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This topic originally started in [livejournal.com profile] dakotamoon's journal, which was probably a little unfair. The comments very nearly had nothing to do with her original entry.

There is no doubt that we live in some difficult times as far as our health coverage is concerned. The price of health care is climbing while the ability of wages to cover health care is dwindling. As a manager of a small business, [9 employees] I am painfully aware of the difference between what we can do and what our associates need.



Recently we contacted a physicians group to see what we could do about a group rate. We almost qualified, but there was one sticking point. They require that 75% of our qualified associates be members. That's fine. Those who were insured by other means, spousal insurance plans, military, whatever, were not counted as those who qualified. That left us with about 4 or 5 people who were qualified.

The sticking point was this; the remaining associates needed to work at least 30 hours a week. If they didn't work then they needed to claim their vacation or sick leave. If any of the 75% fell under the 30 hour mark then the insurance kicked out and we'd have to re-up.
We have what's called Paid Time Off. That's a combination of sick leave and vacation leave in one. It's up to each individual employee to manage their PTO. An entry level person can earn up to 12 days in the first year. We have also been very lenient in letting people take time off without using their PTO, or if they've used up their PTO letting them take time off anyway. That happens a lot as people use up their PTO to make up for late days and such. That means more often then not someone works under that 30 hour mark. In order for this insurance to work the company would have to become extremely hard-nosed with attendance and vacations. "You want two weeks off, but you only have one week of PTO left. That's a problem with the insurance group."

That was enough of a sticking point where we couldn't sign on with the insurance program.

But what of L&I? This was the topic that came up on [livejournal.com profile] dakotamoon's journal. We've had a couple of people in our 45 year history make claims to L&I for injuries that didn't happen on the job, or were questionable. Please note here that in my opinion we have an incredible group of people working for us right now. When someone makes an L&I claim they fill out paperwork with the physician. Often it's not a physician but the one under the physician[I don't know the title] who examines and files the paperwork.

The paperwork gets mailed to the L&I office and to us. We have to fill out our portion and describe where the injury happened, why it happened, who it was reported to, what we're doing to correct the condition that caused the injury, and if we protest the claim. Sometimes the paperwork arrives describing the injury[in bad script] as Cz~p-l t^zl/te-=itz>. In the case of repetitive motion claims we can simply describe what the tasks are and let L&I make the decision. We've had inspectors and State consultants show up at our door. All of whom go away saying we go above and beyond what we need to do to minimize these problems.

Here's the catch; the L&I money has to come from somewhere. It comes from the businesses paying into L&I taxes, a sort of business insurance. The amount we pay is based on what industry we're in and our claim history. The more claims there are the higher your rate goes. That's why I get on a soap box when someone says just file an L&I claim when an injury has nothing to do with the company your working for.

If you're unsure whether an injury is work related, then by all means file. The worst that could happen is that you'll get turned down. Getting turned down is not a reprimand. If you have a pre-existing problem then bring it to someone's attention. There are ways to minimize difficulties. We've minimized back problems by raising a Costco table using $1.50 worth of PVC pipe.

I'll get off my soap box now.
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