Troubled Workers' Comp System Criticized in Audit

Article excerpt

Byline: Associated Press

SPRINGFIELD -- Illinois' troubled system for compensating injured state workers hands out money too readily, sometimes without medical evidence to back up a claim and occasionally paying benefits the hurt employee didn't even seek, according to an audit released Wednesday.

Auditor General William Holland suggested lawmakers follow up last year's overhaul of the workers' compensation system with further improvements in a report that found information about the process "incomplete, inaccurate, and inconsistent."

State workers claiming injury at work received $295 million on more than 26,000 claims from 2007 through 2010, the report found.

Holland's report found overworked claims adjusters assigned to review claims carrying caseloads several times larger than is practical and negotiating settlements with workers' lawyers, a job the attorney general should do.

Files on some claims paid were missing medical evidence for the injury. Arbitrators deciding contested cases had no guidelines for deciding compensation and issued wildly inconsistent awards for the same injuries. Some had conflicts of interest in the cases they presided over.

"We identified numerous shortcomings in both the structure and operations of the workers' compensation program" for state employees, Holland wrote. "These problems have led to a program that is ill-designed to protect the state's best interests."

Illinois budgets money for state workers' on-the-job injuries, paying in various cases medical bills, compensation for missed work during recovery, and permanent disability. The state's personnel agency, the Department of Central Management Services, finds the majority of claims legitimate and pays them. When the state contests a claim, it goes before an arbitrator for the Workers' Compensation Commission.

Those cases are either settled with an arbitrator's approval or the arbitrator decides on an award after a hearing.

The General Assembly ordered Holland's audit last spring as it prepared to reform the system because of rising costs and Belleville News-Democrat reports about outsized payouts at one prison, arbitrators who received their own injury payments or had questionable professional conduct, and other problems. …