In The Stench of Fraud: Why Workers’ Comp Can No Longer Be a Closed System, I briefly mentioned the plight of one individual, who I called “Ms. X”.
I called her that because her case is still winding through the medico-legal system in her state, and I do not want to prejudice her case, or add to her woes by embarrassing her, even though she herself is bringing light to her situation by using all resources available to her,
But I felt that once I mentioned her in my previous post, it was alright to expound on the subject of fraud, and discuss her case without identifying her personally.
According to her own words to me [bracketed below] and in her correspondence to others, this is how her nightmare began:
I am an injured worker who was maimed by the medical providers in the insurance carrier’s network of medical providers. Mine is a long story that began December 12, 2011 when I was hurt at work.
[A herniated lumbar disk from working in a sitting position in excess of 65 hours one week and during that week, picking up boxes of banking and files from time to time. I began to feel discomfort in my lower back, went home, took it easy over the weekend, went back to work on Monday, worked for approx. an hour or hour and a half, got up, went to the copy machine, made my copies, bent over to pick them up and then that is when the disk herniated.]
On the day that I was hurt at work, the human resources manager told me that she was going to call the insurance carrier to find out what to do or where to send me. When she returned, she wanted me to sign a “release letter”. I had just gotten that job on November 16, 2011. I got the message that someone there didn’t want me to file a WC claim by virtue of the effort to induce me to sign a release letter. I needed that job and hoped that my back would feel better. I didn’t sign a release letter but I did write a letter indicating that I was hurt at the copier but that I didn’t want to go to their Doctors. I asked if I could go home. At some point, the HR manager gave me a couple of Advil and water for the pain. I had gone home from there – Monday, 12/12/2011. By Thursday, 12/15/2011, my back did not improve, so I placed a call into the HR Mgr. and said that I need to see their Doctors… the HR Mgr. responded by saying something to the effect “Why, you don’t have any money to go to your own Doctor?” (Not verbatim). I was taken aback by this. She knew I was hurt at work. She continued by saying, “We have a release letter signed by you!”. I responded by saying something to the effect that I never signed a release letter. We argued… and so on.
She goes on to say in her correspondence that:
…former employer who fired me less than 3 months after I filed a WC injury. On the very day that I filed a WC claim, my employer placed an ad on Craigslist to replace me. I didn’t learn until sometime in May 2012 that my former employer lied to the insurance carrier about the circumstances of my injury and what I had said. For the record, I was hurt at work and due to the working conditions and surroundings, including my desk and number of hours that I had to work, 65-66 hours the previous week. Our office had very little storage, therefore, myself and the other Escrow Officer, had to pack up boxes of files for closings and banking. We lifted these boxes weekly and sometimes daily due to the lack of space.
Because of what has happened to me, I have been upfront with Doctors outside of the workers comp system. At one of the Doctors, a pain management Doctor that I went to see in early 2014 – March or so, one of the female investigators that I had seen near my apartment on prior occasions (or was her twin) showed up and was placed inside a room before I was, I arrived first, was placed inside the room next to her. During that visit to the Doctor after being placed in the room next to the investigator, the receptionist from the front desk asked me several times if I did recreational drugs and had I ever done recreational drugs. Clearly, a continued effort to create a negative review of me and/or my history. Another Doctor who I visited to get a referral to an orthopedic Doctor insisted that what I describe does not happen. She said that there are no instances in the US of a person being forced under anesthesia. Further, she said that I was delusional and that I should see a psychiatrist, and that the pain that I have is psychologically driven and not real pain.
She was given three epidurals, and this is what happened to her after the first epidural, which went without incident:
I was forced under anesthesia for simple lumbar epidurals. At the 2nd epidural procedure, after objecting to anesthesia, I was told I had no choice, that it was the policy of the surgery center (_____ ___ Outpatient Surgery Center) that all patients must undergo anesthesia. I awakened from that with severe neck pain and slight left arm pain. My Doctor had injected my neck, left side of my spine, left leg with some sort of chemical that tingled and popped like Alka Seltzer. In fact, the tingling went from my lower left lumbar down my left leg all the way up my back and felt like a popping sensation in my head. I was there to receive a lumbar steroid epidural injection and “trigger point shots” in the left side lumbar area.
The next epidural procedure, I made it clear I that I did not want to be placed under anesthesia not only on the phone (a day prior to the procedure) but also before the procedure in pre-op and I re-stated the same in the operating room for everyone to hear. I restated that I was to get a local pain blocker (just as I had during the first lumbar epidural). Instead, my Doctor abruptly shoved the needle into my back without any pain blocker whatsoever. I could feel the needle going through the textures of my back (not precisely or with care into the spinal area where the disk is). My head flew up as I screamed “Wait!” or “Stop!”. He would not relent! As my head hit the operating room table (where a towel and prop to lay my head was), he moved the needle inside me to the nerve in my back next to my spine and held it against the nerve! The pain was so excruciating that I bit into the towel that was for my head to rest on and screamed with the towel in my mouth. Pure agony! He would not stop! I had no choice once again but to give into anesthesia. When I awakened, I thought to myself, Oh my God, they didn’t! I had injuries now throughout my back, neck, shoulders and arm. I could feel the nerves firing all over my back and next to both sides of my spine from the injections of some sort of chemical (the Alka Seltzer feeling again) that over the coming months, burned and corroded the ligaments in my spine, tendons and muscles in my back. It felt as though I was being burned from the inside out. PAIN from burning, PAIN from damage and maiming! I can now and then could feel that some of the tissue/muscles were pushed away from my spine creating the feeling of divots or holes on both sides of my spine. I could feel what seemed to be a muscle pushed away and hanging down on to the right mid side of my person. The ligaments that are in my neck and run up into my skull feel damaged, sore. My spine felt “chiseled” in specific areas most prominently in the top of my back and neck and the bottom near the lumbar sacrum area. I now have instability in my spinal column. I can feel the vertebrae in my spinal column moving not in sync with the other vertebrae…
There is a lot more detail to her case that is beyond the scope of this blog to address, but I am sure my readers have gotten a clear idea of what she has gone through. As a former Claims Examiner and Claims Administrator for a wrap-up insurance program, I have never seen, nor heard of such abuse inflicted upon an injured worker.
