….continues to exhibit blithe disregard for its legal and ethical obligation to provide medical care to a seriously injured worker. CNA insurance, acting as claims administrator for Wyndham Worldwide, demonstrates a callous indifference to the catastrophic consequences of its delays, inaction, and outright neglect. It seems that the adjuster believes that the employer could evade liability through a see-no-evil, hear-no-evil, passive approach to claims administration.
California Labor Code Section 4600 requires more than a passsive willlingness on the part of the employer to respond to a demand or request for medical aid. This section requires some degree of active effort to bring to the injured employee necessary relief…….requiring that the employer TAKE THE INITIATIVE IN PROVIDING BENEFITS.
The employer’s abdication of its affirmative responsibilities is a far cry from “genuine doubt”. There is substantial evidence to support the findings that the defendant has and continues to unreasonably delay medical treatment for well documented injuries to brain and other body parts and systems for at least one injured worker.
If you have been injured while working for Wyndham Worldwide, know that you are not alone.
WE ARE THE MEDIA NOW.’
IS PERJURY A FELONY?? FRAUD IS.
“Workers’ compensation insurance fraud occurs in simple to complex schemes that often require difficult and lengthy investigations. For example, an employee either inflates the extend of his/her injuries, or simply fabricates injuries altogether. At the other end of the spectrum, white-collar criminals, including doctors and lawyers, entice, pay, and conspire with other individuals in cheating the system through fraudulent activity and insurance companies “pick up the tab,” passing the cost onto policyholders, taxpayers, and the general public.”
ASK ABOUT WORKERS COMP GRAVY TRAINS. ASK AND TELL. EXPOSE AND EXPUNGE.
‘Time for more medical evaluations; no time for treatment. We can pay the doctors to make big expensive reports; We cannot pay for medical treatment that can help you heal and return to work. We cannot. We will not. You cannot make us do so. We are the Law. We laugh in the face of your LABOR CODE. It is nothing. You see, nobody will help you get medical care. Those who know, won’t, as it will impact their ability to continue to ride the WORKERS COMP GRAVY TRAIN. The others are too stupid or superstitious or afraid to help you. You are nothing…… a mere corporate disposable asset that is no longer useful to the company. We have our ways to break you. You will see. The Information Officer has been giving you wrong information….. we laugh as you try to run in the square circles you are sent on, only to laugh again and tell you no, that was wrong, do it this way, or that way, or it’s too soon, or it’s too late…….. jump through this hoop, this is as good as it gets….’
ASK ABOUT #WYNDHAM WORLDWIDE NOW….
…and how it treats injured employees WITH REPEATED EFFORTS TO AVOID OR POSTPONE ITS STATUTORY DUTY TO PROVIDE MEDICAL CARE, egregious behavior which increases the suffering and physical damage to a seriously injured worker.
The defendant has and continues to unreasonably delay medical care authorization requests by approximately 16 doctors for approximately 16 treatments/brain oriented evaluations, since January 9, 2012. The Courts will be asked to impose the maximum penalty under California Labor Code Section 5814: 25% of the delayed medical benefit, not to exceed $10,000, per incident, as separate and distinct acts of misconduct, subject to multiple penalties…..for at least one injured worker.
ASK AND TELL…… START WITH WYNDHAM, AND KEEP GOING.
Can We Talk??
Injured Worker at Expedited Hearing to Defense Attorney: I have had NO MEDICAL TREATMENT for the brain injury sustained on January 9, 2012……That was 546 days ago….. ONE YEAR, 5 MONTHS, 29 DAYS and no hope on the horizon.
Defense Attorney: Look at these doctor records. You’ve seen plenty of doctors.
Injured Worker: Yeah, and I drove 8,696 in a dazed, brain-fogged, vision impaired state to every one of them. Name one treatment authorized for evaluation of and/or treatment of the diagnoses of TRAUMATIC BRAIN INJURY, CONCUSSION, PTSD, ETC?
Defense Attorney: I’m not going to have this argument with you again. Our neurologist says you need only take over-the-counter analgesics for your headaches. Our forensic psychiatrist says you just have maladaptive anger management sKILLS. The Judge is compelling me to send the neurologist and to the forensic psychiatrist these omitted records that you so conveniently happened to bring with you today
Injured Worker: PROOF OF SERVICE NOTE: [As discussed, you’ve received the records multiple times, so, as promised, I intended to bring them to the hearing, and that delivery would be in front of the Judge as final prooof of service. By the way, your paralegal/assistant may need some counseling on the perjury point of a proof of service. After today’s 7/11 hearing, I received your notice of the hearing, with proof of service dated 7/3/13, hand-marked to 7/5/13, and postmarked 7/9/13; the recent letter from your regarding the upcoming QME event had a similar mishap and is beginning to look like another deceptive pattern as it had no postmark date, and took 8 days from the alleged date of service and cost me 8 days of a 20 day response time; is perjury a felony also??]
