"Get Mine" in Ohio

At first the injury claim filed with the Ohio Bureau of Workmen's Compensation by Irving Zilbert seemed routine. Zilbert had injured his neck and back while working on a Cleveland home-remodeling job. The bureau found him 50% disabled, and awarded him the lump sum of $5,600. Next case.

Then investigators learned more about Irving Zilbert. He had died of a heart attack six months before his award check was cashed. Jerry's Home Improvement Co., Zilbert's purported employer, was nowhere to be found; its address turned out to be that of a vacant barber shop. In early August, with the discovery of other false claims, Zilbert's physician, his lawyer, three other doctors, another lawyer and 14 other people were indicted for defrauding the state of Ohio of a total of $65,000. It was only one of several cases to emerge in a mushrooming scandal involving Ohio's workmen's compensation system, which, with assets of $1.5 billion, is the largest such program in which the state is the sole insurer. More than 1,000 suspect claims and scores of bogus companies are currently under scrutiny. The total cost of Ohio's Watergate, as a state investigator called it, to employers that support the workmen's comp system could reach into the millions.

Like most comp systems in the 49 other states that have them, the Ohio program is mandatory for any firm that has at least one employee; all told, 235,000 Ohio businesses contribute semiannual premiums totaling $306.5 million a year to the fund. In turn, the fund dispenses fat benefits--up to $186 a week for life for someone who is totally disabled, for example--with a minimum of controls. There is no statutory limit on medical fees, and only a bleary-eyed staff of nine medical-claims examiners to process 4,000 files daily. About 95% of all claims are paid without a hearing, and those bearing the certifications of a doctor and an employer are given scant scrutiny before they are paid and interred in a medieval record-keeping system bulging with 5-c- million case files. Concedes Robert Farmer, the bureau's claims director: "We're the biggest casualty insurance company in the world, but you can almost write your name backward and get a claim. It's ripe for rip-off."

How true. The probe of the Ohio comp system began last summer, when the Cleveland Plain Dealer disclosed that Gregory Stebbins, the since ousted chairman of the state industrial commission that oversees the program, had approved a $20,000 payment to a claimant who used the money in a real estate deal that yielded Stebbins $7,445. Subsequent investigations by local prosecutors and the state legislature began to turn up a variety of abuses, including payments of wildly inflated medical bills (one clinic charged $52 for removing a speck from a worker's eye) and the likelihood that dozens of dummy firms had been set up purely to help substantiate phony claims. A lawyer under investigation for one such scheme in Cleveland shot himself to death. State probers found that thousands of dollars had been disbursed on the signatures of commissioners long since dead; that a Republican candidate for state treasurer had campaigned by walking more than 1,000 miles across Ohio after collecting benefits for a bad back; that an unduly high percentage of the comp system's own employees (there are about 900 in all) had sent in claims. One lawyer, working out of a van, pocketed fees totaling $172,623 in six months for shepherding claims through the comp machinery.

National Standards. Ohio Governor James Rhodes has given the state's industrial commission authority to hire as many fraud investigators as it needs to clear up the scandal, and a reform bill that would provide for the greater policing of claims should become law by year's end. But officials concede that a thorough cleanup will be difficult. Says Farmer: "It's easy for the 'get mine' attitude to flourish. When Joe down the block collects for his bad back, picking up a piece of lettuce, others are going to try it too."

Unfortunately, Ohio and other states with workmen's comp troubles --Michigan is one--will have to fix matters without help from Washington. A bill that would set national standards for comp systems pops up periodically in the Senate Labor and Public Welfare Committee, and it died again this year; the anti-Big Government politics of 1976 do not encourage new federal intervention in state business. In 1972 the National Commission on State Workmen's Compensation Laws recommended 19 significant reforms, including the expansion of workmen's comp to include all industries, and set a 1975 deadline for states to comply voluntarily. The record so far: no state has complied fully (New Hampshire has come nearest) and many are not even close.

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