finally, during these treatment delays you will probably sit around your house popping pain pills while getting madder and madder at your employer and the carrier until you eventually don’t care if you ever return to work.

Thus, abusive treatment of our medical providers has both reduced the number of doctors willing to treat injured workers and resulted in endless treatment delays. Those treatment delays are the reason why thousands of dollars in unnecessary off-work payments have to be made each month by employers and carriers.

It’s a mess — but don’t despair, there are ways to speed up treatment for injured workers:

» The Department of Labor should announce that medical provider abuse will not be tolerated.

» The Department of Labor should enforce existing rules that encourage treatment to proceed, and guarantee payment for medical providers when treatment plans aren’t denied in writing.

» Gov. Neil Abercrombie and the Legislature should support long-overdue proposals to require injured workers and carriers to "mutually cooperate" in the prompt selection of truly independent medical examiners, when needed. This mutual cooperation would promote trust between workers and carriers and speed up the review of treatment plans.

By following the existing rules and then passing the "mutual cooperation" bill, we can get workers healed faster, and that will lower workers comp costs.

Imagine a world in which we follow a few simple rules and mutually cooperate with each other in order to reduce costs to workers, employers and carriers.

Hey, that’s not a bad way to start 2011.

——

Joseph Zuiker has been an attorney for injured workers for 19 years in Hawaii.