Injured Worker: Here is a list of all physician requested authorizations for treatment and specialty evaluations, ALLLLLLLLL DENIED by you and/or the adjuster, non-physicians, with just token ‘chiropractic, psychological support, and physical therapy. NOTHING FOR BRAIN TRAUMA since January 2012. I WANT MY BRAIN POWER BACK. There are doctors that know how to diagnose and treat brain trauma, and the neurosciences are expanding bodies of information daily.
My speech has improved, processing and sequencing information is still hard, and I have done some extensive survival research on brain injuries. I’m sorry your forensic psychiatrist was offended when I referred to some of the ‘evaluating doctors’ I had been sent to as ‘quacks’……. I thought he knew. For as well paid as he is for his bogus reports, he seems to be rather thin-skinned.
|Specialty||Requesting DR’S speciality||Date||Ever Authorized?|
|MRI – Brain||MD – Family Medicine||1/13/2012|
|Neurologist [with TBI expertise]||Clinical Psychologist||1/13/2012|
|Neurologist [with TBI expertise]||MD – Family Practice||1/13/2012|
|Psychologist / Neuro, Clinical, Psych||Clinical Psychologist||1/13/2012|
|MRI – Brain||Orthopedic Surgeon||1/21/2012|
|MRI – Cervical||Orthopedic Surgeon||1/21/2012|
|Neurologist – referral||Orthopedic Surgeon||1/21/2012|
|Home Ultra Sounds Machine (???)||Orthopedic Surgeon||1/21/2012|
|MRI-head and thoracic||MD – Emergency Room||2/17/2012|
|Psychologist / Neuro, Clinical, Psych||Neuropsychologist||2/25/2012|
|Speech Therapy w/cognitive remediation||Neuro-psychologist||2/25/2012|
|LUMOSITY BRAIN GAMES||Neuropsychologist||2/25/2012|
|MRI – Brain||Neurologist||3/6/2012|
|Psychologist / Neuro, Clinical, Psych||Neurologist||3/6/2012|
|MRI- Brain||Clinical Psychologist||3/14/2012|
|Psychologist / Neuro, Clinical, Psych||Clinical Psychologist||3/14/2012|
|Neurologist – [with TBI expertise]||Clinical Psychologist||3/15/2012|
|EEG Neurofeedback||Certified Practioner of EEG Neurofeedback||4/3/2012|
|Psychologist / Neuro, Clinical, Psych||Certtified Practitioner of EEG Neurofeedback||4/3/2012|
|MRI- Cervical||Orthopedic Surgeon||4/20/2012|
|MRI – Thoracic||Orthopedic Surgeon||4/20/2012|
|Neuro-Vision Optometry||Orthopedic Surgeon||4/20/2012|
|Speech Therapy w/cognitive remediation||Orthopedic Surgeon||4/20/2012|
|EEG Neurofeedback||Clinical Psychologist, Neuropsychologist||4/23/2012|
|Neurologist – referral to Nudleman||Clinical Psychologist, Neuropsychologist||4/23/2012|
|EEG Neurofeedback*||Clinical Psychologist, Neuropsychologist||7/17/2012|
|Psychologist / Neuro, Clinical, Psych||Clinical Psycholoigst, Neuropsychologist||7/17/2012|
|EEG Neurofeedback*||Clinical Psychologist, Neuropsychologist||8/21/2012|
|Psychologist / Neuro, Clinical, Psych||Clinical Psycholoigst, Neuropsychologist||8/21/2012|
|Neuro-Vision Optometry||Clinical Psychologist, Neuropsychologist||10/1/2012|
|Psychologist / Neuro, Clinical, Psych||Clinical Psychologist, Neuropsychologist||10/1/2012|
|Neurology – Functional||BRAIN TREATMENT CENTER||12/7/2012|
|Physiatrist – re-referal||Injured Worker||#########|
|Neurologist [with TBI expertise]||Orthopedic Surgeon||1/9/2013|
|Psychologist / Neuro, Clinical, Psych||Orthopedic Surgeon||1/9/2013|
|MRI – Cervical||Orthopedic Surgeon||2/15/2013|
|Neurologist – referral||Orthopedic Surgeon||2/15/2013|
|Psychologist / Neuro, Clinical, Psych –||Orthopedic Surgeon||2/15/2013|
|Speech Therapy w/cognitive remediation||Orthopedic Surgeon||2/15/2013|
|MRI – Cervical||Orthopedic Surgeon||3/20/2013||4/19/2013|
|Neurologist – [with TBI expertise] appeal of denial||Orthopedic Surgeon||3/20/2013|
|Psychologist / Neuro, Clinical, Psych – appeal re denial||Orthopedic Surgeon||3/20/2013|
|Speech Therapy w/cognitive remediation||Orthopedic Surgeon||4/8/2013|
|Speech Therapy w/cognitive remediation||Orthopedic Surgeon||4/24/2013|
|Speech Therapy w/cognitive remediation||MA, CCC-LSLP||5/1/2013|
|Neuro-Vision/ Occupational Therapy||Neuro-Optomentrist||5/24/2013|
|Neuro-Vision PRESCRIPTION CHANGE||Neuro-Optomentrist||5/24/2013|
