Tuesday, November 11, 2014

Vultures At Both Ends

Yesterday I espoused about our industry penchant to make a very simple proposition much more complex and difficult than necessary. We introduce all sorts of officious intermeddlers into the system and, I believe, that when we really get down to it anything that wrong with workers' compensation is our own doing.

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.


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."


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 ...


The only problem the system has is YOU.

Feed the system crap and you get crap.


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    1. There was a case in WA State where an IW needed $200. for a card dealing class, and if he had that class, he had gauranteed employment. But the WC system would not pay for the class, and continued to pay the iw time loss for years. Good news is, they saved $200 bucks on not retraining a worker.... WOW.

      On a positive note, our WA State Labor Council is starting to get vocal about the abuses going on in workers comp. Im hoping some positive change will come out of this in the long run.. Peace & thanks as always. http://www.thestand.org/2014/11/state-among-least-expensive-for-workers-comp/

  2. In California it's that bad, and worse. A Judge recently ruled that a $16,000 'bonus' paid to an out of state carrier in 2014 by EDD for refusing to pay legally required TTD in 2012-2013 was ok. The Judge apparently bought the story that what was paid the first year by EDD to injured worker relieved the carrier of responsibilities to pay 104 weeks TTD. In CA, the work comp carrier pays benefits 104 weeks and if injured worker cannot return to work (commonly due to failures to authorize medically necessary treatments) then the State pays 52 weeks. Out of approximately $50,000 paid by EDD, a 'negotiated discount allowed carrier to reimburse CA merely $31,000 and if I read the ruling right... the Judge said the injured worker got all she was going to get...approximately 2.5 years of benefits, minimal care for Traumatic brain injury, and she hasn't worked since date of injury.

    Whose money was that $16k bonus? Injured worker was forced to forfeit 6 months disability benefits and without necessary medical care.....can't get back to work either.....and has spent nearly $30,000 on medical expenses that carrier would not.

    Maybe the EDD gave away taxpayer dollars from another coffer? Adjuster expressed fake empathy but said the negotiations were fair and square...for them.

    All this happens with support of Work Comp Info and Assistance people who explain that work comp is an adversarial system and a very small tight community of prople who all know one another and work together.....

    Yikes...sounds more like shell games and public/private corruption! Where is Dano or Elliott Ness???

    Meanwhile. ...Injured workers are the only losers ....of health, , jobs, homes and life, while the fraudsters rake in billions and billions in annual profits.

    In CALIFORNIA. ..Adult Protective Services has been known to intervene on behalf of injured workers with complaints of financial terrorism like this. The Salvation Army helps injured workers with utilities and food.

    Fighting #WorkComp fraud is a tough battle. Somebody's got to do it now. Write on! ♡♢♧☆♡♢♧☆ "WE ARE THE MEDIA NOW"

  3. I would suggest to appeal that ruling.