Joel Ramirez climbs back into his wheelchair with the help of Francisco Guardado, a home health aide, at his home in Rialto, Calif. Ramirez was paralyzed from the waist down in 2009 when a 900-pound crate fell on him at a warehouse. Changes to California workers' compensation laws have impacted his quality of care.
Workers injured on the job are supposed to get guaranteed medical care and money to live on. Employers and their insurance companies pay for that. And in return, employers don't get sued for workplace accidents. But this "grand bargain," as it's called, in workers' compensation, seems to be unraveling. NPRand ProPublica report on the changes to workers' compensation laws and how that's putting more of the costs back onto the families and government.
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Some call it a grand bargain in the American workplace - if you're injured on the job, you're supposed to get guaranteed medical care and money to live on. Employers and their insurance companies pay for that and in return employers don't get sued for workplace accidents. But this grand bargain, the system of workers' compensation, seems to be unraveling. That's according to an investigation we've been hearing about this week from ProPublica and NPR's Howard Berkes.
HOWARD BERKES, BYLINE: Before we get to the investigation, we'll meet somebody who says he's suffered because of changes in California's workers' compensation system. And some of what you're about to hear may be disturbing.
JOEL RAMIREZ: Come here, Bella, come here.
(SOUNDBITE OF DOGS BARKING)
BERKES: In Rialto, Calif., three miniature poodles fight as they vie to lick the stubbled cheeks and chin of 48-year-old Joel Ramirez. He lies on a couch, striped black workout pants covering his paralyzed legs. It's been a long day, with a three-hour round-trip drive to a pain specialist.
J. RAMIREZ: I'm lucky today that I'm - I don't have dirty diaper right now because I'm lucky that I didn't have an accident today.
BERKES: Ramirez hasn't been able to control his bowels since he was crushed and paralyzed in a warehouse in 2009. Travelers, his employer's workers' compensation insurance company, agreed to provide 24-hour home health aides, among other care. The aides help Ramirez move safely from his wheelchair to his couch and bed. And they clean Ramirez after accidents. But in 2013, a new California workers' comp law made it possible to reopen older, approved treatment plans. Travelers took away the aides. With his wife at work and away at times and his daughter at school, Ramirez says these accidents left him sitting in his own feces as much as eight hours.
J. RAMIREZ: There was my mom here, but she's 75 years old. Oh, my God, I was trying to clean up. My God, I couldn't finish cleaning. And I said I can't even do it right now. How am I going to do it when I get older? Those moment is when - makes you think to die before that happens.
BERKES: His wife, Lupita, quit working to help at home and his daughter dropped out of college to help support the family. But there were still accidents when they were away shopping, picking up prescriptions, trying to get some sleep and getting away from the round-the-clock stress of caring for a paraplegic. Ramirez's weekly workers' comp disability payments wouldn't pay for even one day of home health care, so the family was stuck - Lupita Ramirez.
LUPITA RAMIREZ: When he's walking before, he's very, very strong man. Even myself, I can't imagine when I saw him like this, it just destroyed my soul, you know?
BERKES: Travelers insists it did not use the new law to withdraw the aides. But a workers' comp judge and a state appeals board said otherwise in ordering the company to restore 24-hour care. They wrote that Travelers used a separate request for care to modify his treatment and take away the aides. Ramirez went without them for four months.
J. RAMIREZ: It's so embarrassing to talk about these things, but we have to.
BERKES: In state after state, injured workers say they've been harmed by changes in workers' comp laws. ProPublica spent nearly a year reviewing a decade of reforms in every state, finding 33 states with cuts in benefits or new rules making it more difficult to qualify. In Florida, payments plunged 65 percent in the last 20 years for workers left permanently and totally disabled. In California, West Virginia, North Dakota and Oklahoma, workers disabled temporarily lose payments after two years, even if they need more time and treatment to get back to work. And also in Oklahoma, a sharp cut in those temporary support checks left 30-year-old John Coffell unable to make rent, utility and car payments and keep his family of five together.
JOHN COFFELL: We do live paycheck to paycheck. We have our budget set and anything that offsets that budget is going to hurt us severely.
BERKES: Coffell suffered a debilitating back injury in a tire plant last year, just after a new workers' comp law slashed the maximum weekly payments designed to support workers while they're off the job and getting treatment. Under the old law, Coffell would've been close to his actual pay. Under the new law, his income plummeted to under $600 a week, says his wife, Justine.
JUSTINE COFFELL: As soon as he got hurt, it was like - we went from being in a house with the kids and being a happy family to everything just falling apart in one swift motion. I mean, it really felt like somebody just shook everything in our lives and scattered it all over the place.
BERKES: Lawmakers in Oklahoma say they haven't encountered horror stories like this, but could consider tweaking the law if they do. They say they were trying to fix a system steeped in litigation, which delayed treatment for workers and drove up costs for employers, especially when compared to neighboring states. Fred Morgan heads the state chamber of commerce.
FRED MORGAN: Arkansas is a great example. They were in the top 10 lowest premiums for employers in the country. We were in the top 10 highest cost states. So we found we were losing manufacturing plants to Arkansas.
BERKES: This is a common theme across the country, where many workers' comp changes are pushed by business interests and Republican lawmakers and governors. But California's reforms emerge from a Democratic governor and legislature and a coalition of corporations and unions, including Angie Wei of the California Labor Federation.
ANGIE WEI: You know, the cost of health insurance and the cost of workers' comp kills our economy, kills any growth potential for workers overall. And so until we can figure out how we control the cost of health care and workers' comp, it's going to constrain how much we can return to workers.
BERKES: Wei hadn't heard about Joel Ramirez or cases in which insurance companies seem to use the new law to deny treatment they already agreed to provide. Wei helped craft the new law with Sean McNally, an oilfield services executive who says a California overhaul was desperately needed.
SEAN MCNALLY: This was intended to be a simple, no-fault system that was quick in, quick out, get people back to work. And it's like "Alice In Wonderland." It's like stepping through the looking glass. It was a system that was just out of control and incredibly expensive.
BERKES: So far, California's $8 billion workers' comp system is still the nation's most expensive for employers. But nationwide, despite the complaints about cost, businesses are paying the lowest workers' comp premiums since the 1970s. And insurance companies are making money. Profits for workers' comp policies hit 18 percent two years ago. So guess who's bearing the burden of diminished benefits in addition to injured workers? Taxpayers because injured workers are forced to resort to food stamps, Medicare, Medicaid or Social Security disability. Howard Berkes, NPR News.