|Psycho/Neuro, Clinical, Psych||Forensic Psychiatrist||5/28/2013|
|MRI – right shoulder||Orthopedic Surgeon||5/29/2013||7/3/2013|
|Physiatrist – re-referal to Patterson||Orthopedic Surgeon||5/29/2013|
|Neuro-Vision/ Occupational Therapy||MS/OTR – L||6/5/2013|
|Psychologist / Neuro, Clinical, Psych||Clinical Psychologist, Neuropsychologist||4/23/12/|
|LUMOSITY BRAIN GAMES||Neuro OD||verbally|
|Chiropractic||14 sessions thru 4/2/12, 6 more pendiing|
|Physical therapy||8 sessions 4/19-5/8/13|
|Psychologist /Neuro, Clinical, Psych||17 irregular sessions 1/14-8/21/2012|
REQUESTED MEDICAL TREATMENTS — DENIED DENIED DENIED
Defense Attorney: None of the doctors requested a brain doctor to evaluate you.
Injured Worker: The shoulder MRI results just came in. The Orthopedic Surgeon and Primary Treating Physician (for the brain injury) is recommended surgery with a specialist for the extent of the damage. I told him, “NO WAY. WORKERS COMP INSURANCE COMPANIES, DOCTORS AND LAWYERS JUST KILLED A WORKER WITH A SHOULDER INJURY AT RALPH’S MARKETS…. NO WAY WILLL I EVEN CONSIDER IT UNTIL I GET MY BRAIN BACK.”
Defense Attorney: I haven’t seen the shoulder MRI and report yet. Of course, that claim is denied. It was not an approved/accepted/authorized body part.
Side note: Later, over the course of Judge-ordered tasks at the expedited hearing to clean-up the alleged fraudulent and malicious and repeated omissions of records to evaluating doctors, the defense attorney and injured worker compared lists of documents and missing documents. Whines that the records were never received that were quieted with, “yes they were, with and without proof of service, multiple times” were not encouraged by the Judge. In fact, the Judge just wanted solutions to get the matters moving forward….and seemed to hold the belief that TRUTHS WINS IN THE END.
Defense Attorney: I know you think I am evil, but I am not.
Injured Worker: [Sure thing, Lawyer. Prove it. Get me some medical care before I croak! ] Somebody sure is since I have not received reasonable and appropriate and legitimate medical care for the brain injury sustained a year and 5 months ago, except what I have paid for out of pocket. If you will direct the claims adjuster to once and for all reimburse the medical 8,696 medical miles expenses of $2,649 and the medical expenses to date of $12,826.54 PLUS MAXIMUM PENALTIES THE LAW ALLOWS, at least I can proceed with self-procured medical care until the Judge is able to ‘hear’ the issues at hand, and until the District Attorney has time and power to investigate.
Defense Attorney: I know you think I have left out medical records on purpose; that would be illegal.
Injured Worker: YES, IT’S CALLED FRAUD and it’s an uncovered documented pattern with regard to providing medical care to this injured worker. Today’s remedy is just a temporary fix. It’s not over. Today’s outcome determines the depth of the Fraud Complaints to be finalized PDQ.
DATE OF INJURY: JANUARY 9, 2012 Appropriate Medical Care: NONE, except self-procured treatments and evaluations.
“The Workers’ Compensation Fraud program was established in 1991 through the passage of Senate Bill 1218 (Chapter 116). The law made workers’ compensation fraud a felony, requiring insurers to report suspected fraud, and established a mechanism for funding enforcement and prosecution activities. Senate Bill 1218 also established the FRAUD ASSESSMENT COMMISSION TO DETERMINE THE LEVEL OF ASSESSMENTS TO FUND INVESTIGATIONS AND PROSECUTION OF WORKERS’ COMPENSATION INSURANCE FRAUD. The funding comes from California employers who are legally required to be insured or self-insured. The total aggregate assessment for Fiscal Year 2010-2011 was $50,157,805. During Fiscal Year 2010-2011, the Fraud Division identified and reported 5,741 SFCs, assigned 501 new cases, made 254 arrests and referred 272 submission to prosecuting authorities. Potential loss amount to $276,894,742.”
— California Department of Insurance FRAUD: workers’ compensation fraud and convictions page