Wednesday, July 9, 2014

Sad Testimonials

When a business has something good and people like it, you can bet on testimonials from customers. In the Internet age we look for reviews of products or services before we buy, hoping to capitalize on the experience of others so we either make the same great choice or avoid a poor decision.

A WorkCompCentral Forum thread recently popped up that is a sad commentary on our system because the people that are actually in the system providing goods and services have very little faith in workers' compensation to do what it is supposed to do.

And that is a sad state of affairs indeed.
Bowzer won't run into the Wall of Comp again...
I've edited the posts for brevity and succinctness (we all know how forum posts tend to drift off topic). Maybe you want to add your two cents on the topic of "To file a claim or not?"

I wonder, if I was an employee of a company, suffered a potentially severe and life changing injury, would I report it to the employer and file a claim. Or, if I had decent medical insurance, say through my spouse, would I simply seek all treatment through my private medical coverage? Knowing what I know about the nature of medical care received through today's workers comp insurance carriers, with the inordinate delays, arbitrary and consistent denials of treatment, generally poor treatment when compared to the private sector, and the adversarial relationship with the carrier, would I really put all of that on the line and stay within the system? What would I recommend to a loved one or friend facing the same questions?

I have asked myself the same question. As an adjuster, I see the whole picture, medical care, wage replacement, permanent disability, and the need to interact with the injured employees, attorneys on both sides, and some liens thrown in.

I am not sure that I would file a claim, unless it happened right in front of my manager, or something. In that instance, if I felt that I needed better or different treatment than what I was getting, you bet I'd self-procure.

I would only file a claim if I did not have STD and LTD that covered everything. But we speak from a position of privilege in that most of the people who post here have group health and the opportunity and means to purchase disability insurance. So some people have no choice.

There are a few injured workers forums and one on this site where injured workers ask this question regularly. Many who have been through the system tell others to not file the claim and use their private insurance. This is due to delays in medical treatment they have been victims of and receiving sub standard medical treatment in the workers compensation system. I have seen many instances that an injured worker actually becomes disabled further due to delays in treatment.

My response is if the injury is minor, no I would never claim it. If the injury was catastrophic... I am still pondering if I would claim it from the knowledge I have now of what happens to injured workers in California.

No I would not file a claim, knowing what I know now about the California workers compensation system. I think the medical treatment with delays and denials is sub-standard and can cause a person with a treatable injury to become disabled for life. Dealing with UR and now IMR... I and would not wish this upon anyone. My only question would be is it fraud to not file a workers compensation claim for an injury that occurred at work? If so then I would most likely file the claim. I have read conflicting responses to this some stating it is fraudulent not to file a claim when the injury occurred at work, while others have stated you have a choice.

I have had a lot of QME cases where the original orthopedic injury was treated by a private insurance MD who did not report it as a work injury when the worker told them it was a work injury, and kept treating it as non-industrial as it filled billable time and procedures and helped make the doctors house payment.

Isn't it illegal to NOT report an industrial injury.... ?? .... but I think it happens all the time.

When when a WC claim was finally filed, it totally messed up the case. The insurance company can easily say, 'oh look, his private insurance treated it so it is clearly non-industrial"

Perhaps what is being said above reflects declining claim frequency in most geographic areas (except of course the greater Los Angeles area, but we've all seen the latest news stories about atypical behavior coming out of various ne'er-do-wells that seems to account for the volume there) though increasing indemnity claims with attorney involvement.

I've asked myself this question throughout the years of my professional life in work comp. I used to have faith in the system and would have had no qualms about seeking care through the work comp system.

Now I would answer in the negative.

And that really is a sad testimonial.

If you don't have faith in the own system you work in, how can anyone else?

And what is the point in having a mandatory system of insurance if no one uses it?

The Walt Kelly comic strip from the 1960s and 70s, "Pogo," is most famous for this singular quote: "We have met the enemy and he is us."


  1. Wow that person was also right on the money. Im so glad folks are starting to see the truth now. It does help with my angst or what ever it is over the whole freaking deal. Or the lack of a Deal? Here is my take on things today as an light injury worker, who the system made worse, by trying to omit the objective truth in my care, all for the bottom line.

    I think the problem in the workers comp system's across our country, is that a lot of folks don't believe our Grand Bargain, covers the little OJI's
    Or at least they feel it should not. that employers should not have to bear the cost of these little low line injuries and accidents. That the ins. co.s should not have cover these as well, and are willing to omit the truth in our health care, to save the corporate bottom line. To further this error in thinking, and their bias austerity agendas.

