First responders share workers’ comp grievances with Fort Worth leaders
Fort Worth’s Public Safety Committee met Tuesday to address questions about the city’s workers’ compensation program, under the gaze of first responders who have had injury claims denied.
As previously reported, firefighters and police officers accuse the city of making it difficult for them to receive treatment after they’re hurt on the job. Records obtained by the Star-Telegram showed nearly all workers’ compensation claims that were denied over the past two years were filed by police or fire employees.
The claim denial rate for those departments was nearly 25%, higher than any other city department. A city spokesperson did not respond when asked why that denial rate was so high.
Fort Worth’s workers’ compensation program is administered by Sedgwick, which manages claims and approves medical care. The city has a list of medical providers to handle workplace injuries known as the Blackstone network. For the most part, injured city employees are restricted to Blackstone providers when seeking treatment.
Firefighter Skyler Ainesworth addressed Mayor Mattie Parker, City Manager Jay Chapa and the Public Safety Committee, which includes City Council members Charles Lauersdorf, Carlos Flores, Michael Crain, Mia Hall and Elizabeth Beck.
“We’re listening to Sedgwick too much,” Ainesworth told the committee. “Their business model exists to save money.”
Ainesworth, who serves on the board of the Fort Worth firefighters’ union, said first responders didn’t run into the same treatment roadblocks previously when they could work directly with the city’s human resources department to appeal denials. After the meeting, Ainesworth told the Star-Telegram that human resources now largely defers to Sedgwick’s decisions on denials instead of advocating for police and firefighters.
In particular, Ainesworth called out Fort Worth human resources director Kristen Smith while standing next to her at the podium during the committee meeting. When Smith told Ainesworth police and firefighters could call her to help with claim denials, Ainesworth told Smith her “batting average” wasn’t great when it came to helping first responders.
Ainesworth wants to see the City Council take a more active role in getting claims approved. He said the council is allowed to hear workers’ compensation grievances and can expedite care in cases where treatment has been denied or delayed.
Another point of contention, Ainesworth said, was the fact first responders are limited to Blackstone doctors. He and others have argued that police and firefighter injuries differ dramatically from other city employees’, and they should have more flexibility to seek out specialized care.
In one example, Ainesworth said an orthopedic surgeon who treats professional athletes was willing to treat Fort Worth first responders under the workers’ compensation program. But because he wasn’t willing to treat other city employees, the city wouldn’t contract with the surgeon, so firefighters and police can’t use him.
Speaking to the committee, Ainesworth said instead of cutting costs, treatment denials actually increase them. When injured firefighters and police are at home fighting to receive medical care, said Ainesworth, their positions are often backfilled by someone earning overtime pay. And Ainesworth threw cold water on the notion that firefighters are milking the workers’ compensation system.
“The worst thing for us is to leave us at home,” he said. “We hate it. We just want to get back to work.”
And while much of the blame for claims denials is placed on Sedgwick, Ainesworth said the city, which is self-insured, could make it easier for police and firefighters to obtain care.
Smith told the committee the city would issue a request for proposal for a workers’ compensation administrator this fiscal year. A city spokesperson said Sedgwick would be eligible to submit a proposal during the RFP period.
In an effort to improve things, the city is recruiting two senior human resources analysts who will help oversee police and fire injury claims. Smith said those analysts will act as trusted intermediaries to help employees navigate the sometimes-complicated workers’ compensation process. During the meeting, council member Beck said she wanted police and firefighters to have someone with the city whom they can call when they’re having trouble getting a claim approved.
Smith said her department was also working to improve collaboration between the city, medical providers and Sedgwick, and that the human resources department was listening to feedback from employees.