North Dakota’s workers’ compensation law is relatively tightfisted in paying claims from workers whose job injuries can be blamed on previous hurts and natural body aging, a consultant says.
The state’s Workforce Safety and Insurance (WSI) agency has become more aggressive in the past two years in checking whether a work injury is attributable to degenerative conditions that may not be job-related, consultant Maddy Bowling told the Legislature’s Audit and Fiscal Review Committee on October 20..
“In their process of doing that, they identified more claims that were denied, as well as it increased the amount of time that was required (to decide a claim), because the employee and the doctor were given more time in order to respond,” Bowling said.
In 2006, it took an average of 26.9 days for a claim to be denied. The following year, the average increased to 28.8 days, the report says.
For accepted claims, the average number of days it took to make a decision rose from 11.9 days in 2006 to 13.9 days in 2007.
Berry, Dunn, McNeil & Parker, an accounting and consulting firm that is based in Portland, Maine, looked at WSI’s claims denials as part of a more wide-ranging examination of selected aspects of the agency’s operations.
Bowling said BDMP randomly picked 100 denied claims from 2006 and 2007 for scrutiny, and found no evidence of benefit denials that violated state law or WSI policy.
“There were no inappropriate claim handling processes, no inappropriate denials,” she said.
North Dakota law is “extremely conservative” in allowing claims denials if a work injury may be traced to an employee’s existing medical problem, she said.
She suggested that WSI assemble a study group, which would include agency officials and representatives for injured workers and businesses, to research how other states handle similar compensation problems.
“It is going to become a bigger issue in our industry, because we are all getting older,” she said.
North Dakota law says in part that workers compensation benefits may be denied if a job injury is “attributable to a pre-existing injury, disease, or other condition, including when the employment acts as a trigger to produce symptoms in the pre-existing injury, disease or other condition, unless the employment substantially accelerates its progression or substantially worsens its severity.”
Rep. Frank Wald, R-Dickinson, said he believed the report reflected well on North Dakota’s workers’ compensation operations.
Wald is an insurance agent, and he said he has heard frequent praise for the state’s workers’ compensation system from contractors that move into North Dakota for oil industry work.
“North Dakota should not be ashamed of what we’re doing,” Wald said. “Yes, there’s room for improvement, and maybe we ought to relax the pre-existing conditions … but, by and large, I think we do a good job.”