This poor woman, who was just doing her job, was taken advantage of by a broken, corrupt and dysfunctional workers’ compensation system that makes the injured worker seem like the guilty party, when it is the providers and legal system who are guilty of injuring and maiming the worker.
To illustrate just how they are characterizing this woman, here is another part of her correspondence regarding an attempt to make her out to have a psychological problem:
The insurance carrier and/or it’s attorneys are working hard to impair my credibility. Several attempts to have me include a psych claim ,since I finally realized that I was being maimed, have been made. Even the AME has placed a notation in his last report that is false – saying that I have ongoing psychological “???”. For the record, I haven’t any history of psych issues. This is a lie that is meant to bode well in favor of the defense. I have never before had a psychological condition. I did mark on a form that I was depressed but that was due to the pain! Not anything else.
In my insurance career, I came across another poor soul who suffered from depression due to the pain he suffered as a result of his injury. At the time, I was the No-Fault Claims Supervisor of the NY office of an automobile insurance company that insured Black Car limousines (Owner and Owner and Another). A Coptic Christian gentleman from Egypt cried in my office before he was seen by our medical consultant. Recognizing that my job was to limit the amount of money we paid to this individual, I did speak to our consultant just prior to the examination. It was the least I could do for this person. So reading what Ms. X has written does not surprize me in the least.
A letter Ms. X forwarded to me from a defense attorney even stated that her epidurals were harming her and not helping. This letter was part of a plan to get her to settle for a few thousand dollars. The lawyer’s text is as follows:
Additionally, the applicant appears to not be benefitting from the treatment, in fact, the treatment by both the employer’s physician and your physician [addressing claimant’s former attorney] appears to be harming rather than helping the applicant.
She also stated in her correspondence that she discovered that:
…some of my medical forms, surgery reports, paperwork had been falsified, changed over and above my signature and due to the anesthesia form (copy handed to me) was marked differently than the first page that I signed and more.
Finally, to make matters worse, she received a letter from a law firm representing her workers’ comp primary physician, demanding her to cease and desist from making false and libelous statements on the internet about their client. From what I understand, this is the physician who the defense attorney said above was harming her. It is no wonder that by mistreating Ms. X this workers’ comp doctor prompted her to take the actions she did to warn people about his conduct.
As I mentioned in the last post on this subject, Ms, X would have been homeless if it was not for her sister. She was subsequently fired from her job as a Manager of her department by her employer after filing the workers’ comp claim.
The events and actions discussed by Ms. X and disclosed here by me, further elaborates just how much the stench of fraud and abuse in the system has become unbearable. These words that I have quoted are but a small part of the whole story Ms. X has told people about, but it is clear that there is something rotten in the state of CA, if not in the state of Denmark, paraphrasing Shakespeare. And we all know that when something is rotten, the stench is overpowering.
Yet, the medico-legal system is arrayed against Ms. X, and the end result, I am afraid will be that she loses, and her work comp settlement will be liened against by the primary physician’s attorney, or the case will be decided in the insurer/employer’s favor, and Ms. X will be unable to go back to work, and will be forever marked as someone who brings attention to herself and not in a positive light. And furthermore, she may be marked as having a psychological issue, when in reality, she is only trying to get the proper treatment for her herniated disk. This psychological defense strategy smacks of something the Soviets used to do to political dissidents.
One gets the feeling that even though the Soviet Union is no more, we are more like the Soviet Union and other authoritarian states, in that the individual is powerless against the power and prestige of physicians, hospitals, lawyers, the courts, and other medical providers, and the system itself.
If ever there was a more clearer case of why we need to transform workers’ comp from the broken, corrupt and dysfunctional system I have been describing these past two years, this case is it.
How different Ms. X’s life would have been if she had gone to an honest and reputable treating physician, received the proper medical treatment, and if necessary, gotten back surgery to repair her herniated disk, even if she received the surgery from her employer or insurance carrier in another country, as a medical tourism option.
And how different her life would be if she did not have to be threatened with a lawsuit from a shyster law firm that is representing a shyster physician, as well as being misrepresented by bad attorneys, so that I had to ask someone I knew if he could help her. There is a saying, “a fish rots from the head down”, and in this case, the stench of the fish called ‘Workers’ Comp fraud’ is taking down the entire system.