    For it is an insurance policy just like any other. And if I went to my auto insurer with objective prof of damage, and they said yes your damaged, but not enough yet, come back after you have had a bigger accident, then we will honor our end of the bargain.

    Would that be fair?

    So why is it fair in The WC arena for folks to feel that our bargain does not extend to the little OJI's, just as much as it does to the big ones? Little dent, or big dent? should not matter.

    Employers and HMO's ect... Omitting objective evidence to control cost, in our health care, is not being their for the patients nor injured workers. It is allowing a Dr. to do harm, when they have a Duty to not harm. All in the name of saving the bottom line. Like the Dr. who got honest in my care, stated to me. If he did what he did for everyone, which was be honest as far as I am concerned, the wc system would go broke. My Dr., needs to be worrying about ME, not the bottom line. My employer's and the big insurers in this case.

    Well if my car ins. and my mechanic all said no, it's not that bad yet, it's only a broken windshield, your car still runs, just live with it, wait until the car is totaled, then will honor our bargain. and your insurer and your mechanic are all are being paid by your employer.. Wow. See the DOUBLE Standards?

    Treating and Cheating little OJI's as though their not covered under our grand bargain? And omitting the truth to do so, and to cost contain, or push some moral holistic agenda onto patients in your care, is not contractually just. Nor moral to allow one man to use gut instincts and bias, instead of objective medical evidence to deprive another man of the goods and services for which they paid.

    Thus depriving these folks of a civil roads for which to seek relief for the harm done in a fair and timely manor. Justice? NO more oppression than any thing ells I would say. Use up labor and toss it off to the streets or the mercy of the feds, whom these large employers pay no taxes to.

    The FLEECING of the American Workers Grand Bargain out the silent back door of cost containing austerity measures, being imposed upon us by both politcal parties, in our health care and employment needs today. What is an injured worker to do?

    Let's all come to fix this..... More time and money is spent to deprive us of our GRAND Bargain, than if they had just honored it to start with.

  2. Walt Disney once said "I only hope that we don't lose sight of one thing - that it was all started by a mouse." In the same spirit, workers' compensation cannot lose sight of the fact that it is all about injured workers and their employers. This is who the laws were enacted to protect and to serve. The rest of us just provide mechanisms and services and our interests are secondary.

  3. It does not take much investigation to see the workers comp system's are harming patients across this country. So why do our leaders lie to us and tell us that patients abuse is ok, and injustice, as long as corps are profiting from the abuse? Hmm?
    We need justice, weather or economy is up or down. Justice is not something we turn on and off to fit the needs of any ones budget. If JUSTICE is the cost that one must bear in order to get health care in the usa, then what have we come to? NO I WILL NOT Accept it as is BROKEN. TAX The MOFO"S who profited off last two freaking wars. But don't take my rights away, and deny my dignity and justice in my health care. Pleas and thank you. We don't let the auto industry sell ins. in this manor then get away with cheating folks. Why is it OK in comp? Hmm?

  4. I had coffee with my local Green party candidate. And he said folks just need to learn to accept it's broken and move on.

    Im tired of the 15 for 15 an hour folks, and the Dems who claim to be for equality for all, a better justice system, and against corporate greed.

    Yet when you show them were patients are being harmed, and consumers are being defrauded on a grand scale, and that things are broken. They say, OH, Well, yes, but it has to stay broken that way, and folks have to endure unjutice and inequality. So that we can ballance the budget. Since when do folks sell of their rights to justice in order to make ends meet. We should have justice no matter if were making end meet or not. Shouldn't we?

    This is only profiting the elite, off the backs or the working poor. Only 1 percent of the folks who pay into the comp system, will ever use it. yet, more than haft that try, are cheated and then it takes them decades getting justice for the harm done. No worth cheating folks out of their rights I would say. No dollar amount is worth living in a land with one sided justice.

  5. And just for those who care? And for some who may not. Here is my request to the Gov. for help from the patient abuse and persecution going on in mine and my wife HMO care as well. We the people, need our little frivolus law suits back so as to hold the big giants accountable for their actions, or non action in much of our health care today.

    Dear Gov Jay. and like minded A Hole Friends.

    Stop effing me, in my health care please.

    It's seems we have a system that allows injustice by one man onto another. Then the same system protects the man who harms, while persecuting those abused once they try coming fourth with prof of the harm being done.

    Withholding justice from these men for so long, knowing their right, yet continuing to make them prove it through decades of litigation. Desinged to drive folks mad to a point that they go nuts. Then once nuts, the system can poke, prod, and instigate, starve out, and wait out, those they have assisted to be abused....and then profit off the misery caused as well. Hmm?

    Do I have that about right now?

    One set of laws for the abusers, and another for the abused? Hmm?

