Workforce Safety and Insurance-Working or Failing North Dakotans?

Its intended purpose is to care for injured workers and a top priority is to help the injured become healthy and return to work. 


But some say North Dakota's Workforce Safety and Insurance is failing to live up to those promises.
 
For injured worker Gary Sanders, even simple tasks like putting on socks and shoes are no longer simple. Sanders inured his back and shoulder in a workplace accident nearly four years ago.


"It's hard on you mentally. It's hard on you physically. It's hard on your family life," says Sanders, who formerly worked as a pad foreman. 

Now Sanders relies on his wife to help with the everyday things.


"It just breaks my heart. It breaks my heart so badly to see him this way," says Ty Pham-Sanders, Gary Sanders' wife. 

And while the physical injuries have taken their toll, the emotional toll has been just as painful.


"I've never seen him like this. This is the worst I've ever seen him when I'm with him 22 years," says Pham-Sanders. 

Sanders contacted North Dakota's Workforce Safety and Insurance, the state's insurance agency for workers compensation, shortly after he was injured. But a surgery recommended by Sanders' doctor was denied by WSI. 

Earlier this year, the pain became too much.Sanders stopped working altogether and finally began to receive benefits. But just as soon as he began receiving them, the benefits stopped.


"What's happening right now is not right. It shouldn't happen to anybody," says Sanders. 

Sanders appealed the decision and won....sort of. Benefits for the back injury were reinstated. But WSI continued to deny benefits for Sander's shoulder injury, stating it was the result of a pre-existing condition. 

KX News found that Sanders isn't alone. People from Montana to Texas who were injured while working in North Dakota told KX News about denials and delays when it came to medical treatments and workers benefits.

We reached out to WSI multiple times for this story. The agency initially told us it would require Sanders to sign a release form in order to speak with us. But when WSI received that form, the organization informed us Sanders has a pending hearing and its policy is to avoid commenting on pending cases. The agency said it would speak with us once the hearing was over.

Since Sanders originally filed his claim back in 2014, KX News requested an on-camera interview with WSI to discuss general operational procedure instead. That request was also denied.


"There's not sure and certain relief as is promised in the law," says Marvin Nelson, state representative for Rolette County. 


Nelson is among those lobbying to change how WSI operates.


"There has been a concerted effort both nationally and in this state to make sure workers don't have sure and certain relief because it's expensive," says Nelson. 


But in many other states there are options. North Dakota is one of only four states on the country considered a monopolistic state, meaning WSI is the exclusive provider for workforce insurance. 
Nelson and others are working on a legislative measure that would provide for better oversight of the state agency and expanded coverage for workers. 


"People end up injured, disabled, without benefits. Unemployable, it just puts their families in a terrible situation." says Nelson. 


Families like the Sanders who now takes things one day at a time. 


"It's not going to happen over night. But changes have to be made. Otherwise, there's going to be a lot more people suffering," says Sanders. 


But by sharing their story, the Sanders hope that one day the fight for workers compensation won't have to be a fight at all. 


Though WSI denied requests for an on-camera interview, the agency did respond to questions via e-mail.


According to the agency's data, WSI had a 91% claim approval rate for fiscal year 2017. That approval rate includes partially approved claims such as Sanders.

When doctors have differing opinions, WSI sometimes uses providers to conduct what are known as independent medical evaluations.


The State Auditor's Office did a performance evaluation of WSI in 2014. That audit showed that providers doing these independent evaluations found in favor of WSI over the injured worker's treating physician at a much higher rate than in other states with which it was compared. 


Another performance evaluation of WSI is scheduled for next year. 

Sanders has started a Facebook page to connect with other individuals injured on the job. You can reach him at Broken in the Bakken


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