Editorial: Clean-up

Comp system prepares to review PTDs to weed out fraud

The Register-Herald, September 28, 2005

On Sunday we told you about the Workers’ Comp system preparing for the switch from a state government agency to a private insurance operation. Again, we feel the system is heading towards a better day and hope that businesses will be accommodated to make payment of premiums as painless as possible.

There is another part of this picture, the really ugly part, which gives us just as much concern, if not more.

During last week’s State of the State Chamber address in Beckley, the matter of Permanent Total Disability awards was discussed at length.

For years, this part of the Workers’ Comp system has been abused without adequate oversight. There are so many questionable awards, in fact, that all PTD cases dating back to 1993 are going to be looked back into to see just how much fraud actually is taking place.

A Permanent Total Disability means just that, you can’t work. However, there are apparently some out there who are taking advantage of the system and the effort is now on to curb this on-going abuse. Andy Wessels, director of Corporate Affairs for Workers’ Comp, said that as of Aug. 31, there were 9,576 PTD claims being paid and that during the fiscal year which just ended on June 30, $168.8 million in medical bills and awards were paid out during the 12-month period.

While that number is down $14 million from the previous fiscal year, it’s still staggering if you think about it.

You also need to know this — West Virginia’s 9,500 plus PTDs far out-number any other comparable state. Nevada, which has a very similar population base, has approximately one-fourth the number of PTDs. Yes, the system is being beaten over the head with a club in our state.

A test case will be presented to the Supreme Court some time this fall and if successful, the Workers’ Comp program can move forward on reviewing all the PTD awards from the last 12 years with initial screenings at the commission and then subsequent medical examinations for those cases where red flags pop up.

Certainly, and Wessel acknowledged this, there are many deserving PTD recipients out there and they rightfully deserve their compensation. It is those who are draining the state’s pocket without being totally disabled who need to be held accountable.

Wessels said some may have benefits adjusted and reduced, and others, if their claims are found to be false, could well be prosecuted.

We believe the investigations should take place and those responsible for fraud should be prosecuted. It’s time to clean up the Workers’ Comp system on all fronts.