The 6% Solution

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Posted by John Lewis on February 16, 1999 at 19:32:34:

In Reply to: Legislative Alert!!!!!! posted by Merle Campbell on February 16, 1999 at 04:07:44:

Today in Salem:
Mgmt. Labor Advisory Committee (MLAC)has pending legislation which intensifies the business and insurance industry abilities to save more money when you are hurt on-the-job. Some of these are already past the Senate. They are:
213,220,221,222,223,288,284, 460 and 420(?).
Id tell you what they all are except they stink in general.
Write MLAC and simply state that any more "bills" or amendments that can be perceived as harmful to any injured worker's case should be TABLED until direct representation by injured workers is allowed in determining legislation.
C/O Bill Braly
350 Winter St. NE
Salem, OR 97310
This is insane. There are record profits and premium savings and yet the insurance industry feel they need more worker's blood. It's time to let up on "employees" and stop treating them like commodities. We're endangered already.
Hell, the salmon are getting a better shake in Oregon than we are.
Here's a no-brainer:
Today an MCO (Managed Care Organization) lobbyist named Jerry complained that primary physician medical reports carry too much weight in Workers Comp Administrative Decisions concerning MCO care. The facts?
A pie chart showing that out of 100% of the Workers Comp Decisions made by Administrative Judges 63% were dismised/withdrawn,14% are still pending,10% of the time the judge upheld the MCO's determination of denial to the worker and 12% of the time the judge decided for the worker.
Jerry argued that of that 12% of the time when the judge found in favor of the worker half the time (6%) it was because of the weight of the attending physician's report.
In other words, after you are hurt-on-the-job, treated like a dirtbag and can't ever get insurance from an MCO, your appeals to the state are either dismissed or dropped by you out of exhaustion/frustration or your attorney (63%),or your starve-out continues-oh wait, they now call that "pending" (14%), you do get to a hearing and still lose about half the time (10%) and now it seems that of the percentage of injured workers who actually get something they need i.e. a favorable decision(12%), they want half (6%) of them denied anyway because any designated primary physician who, in good conscience, would write a medical opinion in favor of a worker is clearly in cahoots with the worker and should be rejected as a biased-dirtbag helper. (Dont ever forget that getting injured is like winning Powerball.)And the evidence from the MCO/IME/Company Doctor is not unbiased?!?!
The 6% Solution means DOUBLE the money for MCO's.

Don't ever make me try to explain this again.

This is the sort of thing that goes on now in Salem. They filleted the fish(YOU) but now their surgical knives are out to get the eyeballs and the brains out. If YOU are injured you need to take charge! Come to Salem, write letters, fax legislators, call the media but GET INVOLVED.

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