By VIC SPROUSE
CHARLESTON -- Paul Nyden recently had a article in the Sunday Gazette-Mail about how Sedgewick (the folks handling the Old Fund Workers' Comp claims) is denying some Workers' Comp recipients disability benefits.
What's the big deal?
Actually, I would be MORE shocked if they weren't checking claimants to insure that they are in fact still disabled? Somehow Paul has made Sedgewick out to be criminals because…
get this ...
they are checking to see if people receiving comp checks are ...
get this ...
Crazy Sedegwick. They are handling all the claims from the old comp fund. And, shame on them for actually making sure that people claiming to be on comp are disabled.
OK, a little history.
When I first came to the Legislature, I entered into the session of 1995 which will forever be known as the "Bloody Ax" session.
This was the session where the first major comp changes were made. I vividly remember it because there must have been 2,000 union fellas (no exaggeration) descend upon the Capital. Now, I don't know if you've been there, but imagine the entire East Wing and Rotunda area SO full of people that you literally couldn't walk through. That was how many people came down to protest the changes to Workers' Comp.
Because Workers' Comp had devolved into this retirement program instead of what it should actually be -- a wage replacement for those injured on the job.
You get injured on the job. You can't work. You get Workers' Comp to replace your wages.
Sounds simple enough.
Only, with liberal Supreme Court after liberal Supreme Court, the system was in bankruptcy, the state couldn't pay its bills, doctors wouldn't take comp patients, businesses wouldn't even dream of coming here once they saw the sky high rates of Comp. We were literally 17 1/2 times more likely than any other state to award permanent total disability awards. 17 1/2 times more.
I mean, the system was so crooked that if you lost your job and couldn't find a similar job at a similar wage withing 50 miles -- you got Comp for life.
And, what had happened was that Comp had become a lifestyle in many communities.
We made the first baby step changes to that in 1995. Because of those changes that were passed overwhelmingly in a mostly pro-Labor Legislature (much more so than today, in fact), the unions vowed to defeat everyone who voted for the changes.
They defeated a grand total of ONE legislator.
So, pre-1995, Comp was a free-for-all.
After the system was changed in 1995 and then again with another sweeping change in 2003 after my filibuster (another whole post), our Comp system actually is getting to a point where they just don't give every Tom, Dick and Mary a permanent total award without first even checking whether or not they are injured.
Sedgewick is now in charge of those old claims.
And, they thankfully are checking these award recipients to determine whether or not they are STILL permanently disabled.
Nyden pulls out two examples of people who may or may not be completely disabled. Sedgewick says based on their charts and records, they are not. Their lawyers and the recipients say they are still disabled.
Nyden even tells of how mean ol' Sedgewick repo'd the lady's wheelchair that they were paying for…
Of course, the whole repo story stuck me as odd. The lady said she came home and found a receipt for the wheelchair that had been repossessed. I have this terrible trait of skepticism in me that just causes me to ask questions.
Where was the wheelchair when it was taken? I mean, did Sedgewick break into the home and take the wheelchair? Where was the lady at the time they took it? If she wasn't there, where in the world was she that she didn't need a wheelchair? It just struck me as an odd part to the story. I mean, repo'ing a wheelchair isn't like a car. A repo person can simply pull up with a tow truck, hook up your car and take it away without you ever knowing. But, a wheelchair? Someone has to open up the door to the repo man and turn over the wheelchair. It strikes me as unlikely that anyone who knows this lady would simply just say "OK here's the chair."
But, let's say they did. Well, it's not like this lady and the teacher who they profiled are out of luck. They have a right to go to the Office of Judges and have them make a determination of whether or not they are permanently disabled. Obviously, the doctors for the state feel these two should not be considered permanently disabled any longer. They believe they are.
Again, I'm not sure what the problem is. If you feel Sedgewick is wrong, then go to the Office of Judges and get your benefits.
Nyden went to great lengths to profile a teacher who won Teacher of the Year who was injured and now has been denied disability. I'm not sure if Nyden was basically saying that this dude was SO good, that they should just give him Comp and never ask questions again. He was denied therapy, etc. and says he needs it to reduce the pain from his disability that was caused by a fall at the school.
OK, he will have a chance to show that his disability requires it at a hearing before the Office of Judges.
Again, we should be happy that someone is finally looking at these old claims and determining if people who have been receiving Comp for 20 years are still really disabled.
I guess the shock waves that these two cases have caused is that someone if ACTUALLY checking on disability recipients?
Sedgewick has a duty to the State of West Virginia to administer these claims. Administering them doesn't mean rubber stamping everyone one. It means looking at each case and determining whether or not disability payments should or should not be made.
That's their job. We should be thanking them for it.
And, if they have made a mistake in these two cases, that will be proved out before the Office of Judges. Just the way the Legislature intended.
Sprouse is the former Minority Leader of the West Virginia Senate and currently owns a consulting company in Charleston.