First responders say workers comp failed them

Posted at 11:22 PM, May 10, 2016
and last updated 2016-05-12 10:37:10-04

Every day, first responders head out on emergency calls knowing they could be putting themselves in danger. They know they could be hurt on the job.

What many don’t know about are the dangers in store for them, if they are forced to turn to Michigan’s Workers Compensation System.

“I thought no matter what happens, they will take care of me,” said former Madison Heights Police Officer Jason Chaput.

In April 2011, Chaput was rushing to an armed robbery.

“A lady pulled out of the church right in front of my police car,” said Chaput.

He swerved to avoid hitting her, and then other cars.

"I lost control of the police car,” said Chaput.

As he sat in his car after the crash, he knew he was hurt. He had broken several ribs and felt a sudden, shearing pain in his back.

After the crash, he was told to contact an insurance company. Madison Heights self funded its workers compensation, meaning it provided coverage independently.  However, it paid an insurance company to administer benefits and make sure they are distributed properly under the law.

The insurance administrator sent him to a doctor. Chaput said the doctor said he was hurt and needed treatment. The insurance administrator denied coverage.

“I said, you’re overriding your own doctor? How is that possible?” said Chaput.

He says he believes the insurance company and Madison Heights started shopping for a denial diagnosis.

"They kept sending me to doctor after doctor, and the doctor said you’re hurt. And they kept putting me out on the road.”

Finally, two years later, surgery was approved. By then, Chaput says his spinal cord was permanently damaged.  Madison Heights retired him. 

He believes the delay in care ruined his career.

He is one of many who feel their lives have been destroyed, or even ended like one police officer Attorney Alex Berman tried to help.

“He was set to go into surgery. Then, the night before the operation he got a call.  The surgery was denied. His benefits were cut off. Shortly thereafter, he killed himself,” said Berman.

Attorney Berman says that officer is always on his mind as he takes on workers compensation cases. He now is representing former Detroit EMS worker Tim Carr.

“We wanted to help people,” said Carr of why he became a paramedic.

He too suffered a permanent spinal cord injury on the job and said he had to fight to finally get treatment.

Berman said time and time again treatments are unreasonably denied. It sometimes has serious consequences.  There is no punishment for the insurance company. Workers cannot sue if an unreasonable denial hurts their health.

7 Action News reached out to the insurance companies involved in these cases. They both said they were simply hired to administer workers compensation benefits in these cases, not provide insurance.

"We are the Third Party Administrator responsible for handling claims in accordance with the  self-insurance regulations and statues, as well as the conditions in place between the claimant and the self-insured entity and the governing statues and regulations,” said a statement from York Risk Services, which is used by the city of Detroit. "We are committed to handling every claim professionally, ethically and fairly.  In all cases, it is our policy to respect the privacy of our customers and claimants and not discuss the specifics of individual claims.”

A spokesperson for the City of Detroit said due to privacy laws and pending litigation it could not provide  comment.

Changes in ownership made it hard to get a statement from the insurance administrator for Madison Heights, but the current owner deferred to the city for comment.

Madison Heights City Manager Ben Myers released a statement saying:

The City of Madison Heights provides employees with Worker’s Compensation Benefits as set forth under Michigan Law. The act serves as the exclusive remedy for providing employees with benefits for an on the job injury.  Due to an injury that occurred while on duty, Officer Chaput applied for and received Worker’s Compensation benefits. Applications for benefits are subject to an administrative review process.  This process is subject to certain administrative requirements including review by licensed medical providers.  During the claim review process, the City continued to provide Officer Chaput with health insurance benefits.

Ironically, as 7 Action News worked on this story, the state released information on a study.

The Workers Compensation Research Institute looked at 18 states. It found that Michigan’s average cost per claim was the lowest of the 18 states surveyed. The state said this report is evidence that  Michigan’s workers’ compensation system gives the state a competitive economic advantage in attracting new employers, while still ensuring the protection of injured workers.

"Those dollar savings are real dollars that employers can put back into their businesses,” said Mark Long, the Director of the Workers Compensation Agency in Michigan.

"In late 2011, Governor Snyder signed sweeping legislation reforming the state's workers' compensation system. These improvements included defining disability and post-injury earning capacity, and have played an underlying role in the reduction of costs for our employers. The changes brought certainty to Michigan’s work comp system, ensuring the protection of Michiganders injured on the job and has helped put them back to work,” said a press release from the MI Department of Licensing and Regulatory Affairs.

Attorneys for injured employees say that legislation may have decreased costs, but it also decreased benefits and rights for those injured at work.

The injured have to wait longer to go to a doctor of their choice. There are more reasons to deny coverage. Plus, the insurance company can send them to a vocational specialist to determine their earnings potential, and based on that their benefits.

Permanently injured, with no college degree, such a specialist said Tim Carr should be able to make almost $20/ hour. As a result his benefit was cut to $19 a week. He says he can’t find work.

"It feels very disrespectful and a slap in the face to serve this city (Detroit) and do the things I have done, to be treated like this,” said Carr.

He and Officer Chaput have heard insurance companies and the state say that workers always have the right to sue for the benefits they are owed. They say that isn’t enough.They want to see the law changed to allow compensation for workers hurt, because insurance companies unreasonably or fraudulently deny claims.

“It is legalized fraud,” said Chaput.