Page 27


lost-time day, thus charging the worker rather than the company for the lost day. Another way the company prevents losttime, Pilgrim’s employees contend, is by forcing workers to work while injured, or sending them to company doctors who tell them there is no injury and that they must return to work. Many times, workers allege, the company doesn’t report the injury to workers’ comp and doesn’t inform employees of their rights. People who advise workers of their rights, as Arrondo does, find they are no longer welcome in the Pilgrim’s Pride system. THE FIRST STOP for most injured workers is the nurses station, where they might get a pain reliever or balm such as Advil or Ben Gay, Arrondo said. “The worker will say, ‘I’m not getting better this way’ and Pilgrim’s will send them to certain company doctors. And those doctors will tell them there’s nothing wrong, give them pain medication, and send them back to work.” If the worker begins to complain, Arrondo said, they will very often get fired. Juana Martinez, a 31-year-old mother of five small children, had several injuries, Arrondo said. “She had a door fall on the back of her neckone of those big plant doors it fell on the back of her neck. She also injured her right wrist. For two years she had to use only her left hand to work, because the right was injured. In this particular case, I diagnosed [carpal tunnel syndrome] and Pilgrim’s started paying for it. This was early on. They paid for a couple other visits, then they stopped paying. I sent her to Dr. [Mark] Race, a specialist in Tyler, for an EMG [electromyogram], which was positive for carpal tunnel. Once it gets to carpal tunnel, they will very likely have to have surgery.” At that point, said Arrondo, the insurance adjustor said Martinez wasn’t injured, there was “no injury.” “The insurance companies and the loss-control department at Pilgrim’s are working together,” Arrondo said. “Then the insurance company and the TWCC determination officers, as far as I’m concerned, are working together to rubberstamp these claims.” Emil Cerullo is an administrator at Arlington South Orthopedic Clinic and a member of the Texas Orthopedic Business Administrators Association. He agrees with Arrondo and his description of the obstacles workers encounter is not unlike Arrondo’s. “A lot of this is just the Texas Workers’ Comp system and how crooked and how unfair it is for the worker,” Cerullo said. “The worker would become injured and then they would go to the company doctor,” Cerullo explained. “The company doctor will tell them they are okay, give them some medication and send them back to work.” Sometimes, said Curello, the injuries do heal themselves. In other cases, the injury is significant. “So now they go to the doctor for a month or two, they are told nothing is wrong. The patient starts to ask to see someone else.. Enter Dr. Arrondo, who decides, okay, I need to get some diagnostics done in order to prove pathology. At this point the insurance company can simply deny it without any medical reasoning. In other words, an adjuster can simply abort care against a doctor. So even if a doctor is sitting here saying [a patient] is experiencing pain, there is nothing to prevent that doctor from being stopped by a simple insurance adjuster with no medical training. There’s a flaw in the system.” The insurance company ordered Juana Martinez to see Dr. Barry Green in VALERIE FOWLER Texarkana for a second opinion. He diagnosed de Quervains, a form of tendonitis of the right wrist, gave her a zero-percent disability and stated that she had met her maximum medical improvementbefore her surgeryas of August 19, 1993, the date he examined her. “I wrote this man back,” Arrondo said. “I said I have positive EMGs and x-rays. The insurance company was supposed to give them to the doctor. He never got them, I guess. He sent this letter to the insurance company and their -attorney. He did not send the letter to me. I never received anything.” The letter Arrondo refers to, dated September 9, from Green to the Tyler law firm of Cowles & Thompson, attorneys for the insurance company, states that Arrondo sent reports confirming de Quervain’s, but also showed a magnetic resonance image with a “mild disc herniation” and a problem with Martinez’s right shoulder. “When I examined the individual she had no symptoms whatsoever of cervical or shoulder,” Green’s letter said. He suggested a re-evaluation. Upon re-evaluation, Green stated, “there is no basic change from my evaluation on August 19.” However, this time he gave her a 6percent bodily impairment rating and wrote “appropriate treatment has been given and the examinee is plateaued and is not likely to improve with future treatment. By definition she is at MMI as of August 19, 1993.” “It was his word against mine and Dr. Race’s,” Arrondo said. “The adjuster said she didn’t have anything. Who came up with the 6-percent bodily impairment? I certainly didn’t give it to her. I’m supposed to be her attending physician.” According to the workers’ compensation law, the attending physician determines the impairment rating, based on American Medical Association guidelines. If the carrier disagrees with the rating, it can request a patient evaluation from a doctor the carrier chooses. Once a patient reaches maxiassigned an impairment rating, she will receive 3 weeks of benefits for every percentage point of impairment. If a patient has 6percent impairment, she will receive 18 weeks of benefits at 70 percent of her weekly income. This can be paid in one lump sum and is considered compensation for the injury suffered. However, if the patient receives an impairment rating of 15 or above, she will be eligible for supplemental income benefits, which are intended to compensate for the difference between preinjury and post-injury earnings. “It’s a way to try to make you lose as little as possible,” said TWCC spokeswoman Linda McKee of Austin. “Those are paid to a maximum of 401 weeks total from temporary income benefits to supplemental income benefits. Temporary income benefits stop at 104 weeks. Anytime you are determined to have reached MMI, your temporary income benefits stop.” But to receive temporary income benefits, the patient must have missed at least eight days of work; otherwise the worker is “double-dipping.” The eight-day requirement, according to many critics, is a motivation for employers to keep employees on line and not to report lost time. “The MMI is very controversial,” said Cerullo, the orthopedic clinic administrator. “It gives the insurance company the ability to say to a patient ‘You are now MMI.’ They now cut off their benefits. So the patient has no money, no income, can’t work and is still injured.” The insurance company told Arrondo ndo that Green was right and Race, was wrong. The insurance company would not approve payment for carpal tunnel surgery, would not pay for Martinez’s medication, and would not allow her any impairment benefits. In November 1993a full year after Arrondo diagnosed carpal tunnel and requested a surgical releaseMartinez was evaluated by Dr. Bruce Hinkley, an Arling 8 AUGUST 5, 1994