00:10:11 - 05:10:11
Jerrod Bailey 00:04
Welcome, everybody to reimagining healthcare new dialogue with risk and patient safety leaders presented by Medplace. We're excited to bring you conversations with top risk and patient safety thought leaders from organizations around the country. Please subscribe to get the latest news and content and if you value this episode, please share it with your colleagues create meaningful dialogues in your own community if you're interested in participating as a guest, email us at speakers at Medplace.com. Today, I'm joined by Robert Wasniewski that I get that right it did perfect. Hey, in Arizona certified workers compensation attorney. So welcome. So let me give a little bit of your background and feel free to answer embellishments to this. Yeah. So Bob is an active member of the legal community actively writing and lecturing in all aspects of Workers Compensation Law. He's an active member of the State Bar of Arizona association of Trial Lawyers of America, workers Injury Law and advocacy group. That's why LG, Arizona association of lawyers for injured workers it's the a li W. Association of Trial Lawyers of America and Arizona Association for Justice. It's a lot of groups, a
Bob Wisniewski 01:14
lot of abbreviations, but basically, we represent injured workers across the state of Arizona and doing that for many, many years. Where we have the at least the responsibility of representing severely injured workers. My colleague Javier and I. We do hundreds of cases hundreds of hearings. I think I probably have participated in more workers compensation hearings probably on social media, we teach we lecture we've been expert witnesses from time to time, but our primary focus is the hurt on the job called up so we've been doing that for a long time. And representing severely injured workers in in every county in Arizona, our courts used to travel circuit and they don't circuit anymore because of technology and zoom and things of that nature. All of our hearings emanate out of Phoenix or Tucson where the judges are located but the hearings are done by a Google hundreds of miles away yeah or even in other states were before that presented a logistical and financial difficulty for our clients that have an expert witness where their treating doctor in Missouri you are not going to Arizona so we're just chilling. We bring our clients to our office and we have a we call it a Zoom Room all set up for them to testify because we recognize they may not have adequate electronics if they're using an iPhone and their testified all we're saying is generally the top of their heads we say welcome if you don't have adequate electronics then we would like you to come to our facility and do it there and everybody's pretty good. It started in more industrialized states in New York. Other eastern states that came here as part of the last state to be in the Union remains the mainland union. It's part of our. The process of worker's comp is to avoid having a civil lawsuit In the workplace, if I leave up my briefcase on the floor and my secretary trips over it, that becomes a workers compensation claim. If it hadn't been that she could sue me in civil. And we don't want those kinds of conflicts in the workplace. So that's how it started. There's, it's an easy process, we are a little bit more electronic now on our Industrial Commission, you can file a claim by going on azica.gov. For Arizona Industrial Commission, government, file it right on online, which is a remarkable change. And we encourage people to do that almost every day that we speak to. And then there's a three, they get their claim accepted in writing, and there's a three stages of workers comp there is where you are totally disabled, getting medical care, then maybe one that we know is lightwork. We've modified work where you go back to work to some level, and you get a check from your employer for your wages. And then the insurance company figures out what the difference is for your workers compensation. And then the last stage is a permanent disability either total or partial. We have two kinds of disability essentially, in Arizona, one is called scheduled, and that's like arms and legs, and it comes out of a book. That's why it's called the schedule, and the other one is unscheduled. And those are typically multiple schedule injuries, back injury, that's the best way to describe that. So the process is an administrative court. And it's meant not to involve litigation. But unfortunately, the system has become somewhat litigious over the years just because of the volume of people the volume of claims. involved with insurance companies. We have self insurance, like the power companies and things like that are large enough to be insured, and it's their own money and not an insurance company. So that's the process.
Jerrod Bailey 06:55
Okay, great. So I've got some questions here. And we'll see. And we'll just kind of move through some of these. But we can we can just get away from as much as we want. But what kind of kind of trends. So that was a good foundation, sure what sort of trends are happening in the industry that now you know, that foundation, like what kinds of things we're listening for looking at? Well, some
Bob Wisniewski 07:17
of the things that make it a little more difficult on both sides of the equation is the fact that everybody is remote. The insurance adjusters are typically working remotely. So the insurance lawyers we call them the defense lawyers and they have a hard time even reaching their client because they're on a different time. We do a lot of litigation in our state compared to other states, other states are surprised that we litigate at almost every step in a worker's compensation Lab, which is difficult. For example, Kansas has a an adjunct position that says, Look, if you don't believe this guy get hurt at work. And they're disputing what we call compatibility. you file a request for hearing, that hearing will happen within 30 to 45 days, and they'll get a decision in 30 to 45 days. That's remarkable so that within three months, you know whether you're going to be covered for medical care and some indemnities money or not. Yep, in our system that could take months, maybe even a year. Wow. Which is unfortunate.