    IS this really good for our public's safety over all?

    Allow one group to stick it to the other, then hide behind the law? Then you have no law. ONLY THUGS with guns that carry out your bias one sided wishes and commands, to PURGE the world of those, your GATE Keeper deems unworthy. WOW Just A bit like Nazi Germany I would say.

    And the republicans told us this would happen. The funny part is that they laid the ground work for the State Med Tort Laws that allow the abuse to go on.

    Both parties bought out and fleecing the poor working class through our health care, A Group of Elites purging the world of those they deem, with a sniff and glare, to be worthy or not? Eff, you arrogant money whores.

    Maybe it's not the guns we need to take away?

    Maybe we don't need to take away folks civil rights?

    Maybe we don't need to sedate and incarcerate all the abused.

    Maybe we need to give folks equal justice for all, to start with?

    For possibly if folks had justice and equality, then we would not need to even address the mental health issues, that lead to the social angst to start with.

    Of course big pharma would not be able to tell folks their depressed or bi polar, and sell all those drugs, and all the others who profit off this misery created by this original sin of a lack of justice in our lives, and healthcare and employment needs today.

    The hindering of any right of one man to seek speedy relief for the harm imposed, by another man, is not moral, humane, nor just. SORRY I DO NOT HAVE TO ACCEPT BROKEN because a few people are getting rich off it remaining that way.

    1. Well said. I hear your pain and suffering. Feel it. Know it. Support from Canada. We are dealing with an International insurance fraud. All the commonwealth and U. S.

  6. How Much persecution in your health care must folks endure. Here's a what our leaders are telling me about our workers comp system. Just smile and take it.

  7. If I were able to work again, if I ever got hurt at work again, I would never file a WC injury claim again! The fraud that proliferates the WC system is profoundly on the part of the insurance carriers, doctors and attorneys and employers. The insurance carrier and other defense members will stop at nothing to save money on a claim. The Doctors & other medical staff will accommodate the fraud in order to be assured of future referrals and to keep their place in the WC insurance carrier's "network of medical providers".
    It is a common practice to alter & falsify information on documents, adjust surgery reports, deceptively have an injured worker sign documents that aren't marked as they appear to be marked and more.
    In my case, at the 3rd epidural, inclusive of the above, I signed 2 anesthesia forms, one form out front in the lobby of the surgery center along with many other documents before I went back to pre-op and one in pre-op. Neither of the anesthesia forms was marked "monitored" anesthesia! A blonde gal who approached me as I was laying down in pre-op had me sign the 2nd anesthesia form which was clearly marked "local anesthesia" on the first page. She held onto the form with two hands. One at the top of the form and one at the bottom. I thought that she was a control freak. I didn't suspect that underneath the first page, that the flow through pages would be marked differently. In fact, they were. When I left there that day, maimed and battered, injections all over my person of ??? what, I don't know, I was handed one of the anesthesia forms (the copy behind the first page) that I signed, it was marked "monitored" anesthesia. What a well-orchestrated deception on the part of the surgery center, Coastline Surgery Center, in Santa Ana, CA and whoever that gal was and more.
    If it weren't for my wonderful sister, I would be homeless today. :( This is true of many injured workers. Does our government not value the employee once they have been hurt at work? Have injured workers essentially, been abandoned?
    If this practice of deceiving, maiming the injured worker has been going over for 20 plus years, why isn't there a disclosure mandated that requires the injured worker be made aware of this?

  8. The writer in this article writes: "The abuse faced by injured and ill workers needs to come out of the shadows and receive the attention it deserves. Ten years ago, I sat down for my first interview with an injured worker. That worker told me a story so outrageous and convoluted that I worried about his mental health. But, as I continued to interview workers, more than 100 injured workers that year alone, we heard similar stories of abuse over and over again. It became clear that the system is inflicting tremendous harm on the very people it is supposed to help. Regardless of the impact of this particular decision, the reality is that this court is right. All people have basic human rights to economic security and health care. Workers’ compensation systems are violating these rights throughout the Country."

  9. The way companies delay the medical treatment of their injured workers make them doubtful to file the claims. The decline of insurance claim frequencies pile up because injured workers are more than familiarized with the long process of investigations. Simply put, the delay of medical treatments when it comes to insurance claims, that could cause permanent disability, is not worth the threatening cons of paying for your own medical bills. Hence in conclusion, I find that workers find it more aggravating to be penalized by being disabled permanently, than be robbed financially for treatments the company they work for should be held responsible to. In any case, that was a very stimulating topic, David! I enjoyed reading your post! Thanks for sharing! All the best to you! :)

    Betty Rose @ Phenix Investigations