Fort Worth workers’ comp a system of ‘red tape’

Like most in law enforcement, Fort Worth police officer Jody Boday knew that it was a matter of when — not if — she would get injured on the job.

But when she started with the Fort Worth Police Department as a rookie in 2005, the job was worth the risk.

“When I first got on, I thought the world of the city. I was just so proud to have made it through the academy and just to be a police officer,” Boday said.

The first time she was injured — tearing her anterior cruciate ligament from the bone during an on-foot pursuit in 2007 and tearing a ligament in her shoulder — the city’s third-party workers’ compensation administrator got her the needed surgeries with little fuss.

Jody Boday, a Fort Worth police officer injured in the line of duty in 2012, talks about her struggles dealing with CorVel, the city’s third party workers compensation group.

That company, Contract Claims Services, was replaced with CorVel Enterprise Comp in January 2013, months after Boday’s second major injury — a fractured collarbone, torn meniscus in her knee and vertebrae misalignment in her neck from jumping a fence on another on-foot pursuit.

Two attorneys, denial after denial of claims, being spied on and videoed by a private investigator, winning a court hearing at the state level and 21/2 years of pain and inactivity later, Boday finally got the needed surgery in January to fix her spine.

“Being in a situation like I am now, I never ever thought of that,” Boday said. “You never think you are not going to get fixed and that you have to go through so much garbage just to get close to where you were before.”

“People probably wouldn’t even treat animals like that. If there is a hurt animal, you take them to the vet and get them fixed. We are humans.”

Boday is not alone in her battle to get care, said Rick Van Houten, president of the Fort Worth Police Officers Association and Jim Tate, president of the Fort Worth Professional Firefighters.

“We’ve had problems with CorVel ever since they came on board,” Tate said. “It has just been constant denials of things that seem obvious.”

City employees have expressed concerns about CorVel for some time, said Brian Dickerson, the city human resources director.

“Since the day I got here, police and fire have been talking to me — ‘Brian there are issues here, there are issues here.’ And I don’t disagree,” Dickerson said.

In a statement, the company said that it “puts people first” and that as a third-party administrator, CorVel does not have a financial interest in whether claims are granted or denied. CorVel does not get financial incentives for cost containment.

Still, criticism of CorVel are getting widespread attention since Mayor Betsy Price blasted it last month for directing “inflammatory questions” to the family of a shot police officer. She also called for an audit of the company’s handling of cases.

Creating a bureaucracy

Many of the criticisms — delayed treatment, denying therapies and surgeries. and requiring extensive documentation — are common problems in a state-regulated workers’ compensation system that is full of “red tape,” Dickerson said.

“Workers’ comp in the state of Texas is an attempt to balance making sure the employee gets the care they need, and ensuring that unnecessary procedures or fraud or things like that don’t happen, either. So what you end up doing is creating a bureaucracy,” Dickerson said.

All that red tape doesn’t frustrate just patients, but doctors as well, with 59 percent of physicians surveyed by the Texas Medical Association in 2014 refusing to see patients being treated under workers’ compensation.

In the same survey, doctors who did accept workers’ compensation patients said the system led to poor care, especially because of delayed treatment.

For Boday, the delay in getting the needed surgery on her neck will mean a longer recovery, because nerves in the spinal cord were constantly pinched together for more than two years.

“There was a judgment call made in the very beginning of her injury that the neck was not a part of the injury,” Dickerson said. “Obviously, because in the end she won, that was not a good decision. Those are judgment calls and we get input from the third-party administrator.”

Dickerson said that 27 out of 1,095 medical and indemnity claims in 2014 ended up going to contested case hearings. However, some officers end up going through their own, personal insurance to get treatment because of the hassle and lengthy process, like officer John Bell.

Bell, a 33-year police veteran who was shot five times by a gang member, had one of his own doctors recommend that he hire an attorney to get the treatment he needed.

Bell lost the sight in his right eye after one of the bullets from the January 2013 shooting hit him in the face. Another bullet, aimed for his groin, meant he had to have a complete hip replacement. He also lost the middle finger of his left hand, and a bullet hit him in the shoulder.

Despite pictures from Bell’s time in the intensive-care unit clearly depicting a hole in his shoulder, CorVel denied treatment of his shoulder injury because Bell did not immediately complain about shoulder pain, he said.