Jerrod Bailey 09:28
Do you see TCM changing? Is there anything on the horizon? Is that being pushed? You know,
Bob Wisniewski 09:34
one of the part that I that makes it difficult is that sometimes when the insurance adjuster turns the file over to their defense lawyer, they forget about the file. So our lawyer has it. So we can't touch it anymore. And I lecture to insurance adjuster and say don't do that. You're losing control of the file. You just some of the defense lawyers, just keep the file calling and going because they're billing the insurance company for the time They're working on the case it's great. division between what is a big case and a small case, which we treat in our system, a big case the same as a small case that would be the same as a very severe back injury, my thought would be, maybe we can parse that out to a judge that could get involved early and say, well, this isn't a, this is a $5,000 case interest, rather than a 25, or 50,000 or $100,000. Case. But everything gets in the same track at the same time, and it goes on forever.
Jerrod Bailey 11:27
So we need the ideas, we had a better triage system, maybe that's a good way to put it might be able to handle these things a little bit more efficiently. Right.
Bob Wisniewski 11:36
And I'm not so sure that the system as it's set up now permits that it could or should, if we had some gateway, look at it early on midea, an early intervention of a judge with maybe a pre hearing conference saying, Well, what is this case about is the same run of the mill your doctor against my doctor, in the gentleman's off for a short period of time, let's get it resolved. We have some of that facility aside, we really don't have a very good process on the industrial side for that. Oh, you
Jerrod Bailey 12:08
think everybody's motivated to see something in place? That makes us a little
Bob Wisniewski 12:13
bit? Well it's it's, it's an institution, the Industrial Commission, and all the stakeholders, we have self insurance. We have insurance companies, we have doctors involved with therapist, Bob, it's, it's to move. It's like trying to turn a battleship sometimes. Yeah,
Jerrod Bailey 12:31
no kidding. Well an Arizona is pretty active. Right? From what I understand from ORKESTAR perspective, we are, don't we lead the country in a couple of metrics here,
Bob Wisniewski 12:45
you know, I saw that information and what your office sent over it. And I don't know that statistically. But that wouldn't surprise me. For example, my colleagues in Florida say, and that's a large state going, you go to that many hearings a year, we mediate, we mediate, we get everything done by mediation, we do not do religion. What's the resolution before you go to a football hearing? This the hearings take time. Usually, it's the applicant, the injured worker who's testifying at the first hearing. The second hearing, which may be months later, will be his treating physician that he's going to relate the complaint, the condition, the diagnosis to the work, activity, the facts. And then another month or so they'll be the defense doctor who says, Oh, he had all that before it's not related. Or it's not as bad as he thinks it is. That process can take a minimum on a good day. Three to six months. Yeah. So that's, that's too slow. Wow.
Jerrod Bailey 14:09
So, so interesting. I do want to just dig into Arizona. I'm not sure what other states have with the compares to us. Industry wise, we have a large services based industry here. We have a huge construction industry here. Do we have the industry makeup? That's also going to give us a bit of more of a higher profile for work comp stuff? Or is it really just other types of things? Not really, that well streets?
Bob Wisniewski 14:38
I think construction is the primary source of labor and construction as the primary source of Workers Compensation injuries. The repetitive injury from like an assembly line, we don't see too many of those. We're not a factory oriented, huge trade union. But when it comes time to have him testify, and before it was just over the telephone, we did telephone now you have telephone and digital video. He can't put he can't be a teacher, he can't portray it and explain it to the judge and explain why his opinion might be better than the other side's opinion. So we're looking for physicians that are regular people that can break it down, that have good rapport with the patient, and able to elicit from the patient, the information that makes the claim. Yeah, that person's consistent. Yeah, that person's a good story. Yeah, that person's been a reliable patient of mine for all these years or months, I've asked them about their problem. Yeah, that's what we're looking for.
