Is Wyndham Worldwide Committing Workers’ Compensation Fraud in California?? ASK AN INJURED WORKER TODAY!

DRAFT TWO:  TO WHOM IT MAY CONCERN

Just the Facts, Jack and Jill!

“A WITNESSED SLIP AND FALL WITH LOSS OF CONSCIOUSNESS AT WORK….”

#WorkComp NEGLIGENCE BAD FAITH AND REFUSAL OF WYNDHAM WORLDWIDE TO PROVIDE NECESSARY MEDICAL TREATMENTS TO INJURED WORKER SINCE 1/9/2012

Forensic Psychiatrist:  “Treatment should only be provided industrially if the Finder-of-Fact finds some evidence of an industrially-related concussion injury.”  April 2013

wc workers-comp-fraud  if your company lies

OFF WORK NEARLY 1,000 DAYS…EVALUATION AFTER EVALUATION, RECOMMENDATIONS FOR TREATMENT REPEATEDLY BY MULTIPLE EVALUATING DOCTORS…IGNORED OR DENIED…NOT AUTHORIZED.

Wyndham Worldwide #WorkComp BAD FAITH DENIALS;  JUST THE FACTS!  USA SOS!!!

STILL ON THE ‘REST AND WAIT PROGRAM’, WITH REQUESTS BY DEFENSE FOR YET ANOTHER ORTHOPEDIC EVALUATION, WITH A REQUEST FOR AN ORDER TO COMPEL…. in order for defense to ‘defend’ against the demand for medically necessary treatments, denied since date of injuries.  #USA SOS!!!

Liberty face palm

Wyndham Worldwide:  http://www.wyndhamworldwide.com/  

http://www.wyndhamworldwide.com/about-wyndham-worldwide/mission-culture

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draft 1  – June 16 2014; sent to Grancell Stander Reubens, et al,  CNA Insurance/American Casualty and Corvel Corp-Utilization Review Department, as well as Dr. Darren Bergey, Orthopedic Surgeon PTP  and Dr. Hilda Chalgujian, Neuropsycholgist.

draft 2 – June 29, 2014  …herewith:

LINDA AYRES VS. WYNDHAM WORLDWIDE   ADJ8181903    NEGLIGENCE, BAD FAITH AND REFUSAL OF EMPLOYER TO PROVIDE IMMEDIATE REASONABLE AND APPROPRIATE MEDICAL CARE, SINCE DATE OF INJURY, JANUARY 9, 2012, WITH FURTHE BAD FAITH ACTIONS CAUSING IRREPARABLE HARM TO INJURED WORKER.

[a friend, A RETIRE NURSE, helped organize these facts, without the emotional ‘charge’ around them.]

No head injury is too severe to despair of,
nor too trivial to ignore
-Hippocrates 400 BCE

Date of Injury:  January 9, 2012, approximately 8 a.m.

Injured Worker: Linda Ayres, TimeShare Sales Executive –

Vacation Ownership Sales, Real Estate Broker

Claim #: CNA e3269102     WC #:  ADJ8181903

 

A witnessed slip and fall with loss of consciousness at work.  Able to stand with assistance.  Complained of feeling “dazed and confused”.  Also, c/o headache and pain in back of head, neck, back and right ankle.  Was neither advised nor offered a ride to seek medical treatment by sales manager who had witnessed the fall and assisted with getting up off the snow covered ground.

 One unfortunate event led to another unfortunate event, which led to a series of unfortunate events with wrong dates, doctors, omitted records and misinformation and inconsistencies with misrepresentations.  The harm caused to the injured worker by these unfortunate events is irreparable.

She continued with “usual work” (sales meeting followed by sales presentation) with above symptoms, including severe confusion, until approximately 10 am, when administrative manager approached with work comp form stating “you can see any doctor that takes work comp insurance”even though the form had no insurance information on it.  Again, she was not offered a ride to the Emergency Room nor was she advised to seek immediate medical treatment.  She continued with above S/S, including confusion and dizziness.  She left work at approximately 2 pm, (approximately 6 hours post fall) with her manager’s knowledge of an approximate 1 hour drive home – 20 miles down steep snowy mountain road, 40 miles of flat desert road.

