What Price Profit?

WorkersComp

For my first post of 2015, I want to go back to a subject I wrote about last year, namely the fraud and abuse perpetrated against injured workers by their employers, by lawyers, by the medical profession and the insurance industry at large.

Wall Street hedge funds and private equity firms, in particular, who are taking an greater interest in the workers’ comp industry, and as has been written extensively about, are buying up various workers’ comp service providers, thus shrinking the industry and squeezing every last drop of profit from the claims process while cutting back on services, or even raising the price of those services.

I discussed the issue of fraud and the plight of an injured worker I called “Ms. X” in two articles; the first article, The Stench of Fraud: Why Workers’ Comp Can No Longer Be a Closed System, dealt with the use of phony or unapproved implants, the second article, The Stench of Fraud, Continued, described the ordeal Ms. X suffered after being injured at her place of employment.

Today’s article, also highlights the ordeal suffered by an injured worker, who I will call “Ms. A”. The following text below is the actual words written by Ms. A on her personal blog, with some minor editions by myself.

I will point out that Ms. A was an executive with a very large corporation, whereas Ms. X was an employee of a small firm, and was not an executive. This will give the readers some idea that the fraud and abuse is not confined to low income or clerical workers, but could be experienced by anyone, at any level of employment, so long as they are not the owners or managers of companies.

Here is Ms. A’s story:

January 9, 2015 marks 3 years since a witnessed slip and fall at _________ by ________________ in Big Bear, California and Traumatic Brain Injury. Still waiting for medical care and benefits. Thousands and thousands of dollars have been paid out in evaluations; very little in the way of ‘medical care’ requested by treating physicians.

Friends have suggested that since _________________________ and it’s Work Comp carrier, CNA Insurance,…refuse to provide medical care, and continue to refuse to reimburse nearly $30,000 in properly submitted medical expenses for mileage to their designated doctors and medically necessary treatment that they unlawfully denied, that GOFUNDME might help.

I lost professional credentials…. Hawaii Real Estate Sales License, California Real Estate Broker’s license, and California Notary license. Failures to provide medical care, disability benefits, and return to work opportunities! Thanks _______.

I was basically thrown out of a public CAREER NIGHT at ________________ Indio in December 2014, which was a public invitation to learn more about the company and working as a sales person. I was able to say hello to several co-workers while HR pondered on what to do with my attendance at their public event. The Project director advised that Human Resources said he could not talk to me, and… LOL, I was the only person from the “PUBLIC” who showed up for the event.

Social Security Disability has been denied twice, and Long Term Disability is at constant threat of being discontinued, despite the policy and fiduciary responsibilities.
Some say that upon diagnosis of anything to do with Brain Injury, Work Comp carriers fully and immediately breach fiduciary responsibilities and expedite 3D practices….”DELAY, DENY, DECEIVE” rather than to expedite immediate medical care to mitigate harm and risk.

The first year, I could hardly speak, and leaving the house was only ‘as necessary’ to various doctor evaluations. My speech is still ‘dysfluent’ but improved. I experience cognitive fatigue more often than I care to admit. There are other impairments, but being a sales person and personal-development-activist who has walked on fire and bent rebar at the throat chakra, I muddle along to the best of my abilities.

If you remember 286 computers and dial-up, no clip-board, no copy and paste then you have an idea of what it can be like living with a brain injury.

I am a “High IQ TBI and Work Comp Survivor” Some new and old friends say I am still brilliant, just different, and much slower.

Typing is still a strong suit. Different lobes govern different functions. The brain is an amazing organ. Neuroscience is truly the New Frontier. Ask a Veteran today!

One doctor, in 2012, advised to “never tell anybody you have a brain injury, as it has a stigma”….He wanted me to spend out of pocket $500 for a day-planner to conceal the impairments. I didn’t start screaming loudly about it until year two, when I could better grasp the extremely dangerous situation I was in as an Injured Worker in America. It became very clear what a corrupt and vile system Work Comp in America, and elsewhere, is. Consider Japan’s Nuclear Meltdown workers.

If you say Work Comp is none of your business, I must assume you are not part of the Human Race.

When I slipped on ice and fell backwards on 1/9/12 and conked my head really hard at Big Bear, I laid in the snow for what seemed to be about 5 minutes. I was asked if I was ok, and I said, “No, I hit my head really really hard.” I was dazed and confused, but eventually got up, dusted the snow off, and reported to the sales meeting. My colleagues had a great laugh about my fall, and one even said, ‘Ewwwwwwww, she has Fukushima radiation all over her now from the hot-snow!’

I gave a ‘timeshare tour’ at 9 am, and I was very apologetic for my extreme confusion and disorientation and they were grateful for a short tour, and a fast gift.