And there's a handful of doctors on each side that can do that. It's the ones that are just maybe starting in the business who'd like to do workers comp, sometimes they need to be educated. Yeah, and because I think. Blue Collar At best, they have their own perceptions from the internet about well, what they want, prove and gee, the Boston take me to the hospital, he wasn't a nice guy, we have to say, look, we got to get past that we're here to prove that you got hurt at work, and you have this condition, and you need medical care for that. He wasn't a nice guy, you got to forget that. So we have to try to set him up. This is what we're going to identify, we're going to move to the conclusion. And you've got to kind of ride the wave with us rather than what you think is important from your friends, your family or the internet.
Yeah, that's difficult on all phases, because they've seen the internet, they know that oh, well, the medical. And we have to say, No, my job is to control our expectations. This system only provides this and this. It doesn't provide extensive lost opportunity money for a lost opportunity of job, or things that you would get in a personal injury system. I say, look, workers, cops, Walmart, not Nordstrom. You know, it's not the fancy stuff. And they don't want to get that because they've seen all the ads on TV from the Personal Injury Lawyer as well. We'll get you a million dollars for this and we'll get you there. So we'll get to that. Those are all consequential damages from a horrible accident. And worker's comp, we pay for the medical bills. I made a mistake once saying bills and everybody says oh, here's my mortgage. And then we paid for time off and some permanent impairment money. So it's it is a very limited system. And sometimes we have to control our own clients expectations throughout the case, to say look That's, that's not much good again, and we're hopefully we're successful. Yeah, calling him that. But sometimes, every day, there's something new. So I'm gonna throw me a ringer. And I'll say, Oh, well, what you must have stayed up all night thinking about that. Yeah, not gonna get that. Yeah,
Jerrod Bailey 20:13
you know, it's, that's, that's really helpful. It's a very different expectation setting, right, a worker's comp.
Bob Wisniewski 20:20
Everybody knows the $9 million, the guy from McDonald's by spilling the coffee on his groin, brain, we don't do that.
Jerrod Bailey 20:27
Right. Right, right. You know, a lot of our audience are doctors who, in nurses who are looking for us supplemental or alternative income to what they're doing clinically, right. And they're all around the country in our platform, doing other things to, to do that. And a lot of them ask about independent medical exams, and whether it's something they should get into, they really know how to get into it. They don't have the requirements to do it. You gave us some already, just like, what they're sort of starting skill set that they need. Just curious if you have any other advice for reps thinking about it,
Bob Wisniewski 21:04
I think they just need to be honest. Yeah, because they are called independent medical examinations. And you know, some doctors won't give you anything, they have their script, and this is what they're going to say. And they're always going to get the same thing, and perhaps on both sides. But if you're truly independent, and truly able to articulate your findings, and explain those, I think they'll get a fair amount of business from perhaps one insurance company, or self insured, or a nurse that's managing the claim. And the adjusters talk. Yeah, and they'll say I had Dr. So and so he was just really good at explaining that foot injury. Maybe you should try. And when no one is looking for an advocate on each side, either side. But sometimes that's what the doctor degenerates into that become an adolescent. And then we can either side can see through Well, I could write that report before you see the doctor or like, or they could write my doctor's report, if it's one of those that tends to say the same over
Jerrod Bailey 22:05
and over. So a doctor that's looking good into space, or has been in space a while should self reflect and look back at all the exams they've done, and have they you know, they've been very one sided thing,
Bob Wisniewski 22:18
and then maybe talk to someone who actually is doing in his specialty area, an independent exam practice, who was the competitor may not want you to learn how to do it from him. But I think some of the doctors are cooperative. And I hear from each side that gee, it's we're getting to the point that we need more doctors on each side, because people are retiring, or doing something different and where they don't want to do this. You can be rigorous at times.
Jerrod Bailey 22:47
Well, sometimes what keeps doctors away from it is they may have done at once. And it was a lot of overhead you mentioned before the time and the back and forth and getting records in a banker's box shipped to their office and things like that can turn a lot of doctors off. So the traditional way of doing also has come with some overhead sometimes some people out where we're trying to address that imperfect technology through technology. But I mean still the need is the doctors who can be impersonal if you teach right
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