Michigan forces businesses to spend millions of dollars every year on workers' compensation insurance to protect their employees should they be hurt on the job.
But does the insurance really protect workers? Or, under current law, does it empower insurance companies to fight people with legitimate claims in their time of need?
"I loved my job. I was a truck driver, something different every day," said Mark Marusza, who now knows the Workers Compensation System firsthand.
His boss at Detroit Intermodal Transportation says he was an ideal employee. Then, he was in an accident about five years ago while on the clock. He broke numerous bones and suffered a neck and brain injury.
"If they saw a dog get hit, they would probably pick it up and take it to the vet. Not me," said Mark.
First, he struggled to get neck surgery. His attorney says it took two years to get the insurance company to approve the operation. While he waited, he was in excruciating pain.
Now, he continues to struggle to get the insurance company to cover treatments prescribed for his traumatic head injury. Multiple doctors have diagnosed him with the injury, observing memory impairment, confusion, and irrational agitation. How can the insurance company deny coverage?
Workers' comp insurance companies have the right to send you to what they call Independent Medical Examiners. Mark's attorney says the name is misleading.They are anything but independent.
"They are what we call whores. Whore doctors. Who make $300,000 to $700,000. Paid by the insurance company," said Marshall Lasser, Mark's attorney.
Lasser says two out of three insurance company specialists examined Mark during a short visit and diagnosed him with no brain injury.
"When we got the report back, I am like 'you got to be kidding,'" said Nancy Gucwa, Mark's wife. "I can’t believe a doctor would say this. This isn't a doctor."
Not long after that finding, the insurance company stopped paying for a medication that eased agitation caused by his brain injury. Mark couldn't afford it.
He lost control one morning after his wife made breakfast. He was confused and became agitated. He wrongfully accused Nancy of putting onions in his omelet. He grabbed a gun and threatened to kill her and her teenage daughter.
After a police standoff ended peacefully, Mark was hospitalized. Doctors said his brain injury caused his irrational outrage.
"This is just the tip of the ice berg," said Lasser. "This is one out of hundreds and thousands of stories each year in Michigan."
Marshall Lasser is suing, accusing the Blue Cross Blue Shield's Accident Fund of working with doctors to fraudulently deny claims. He says the law bans patients from investigating such frauds in court. He can't through discovery find out about communication between the doctor and the insurance company. Independent Medical Examiners are protected from malpractice claims.
Lasser says the state forces employers to buy workers' compensation insurance. Laws should make sure doctors diagnose honestly.
7 Action News reached out to the state agency that oversees workers compensation. The Department of Licensing and Regulatory Affairs says it isn’t its job to make sure doctors are credible.The state relies on the various boards that license doctors.
An attorney for one IME doctor says the accountability is in the court system. Mark’s case will eventually be decided by a judge. But is that enough? Mark’s attorney points out he has already suffered for years - denied care.
"If you steal a candy bar from the store you are going to go to jail, but if an insurance company and their doctor allies steal doctors from injured people - nothing happens in Michigan," said Lasser.
The Accident Fund Insurance company offered this statement:
“AF Group is committed to providing workers’ compensation benefits in a fair and lawful manner and we take allegations of wrongful administration of the Workers’ Compensation Act very seriously. We believe our actions were justified and in compliance with the law and since this case is currently in litigation, we cannot offer further specific comment.”