Around 10 am, the administrative manager asked if I was going to a doctor, and I asked if I had to see any special doctor. He said, “See any doctor that accepts work comp” and provided me with an incomplete DWC-1 form, that had no insurance info on it. I drove down an icy mountain after the last tour of the day, about 20 miles, then another 40 miles of flat desert. How? Dunno! Just did.

Nobody thought I might need a ride to a doctor, or a hospital, or even a 911 ambulance ride? I haven’t worked since, and I have spent more than $30,000 out of pocket to discover and obtain help for brain injuries. Had I received immediate and appropriate care, I am told I might have returned to work that first year.

Recently, after denied TTD and PD benefits for months, and years of failures to authorize medical treatments, the attorney for _______suggested that if I reviewed the situation, it would be clear that the failure to obtain medical care is all my fault, and he further asked why I believe I am entitled to any benefits.

He sent a nasty little note with his legal opinion on my medical conditions, suggesting a Court Appointed ‘Conservator’ to make my decisions, since I struggle so with the Work Comp system. It sounded to me like he was suggested I agree to let the Court appoint an insurance company goon to finish the kill? Yikes. The contempt and disdain is mutual.

That doesn’t even mention the insurance guy who called and after listening to me whine about no medical care for nearly 3 years asked, “….so when ARE you going to die?”

The insurance company and attorneys had me driving everywhere; I don’t know how I did it either. One doctor wanted me to drive with a brain injury, sleep deprived, over 100 miles for an ‘exam’ and that’s where I drew the line. I knew that was insane, and would be a danger to me and to the driving public. Where do they find those Work Comp neurologists? Haven’t met a smart one yet.

You can see from her description of her ordeal, there is something going on with her claim and the claims of so many other injured workers.

She is coping with this traumatic event the best way possible, but the system that was designed to care for people like her has failed time and again, and for no other reason than to protect the profits of those who are inflicting harm on her, after initially suffering an injury not her fault.

A wise man once said, “for what hath it profit a man if he gains the whole world, and loses his soul,” To me, it would seem that the workers’ comp system, the legal system, the medical profession, and the insurance industry has lost its soul on the way to gaining the world and profit.

As for Wall Street, two hundred years of lying, cheating, stealing, conniving, and manipulating has proved that they have no soul, only dollar signs where their hearts and minds should be.

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This entry was posted in Abuse, Claims, Fraud, Medical Tourism, Medical Travel, Unethical behavior, Workers' Comp, Workers' Compensation and tagged , , , , , , on by .

About Transforming Workers' Comp

Have worked in the Insurance and Risk Management industry for more than thirty years in New York, Florida and Texas in the Claims and Risk Management spheres, primarily in Workers’ Compensation Claims, Auto No-Fault and Property & Casualty Claims Administration and Claims Management. Have experience in Risk and Insurance Business Analysis, Risk Management Information Systems, and Insurance Data Processing and Data Management. Received my Master’s in Health Administration (MHA) degree from Florida Atlantic University in Boca Raton, Florida in December 2011. Received my Master of Arts (MA) degree in American History from New York University, and received my Bachelor of Arts (BA) degree in Liberal Arts (Political Science/History/Social Sciences) from SUNY Brockport. I have studied World History, Global Politics, and have a strong interest in the future of human civilization in all aspects; economic, political and social. I am looking for new opportunities that will utilize my previous experience and MHA degree. I am available for speaking engagements and am willing to travel. LinkedIn Profile: http://www.linkedin.com/in/richardkrasner Resume: https://www.box.com/s/z8rxcks6ix41m3ocvvep

5 thoughts on “What Price Profit?

  1. Transforming Workers' Comp Post author

    Irene,

    There is a reason why the exclusive remedy was instituted in the first place, and while most of us were born well after workers’ comp was enacted, the truth is that without exclusive remedy, injured workers were at the mercy of the courts, which did not always side with the worker. In fact, it is why exclusive remedy exists, so that when an worker is injured, he or she does not have to go to court to get their medical bills paid for or to have their lost wages paid for.

    You want the worker to have his day in court, but my advice to you is to be careful what you don’t wish for, because you just might get it. If think things are bad now, just wait until workers are left to the mercy of the courts and the employers who have legions of lawyers to rob them of their medical care and wage payments.

    Do you really want to go back to the bad old days before exclusive remedy? I don’t, and that is why I have written about it. A little history lesson is in order here. Capitalism does not recognize workers rights, and courts serve the capitalists, not the workers. Real workers’ comp reform would leave exclusive remedy alone, and fix the problem at the source, namely the so-called reforms of the past thirty years or so that made things worse, not better, and especially in CA, as David De Paolo writes about daily.

    One word of caution, workers’ comp is under assault because of plaintiff lawyers and juries that have “given away the store”. What you and others are reacting to is the way in which business is responding to this trend of making business pay for serious injuries that are impacting their bottom lines. There needs to be alternatives to the high cost of workers’ comp, but getting rid of exclusive remedy is not one of them.

