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WSI is correcting 10 percent of reviewed cases

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WSI is correcting 10 percent of reviewed cases
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BISMARCK -- About 10 percent of injured workers who asked Workforce Safety and Insurance to review their cases are getting additional aid, an agency lawyer says.


Tim Wahlin, WSI's chief of injury services, said payments range from $40 for mileage that should have been paid to a few major reversals resulting in tens of thousands of dollars in retroactive benefits previously denied.

Wahlin told the WSI board last week total retroactive benefits paid out in the review should not cost WSI's fund more than $2 million, though that estimate is "a complete guess."

About 270 North Dakotans have taken advantage of the opportunity to have their closed cases reviewed since the process began Jan. 1. Rep. George Keiser, R-Bismarck suggested the review last fall, as controversy at WSI reached a crescendo. An internal auditor had claimed that WSI had a "dirty little secret"--going out of its way to deny claims. She has since been fired.

WSI is the state workers' compensation agency.

Wahlin said, "I know we've reviewed in excess of about 120 so far," and hopes all can be finished by late August. A few new cases come in each week and workers have until June 30 to seek review.

"When this process concludes, we'll have a pretty good breakdown on the numbers," Wahlin said this week.

Cases in which workers have seen additional benefits:

-A worker not reimbursed for mileage after traveling out of town for a WSI-approved doctor's appointment.

-Workers not evaluated or paid for permanent partial impairment who should have been.

-Major cases in which someone's claim had been ruled not work-related, and, during the current reviews, "We've flat-out reverse it."

The largest awards are for claimants who lost time from work due to injuries and were denied wage replacement.

"The rule of thumb is a time-lost claim now costs us $50,000," Wahlin said. "Any one of those we reverse, it's going to be around $50,000. It's real money to somebody. It's meaningful."

He knows of two major reversals so far, and there are another two or three more that will probably be reversed in favor of the workers once the review team receives confirming information from doctors or other experts.

Wahlin said the cases with major reversals involved tough decisions from the beginning, such as workers with claims for arthritis, carpal tunnel syndrome or back problems, and in which it wasn't clear whether it was work-related.

Most old decisions, though they may seem unfair to the worker, are found to have been made exactly as state law dictates, he said.

If reviewers find someone is owed money, there's little delay, Wahlin said. "These checks are cut as the determination is made."

A final report on the reviews will go to Keiser's Workers' Compensation Review Committee. Wahlin and Keiser said there may be proposed changes in state laws as a result.

Keiser said he looks forward to the report, saying two injured workers advocates, Sebald Vetter and Ed Christensen, both of Bismarck, told him the agency has wrongly handled large numbers of cases.

"Ed, primarily, said he knows of 300 situations where (workers) had been improperly denied," Keiser said.

Christensen said that's not true.

"I know I never said 300 people. I said a ton," he said Wednesday.

Vetter doesn't trust the re-review and says others don't either. Workers with bad WSI experiences are just "sick and tired of it. So they wouldn't bother," he said. "It's phony what they're trying to do. It's election year (tactics)."

Keiser himself said that fewer than 300 review requests "suggests there may be some people who are so tired of it they didn't come forward, or people are pessimistic."

Correcting even one wrong decision is important, he said. "If there's 10 percent or 5 percent or 1 percent, they should be adjusted."

Janell Cole works for Forum Communications Co., which owns The Dickinson Press.