Even on this own blog you are likely to run into advertisements like this one:
|Would you click this ad?|
Clicking on this ad will take your browser to http://workers-compensation-law.us where you will find "Free Workers' Compensation Help - Get your FREE, no-obligation evaluation today and find out how much your claim is worth."
This is obviously an attorney referral service, and frankly is probably against state bar rules in many states - but how can that be regulated effectively over the Internet and across the nation?
The website says that when you submit your information you are going to be contacted, and not necessarily by an attorney, but probably by a slick telephone sales person that will prey upon your work injury weakness and ensure that you are directed to one of their referral clients:
"By submitting your request, you grant permission for up to two of our premier partners to contact you using the phone number or email address that you have provided so we may assist you with your request for a free case evaluation and potentially an offer of representation and services. You agree that the matched partner may use an automatic telephone dialing system even if the number you provided is a wireless phone number. You understand that consent to being contacted is not a condition of purchase or acceptance of services of any kind."
Click around and you are taught that it's probably a good thing to get an attorney through this referral system:
"By law, you have the right to represent your own interests when filing a workers' compensation claim. You are not required to hire an attorney. However, because the process of filing a workers' compensation claim can be complex, many injured workers hire a legal professional or an attorney to advocate on their behalf. This is to ensure that they receive the maximum amount of compensation for which they are eligible."
The advertisement play hard on the adversarial nature of employer versus employee, I'm sure hooking every injured worker out for revenge:
"If you are an injured worker that has always worked hard for his or her employer, it may be difficult to accept that you can no longer work in the same capacity as you once did. Moreover, you may also have personal issues with receiving the assistance you need to sustain yourself. An attorney or legal professional can help to ease the burden and stress of dealing with the complex and bureaucratic process of receiving compensation. Furthermore, dealing with the complexities of the workers' compensation process as well as the emotional and physical strain of a debilitating injury is overwhelming for most people. An attorney advocates for you and eases many of the legal and emotional hassles so you can focus on recovery or rehabilitation.
"Insurance companies and state agencies are focused on giving you the smallest amount possible for your injury. They are professionals and deal with this system on a daily basis. Their experience and knowledge of the system is a tremendous asset in contested or difficult claims.
"If you are injured you deserve the maximum amount allowable in order to take care of yourself and your loved ones. A competent experienced attorney or legal professional will ensure that your claim receives the benefits you deserve."
The salacious solicitation goes on and on with predatory appeal to emotions surrounding entitlement mentality, insecurity, retribution and vengeance, and of course just plain greed.
BUT IS THAT ANY WORSE THAN THIS?
From a recent post on the WCC forums:
"I have found at least one major CA UR company is limiting 50 pages of medical documents allowed when appealing a UR denial. If more than 50 pages are sent, they call the claims adjuster and ask for approval to review more records. If the claims adjuster says no, then they stop reviewing records at page 50. There is nothing in the states rules and regulations that state such a limit. I did ask if they notify the person who sent the records, either the doctor, attorney or injured worker when they do not review all of the records. The answer I got from a UR supervisor was "no, the claims adjuster is our customer and we have to do what he says, if he does not want us to review more records or does not want us to review certain records we do not". I was advised to ask the claims adjuster about this as they only do what he states they can do."
ARE YOU KIDDING ME?
So let's drive the claimants to attorneys with nonsense like this. Limiting the quantity of records that are sent to utilization review is, in my mind, not only against the Labor Code and regulations concerning UR, but is both a sanctionable event via hearing before the Workers' Compensation Board (I know, claims LAUGH at penalty attempts now a days since they were essentially eviscerated by SB 899) and California Audit Unit (which as we have seen in prior posts is laughably meek as well).
It seems to me that this claims directive of randomly limiting the number of pages of records to 50 in order to save a couple scheckles is practicing medicine without a license. It's also behavior that intentionally deprives an injured worker of a fair review even if the UR company isn't also owned by the claims house or getting kickbacks, or some other nefarious financial interrelationship that is of questionable ethics.
“Analytics can give you a sense of which types of claims result in litigation, how much it can cost and can perhaps tell you how to alter the claim management so, again, there is less likelihood of it resulting in litigation,” Robert Hartwig of the Insurance Information Institute said in a story this morning in WorkCompCentral News.
Guess what folks, you don't need analytics. You just have to look at examples like the one above to understand what needs "alteration."
I've said it before and I'll say it again, and again, and again ...
THERE'S NOTHING BROKEN ABOUT WORKERS' COMPENSATION!!!
The only problem the system has is YOU.
Feed the system crap and you get crap.