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  2. Transforming Workers' Comp Post author

    Darren,

    No, nationalization is not the answer. What will work is strengthening the laws and working to make the exclusive remedy better. Do you really want an injured worker to take a chance on a court trial, especially in a jurisdiction that is very conservative, where the employers have a lot of pull with the courts, or do you want a “no-fault” system that assigns no fault to either side, but is fair and equitable to both? Work for making the system better, not taking it backward to the days of litigation and lawsuits that workers, many of whom could not afford to file.

    Yes, there are problems with the system, as I and others have written about, but to undo everything that has been done, and that is working for the majority of claimants is wrong and dangerous.

    Fix the system.

    Liked by 1 person

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    1. Transforming Workers' Comp Post author

      First of all, nationalization of workers’ comp is not on the table, and never will be. The industry will never allow that to happen. Nor was it brought up during the runup to the ACA enactment. Workers’ Comp is too complex to nationalize, and because each state has different rates for workers’ comp premium calculations. Then there are the federal workers’ comp programs like those for railroad workers and for longshoremen and harbor workers, etc. Too complex. I know, because I worked for a broker who was involved with those areas.

      There are no easy answers to what you and others have gone through, but is it fair that the majority who have not had problems, lose that exclusive remedy that pays their medical bills and lost wages? You want the many to suffer along with the few. Is that fair?

      The real problem is not the laws, but the lawyers, both plaintiff and defense, and their clients, who have tried to gain advantage every time a case goes to court after exhausting the state’s administrative process. The demands made by plaintiffs, and the tactics employed by defense attorneys to save their clients money and to prevent workers from taking too much from the employer, has lead to these problems.

      And if you want justice, to paraphrase Bonasera, “go to a voting booth and vote”. You won’t get “justice” bitching and moaning. Vote for those local, state and federal candidates who care about workers and not those who care for the rich, the business community, and those who care about the middle class.

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    2. ccintheooc

      Here in Orange County, CA, a conservative county, bias against the injured worker in the WC system is prevalent. In my case alone, even the Judge did not allow me to present my case during trial! I was asked questions by the Judge during my trial, then the Judge asked me if I had anything to add, my response exactly was “Yes, but I don’t know where to start!”. The Judge then said, “I think I have enough.” and then asked the defense attorney if he had anything that he would like to ask me. He responded, “No.” What kind of trial was that, I ask! I had 80 plus pages of exhibits & I found out later the Judge had eliminated one entitled, “Description of Employees Job Duties”. She also ruled in favor of the defense at the meeting before the trial when he objected to my including a letter that he had written to my former attorney, wherein he points out that the “treatment seems to be harming rather than benefiting the applicant!”. There is much more that I can add however, the bottom line is that here in California, I have to agree with several other bloggers who are in fact, WC industry professionals. One stating – “California’s workers comp system is a cesspool of fraud!” Another, David Depaolo, of WorkCompCentral, a former defense attorney in workers compensation and now an educator and blogger, said in his 2006 article, “Stop the Hypocrisy”, “It seems that fraud and Workers’ Compensation just belong together. The sad part is that those who commit the most heinous criminal acts and cause the greatest civil damage always seem to be just out of reach of the “long arm of the law.” What’s worse, is that we as an industry not only seem ambivalent towards this criminal behavior, some even seem to condone it! The pervasive greed of those feeding off of the Workers’ Compensation gravy train is so endemic that there is no sanctity, no island of honesty, not one bit of redemption that any amount of reform or public humiliation can rectify.”
      What we need is a system wherein injured workers can go to make a formal complaint regarding matters of their WC claim. A system where the names of those accused of wrong doing i.e. corrupt Judges and Attorney’s, network Doctors who in fact are maiming injured workers, employers who lie in an effort to deny the injured worker the remedies available under the WC system, surgery centers, hospitals and other medical providers who cooperate in these crimes against injured workers, all of which should be monitored and the data shared to protect the injured worker! This data should be available to all injured workers & a mandated disclosure distributed to warn injured workers of the most common and most prolific crimes that are inherent in the workers comp system, those being the crimes that are committed against injured workers!
      We can’t have those who work in the workers compensation industry monitoring themselves for example the DIR, DWC & WCAB, all of which seemingly work together to hide the stain of of what should be shame. Unfortunately, we have learned that they are “un-interested” in the plight of injured workers! They too are seemingly bought and paid for or are enjoying the rotten fruits. I say “rotten” due to the crimes that have been committed against me and are ongoing, and the stories I’ve heard from other injured workers and finally, those in the system / industry who themselves who are willing to say, “California’s workers comp system is a cesspool of fraud!”.
      How can these people look at their career and be proud? What can they say that they have accomplished? And,where are the whistleblowers? Like many other industries, people who consider “outing” the corruption or crime in their industry or at the corporation that they audit or work at, consider the ramifications that follow being a whistleblower. We need whistleblowers and we need to not only protect them, but we need to reward them!

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