Robert Ceniceros of Business Insurance has written an informative article about some of the barriers to ensuring that illegal workers who are injured at work obtain the medical care they need. Language barriers, poor housing conditions, false addresses and IDs, and suspicions create problems, according to care managers.
Illegal workers pose comp care challenges
By Robert Ceniceros
Cultural, administrative issues test case workers
Guiding illegal immigrants injured on the job to appropriate medical care requires workers compensation case managers and claims handlers to take on the role of social worker, detective and translator.
Even delivering indemnity checks often presents additional challenges when injured workers reside in the country illegally, the claims and case managers say.
Still, experts say, comp claims for illegal immigrants must be managed effectively to ensure that treatment is delivered before medical conditions worsen and drive up claims costs, and before attorneys become involved.
Claims managers say they face numerous hurdles when they try to contact illegal immigrants injured at work. Fraudulent Social Security numbers are common, home addresses are wrong, and the workers and their families often are distrustful and unwilling to provide necessary information, fearing immigration authorities may become involved.
Laws in most states, however, mandate that illegal immigrants injured on the job receive the same care and benefits as legal workers.
One common challenge, say nurse case managers who specialize in helping catastrophically injured workers, occurs when assisting undocumented workers return home from a hospital stay.
“You are trying to work on discharge to a particular address and it doesn’t exist or it’s not the address they are actually living at,” said Marlys Severson, president of SCM Associates Inc. and a network manager for Paradigm Management Services L.L.C., a Concord, Calif.-based catastrophic case management company.
“It makes it really tough to try to pull everything together to make for a smooth transition and good medical care,” Ms. Severson said.
Impoverished living conditions can make returning patients home medically impossible, said Mary Hawkins, a bilingual catastrophic nurse case manager in Atlanta for Intracorp, a unit of Philadelphia-based unit of CIGNA Corp.
“If they have been living 12 (people) to an apartment, sleeping in shifts on the floor, you can’t send someone home with an infection and an open wound,” she said. “You can’t send someone home who is a new paraplegic (under those conditions.) You can’t send someone home who is an amputee.”
Catastrophic nurse case managers’ responsibilities include visiting the residences of injured workers to verify their home accommodations will be safe for recuperation after leaving treatment.
“I’ve had instances where I’ve gone to the house and there are 15 to 20 people who happen to be living with no furniture and you have an injured worker who’s laying on the floor on a blanket,” Ms. Severson said. And the workers don’t have access to social resources available to legal workers.
Living conditions may impede healing and require medical case managers to spend more time educating patients about caring for themselves, said Adolfo Arsuaga, branch manager in Reston, Va., for the Hispanic Resource Center, a unit of Genex Services Inc., a disability management company.
“They do require a little bit more handholding,” Mr. Adolfo said.
Providing illegal immigrants with disability payments can present challenges because they don’t have appropriate documentation to open a checking account, he said.
In some cases where injured workers’ accommodation is not appropriate for their medical condition, insurers pay to rent a new apartment. But finding one can be difficult because some apartment owners demand proof that the injured worker is in the country legally, case managers say.
“Half the time you end up literally having to put them in a hotel room (with accommodations for disabled guests) month after month because they can’t sign a lease,” Ms. Hawkins said.
Workers comp insurers say they do not ask whether someone is undocumented and claim forms don’t require such information. But case managers and claims managers say there are several clues.
The use of multiple Social Security numbers for a single claimant is one tipoff for claims examiners, said Darrell Brown, workers comp practice lead for Sedgwick Claims Management Services Inc. in Long Beach, Calif.
Others agree that multiple Social Security numbers are common.
“We have seen undocumented workers having multiple (Social Security numbers). One for the job, one for the third-party administrator, and one for the health care facility,” said Thomas Newman, marketing analyst in Nashville, Tenn. for Alternative Service Concepts L.L.C., a claims management company.
Establishing addresses also can prove challenging for case managers. Financial instability often forces undocumented workers to move frequently. Or they provide false addresses because of their fear of immigration authorities.
Illegal immigrants change telephone numbers frequently, or they may not have a telephone, so case managers visit their homes more regularly to ensure they follow through with treatment.
“There (are) a lot of scenarios involved, but it just makes it really difficult for (health care) coordination (and) getting them to and from their therapy, being able to get them to and from their doctor’s appointments, being able to provide them adequate care,” said Ms. Severson.
The additional hurdles to providing care to illegal immigrants increases the likelihood that their medical outcomes will not be as successful, claims managers say.
Sometimes the outcomes are heart-wrenching, nurse case managers said.
One worker returned home to Mexico rather than stay in the United States and undergo surgeries that could have restored the sight he lost in one eye, Ms. Severson said.
Distrust and a desire to return home when injured is common, she added. Some undocumented immigrants fear that flying across state lines to medical centers of excellence could expose them to immigration officials so they choose to forgo the specialized care, Ms. Severson said.
Ultimately, resolving claims filed by illegal immigrants requires that claims examiners and others build a trusting relationship with them, said Kimberly George, vp and managed care practice lead for Sedgwick in Chicago.
But earning trust and building a relationship can take “a lot more time, energy, effort and teamwork in order to provide good care for them,” Ms. Hawkins said.
“You have to be an investigator, a social worker, a spiritual adviser, a medical coordinator and a translator,” said Ms. Hawkins of Intracorp. “You have to speak English, Spanish and medical.”