“Since I did not complain about pain early on, then that bullet had nothing to do with the pain now. … The pain may not be from the bullet, but they didn’t even want to check it,” Bell said.

Now, days out from retirement, instead of fighting the system, Bell said he will wait to have his personal insurance work on his shoulder. He did retain a lawyer to contest his score on his maximum medical improvement exam, which he said was completed before he finished treatments.

In the statement, CorVel said it uses peer-to-peer clinical reviewers to resolve disputes over care, and those physicians follow standardized national treatment guidelines for the specific injury being treated.

But Bell said those national guidelines don’t take into account specifics of each situation. For example, when he lost his finger, pieces of the bullet also blasted through his hand and caused nerve damage. Despite his suffering from carpal tunnel syndrome now, CorVel denied continued treatment for his hand.

‘Inflammatory questions’

Sgt. Shane Drake, a 19-year Fort Worth police veteran, was shot in the abdomen in January as he and another officer responded to a woman’s 911 call for help with her son.

Price said the workers’ comp representative showed up at the hospital the morning after the shooting and directed “inflammatory questions” to the family, officers and the hospital staff.

In emails obtained by the Star-Telegram through an open-records request, officer Joseph Hill, on the peer support team, said the nurse case manager who came to handle the case was “unprofessional and insensitive.”

According to his statement, she asked questions like “Did he have his vest on. If he did, how did get … ?” (Some words and phrases were omitted because they deal with medical or personal information about Drake).

Drake’s next-of-kin was visibly upset, according to the report, and said: “It hasn’t even been 24 hours yet. This is all too fresh and I can’t deal with those questions.”

According to the statement, two women from the hospital’s administration asked the nurse to leave for not following hospital protocol, and security was notified and told to escort the nurse from the property if she returned.

Price then demanded the audit of CorVel’s cases with the city, and she demanded that a written apology be issued to the family.

CorVel maintains that the nurse acted professionally, though it has issued an apology for any misunderstandings and assigned a new nurse case manager.

“We are confident that the nurse’s intentions were good and her primary purpose was to provide assistance to the wounded officer and his family, as she had done previously for several other seriously injured members of the city’s workforce,” the company said in a statement.

Auditing CorVel

Dickerson said a comprehensive audit examining the past three years of CorVel’s work should be completed by mid-March.

The audit, conducted by McGriff, Seibels & Williams, a healthcare and workers’ compensation consulting company, will include:

▪ Comparing the number of claims, pre-authorizations granted and the denials against the state averages.

▪ A review of CorVel’s internal procedures and controls, followed by a survey of a sample of city employees who have had case management.

▪ A review of denials of claims and the appropriateness of those denials.

▪ A look at the “textbook” cases brought to the attention of city officials by members of the general employees and the police and fire associations.

▪ An analysis of complaints received about CorVel.

Of the 2,948 claims managed by CorVel since 2013, the company said it is aware of only nine complaints related to denial of recommended services and 14 cases that went to litigation.

Dickerson said the city also plans to issue a request for proposals for a third-party administrator, because CorVel’s contract is up in December. Handling the job in house is an option.

Cost containment will be a priority, Dickerson said. The city spent $10.6 million on workers’ comp claims in 2014, down $1.7 million from fiscal 2012. Costs are expected to go up to $18 million in the next five years, Dickerson said.

Still, those costs don’t include lost employment, such as losing Boday as a full-duty officer since May 2012. She likely won’t be able to return to active duty until this summer, three years after she was injured.

Getting healed

For Boday, who has not been able to do the activities she loves — like mountain biking, going for runs or going to work — getting healed has been her top priority.

And it should have been the city’s, too, she said. She hopes the audit will result in changes in how claims are handled.

“This definitely is something that has been really, honestly one of the biggest trials of my entire life. I’ve had two solid years that have been dark and gloomy in dealing with this. But it happens for a reason, and I want to stay optimistic that it happens for the good.

“I don’t want this time of misery to be wasted. I want this time of misery to make a difference in getting someone else help.”

Caty Hirst, 817-390-7984

Twitter: @catyhirst

http://www.star-telegram.com/news/local/community/fort-worth/article10925195.html