 

She continued with headache, confusion, dizziness, head, neck back and right ankle pain.  She drove directly to the chiropractor who had been seeing her periodically (every 1-2 months) for maintenance.  Upon arrival, the office staff commented on her state of confusion and general “dazed” appearance.  She informed the chiropractor about the slip and fall at work, her LOC and immediate and persistent pain, headache, confusion and dizziness.

 

The doctor’s office attempted to contact her employer for needed information regarding a work comp claim.  Messages were left but employer did not return calls.  (See email from Dr. Whitlock to Daniel Elliott dated Tuesday, 2-28-12, CNA Adjuster, and return email authorizing more chiropractic visits #14)

 

1-11-12 injured worker presented self to Avalon Urgent Care due to increase in confusion  and pain and headaches.  (See 1st Report of Occupational Injury).

 

Injured worker was not contacted by employer for follow up.  Not given a list of MPN authorized providers.

Was given an incomplete Work Comp form filled out by employer.  Personal health insurance (CIGNA) billed for Work Comp by Avalon Urgent care due to lack of infomration on Work Comp DWC-1 form.  Attempted authorization by Urgent Care.  No response from emkployer or Work Comp Insurance.  Injured worker had to pay out of pocket for co-pay and medical tests including Xrays (request for MRI).  This office was not a member of alleged MPN at the teime, but apparently later became a member.

 

On 1-11-12 injured worker contacted EAP provided by employer due to continued confusion and concern thereof.  Continued lack of support by employer.  She continued to update employer  No authorization for medical treatment.

On 1-13-12, Injured worker was seen by Dr. Daniel DeGoede, Clinical Psychologist,  referred by employer EAP (Employee Assistance Program).  See handwritten referral dated 1/13/12 from Dr. DeGoede  to Dr. Esmael Sebti, Neurologist for scheduled appointment on 2/7/12.  Was refused evaluation and referral when appearing for appointment by Dr. Sepbti due to non acceptance of work comp patients.  It was later discovered that this doctor’s two offices were a part of the alleged MPN network.

 

On 1-21-12 Retained attorney due to lack of medical treatment and appropriate authorizatin for treatment of head injury and was scheduled for an appointment on the next day by the law office with an Orthopedic Surgeon. Dismissed law firm with cause shortly thereafter, at the recommendation of a retired Judge, and worked directly, in-pro-per,  with Adjuster to coordinate a team of providers, with Dr. DeGoede, Clinical Psychologist as lead doctor and designated PTP.

 

On 2-4-12, sustained further injuries after two falls at home from LOC due to head injury on 1-9-12 with undetermined periods of loss of consciousness, suspected to be less than 30 minutes each, but unknown.  (See attached Hi-Desert Hospital ER report of Dr. Lambros, NO EEG DONE.

On 2-6-12  MRI Brain (one month post initial injury, 2 days post subsequent 2-4-12 injuries).  MRI not authorized by WorkComp Carrier even though it was recommended by 1st treating doctor in Urgent Care prior to subsequent fall on 2-4-12.   The MRI WAS authorized by employee health care provider, CIGNA, with a large co-pay due at time of MRI.

On 2-22-12, Authorized referral (non-MPN) to Dr. Eileen Kang, Neuropsychologist, by Dr. Daniel DeGoede, Clinical Psychologist (EAP referral, and ultimately authorized (non-MPN) at PTP.  Dr. Kang performed a battery of neuro-psychological tests and recommendations for further treatment were ignored by insurance carrier.

On 3-6-12, was referred by office of Dr. Kang  to Dr. Stephen Waldman, Neurologist  (2 hour drive from home; non-MPN provider, no TBI expertise; field of expertise epilepsy and fybromyalgia)  after several failed attempts to find a neurologist on the alleged MPN list.   Without medical evidence, Dr. Waldman recommended ‘precautionary epilepsy medications with mood elevator’ and attempted to have driver’s license revoked for decline of offer of unfounded medications.  A second neurologist was requested, but denied by carrier.

 

In March 2012, was referred to another  attorney, who was retained until November 2012 .

On 4-23-12, was then referred, again by another attorney, to a clinical psychologist, Dr. Marcel Ponton, in Pasadena (3 hours from home) who’s colleague, Dr. Gunn, re-administered a similar battery of neuro-psychological tests and recommendations for further treatment and evaluations were ignored by insurance carrier and in fact, TTD benefits were terminated on 4/30/12 in bad-faith action by carrier.

Dr. Marcel Ponton then referred injured worker to a second Orthopedic Surgeon, Dr. Kahlid Ahmed for a second consultation, and to a physiatrist, Dr. David Patterson, Medical Director at Casa Colina Rehabilitation Centers, for DMV eval to disprove Dr. Waldman request to revoke driver’s license.    Recommendations for further treatment and evaluations were ignored by insurance carrier.

 

Diagnosis through March 2014

850.1 Concussion w/brief loss consciousness, 338.11 acute pain due to trauma, 847. 0 Cervical Sprain/Strain, 839.08 Disloc mult. cerv vert clos, 728.85 spasm muscle, 839.21 Disloc thoracic vert close, 739.3 Nonallopathic lesions lumbar nec,  854 Closed head injury, 784 Headaches, 310.2 Post concussive syndrome, 850.1 Concussion with brief loss of consciousness, 850.9 Head Concussion, 309.81 PTSD, 310.2 Post concussive syndrome, 780.93 Closed Head Injury with amnesia, 921.00 Contusion (left orbit), 750.90 Concussion, 959.01 Head Trauma, 959.01 Cognitive Changes following head trauma, 850.0 Concussion, 959.00 Head Trauma (Contusion x 2) with Impaired Memory, Speech, Balance and Vision, 850-854, 959.01 Somatic/cognitive dysfunction and emotional dysfunction, 310, 310.8, 438 Mild cognitive dysfunction, memory processing,, 850 Mild TBI positive lapse of consciousness, 310.20 Post Concussive Sydrome, 309.28 Mood Disorder secondary to Post Concussive Syndrome, 959.01 Head injury,  Lobe Disorders: frontal, parietal, cerebellar dysfunction, motor dysfunction, segmental dysfunctions, Closed Head Injury with Ongoing Sequelae, Psychological sequelae, possibly secondary to industrial injury, 959.01 Closed head injury with cognitive dysfunction and speech dysfunction, 784.00 post traumatic headaches, brain based vision impairments, brain-based vestibular and balance disorders + secondary to head trauma, NECK, BACK, Shoulder PAIN and related ICD-9 codes, 850.9 Head Concussion, 854.0 Closed head injury, 784.0 Headaches, 294.9 Cognitive DisorderNOS, 310.20 Post Concussion syndrome, 850.9 Head Concussion, 378.42 Exophoria, 378.43 Vertical Heterophoria, 368.33 Fusion with Defective Stereopsis, 368.13 Visual Discomfort. Neck Pain 723.1, Mid-back pain 724.1, [Note: “A Vision rehabilitation program is medically necessary to improve Linda’s deficient visual skills, as noted…(March 22, 2014, Dr. Lynn Lowell, Neuro-Optometrist, Ketchum Eye University 2014, as also indicated by Dr. Eric Ikeda, Casa Colina, Neuro-Optometrist]  Closed Head Injury 854.0, 784.0 Headaches, 294.9 Cognitive Disorder NOS, 310.20 Post concussive syndrome, 850.9 Head Concussion.

.einstein concussion

 

Dr. Hilda Chalgujian, Forensic Neuropsychologist: May 2014 –

‘…recommend this patient be monitored neurologically in light of the above-noted cognitive issues; patient will benefit from a neurologist with experience int he treatment of traumatic brain injury; … recommend patient continue with individual therapy to help develop better insight into her functioning and increase her coping skills, and minimize external stressor;… supportive individual psychotherapy will help her develop strategies to help her…;  recommend she receive speech therapy to directly address her current difficulties with communication, including verbal fluency, as well as attentional issues…; recommend she is evaluated and monitored by a neuro-ophthalmologist to assess her ongoing and longstanding complaints of impaired vision, and explore vision therapy…; she may also benefit from occupational therapy to address ongoing visual concerns; this treatment should also address how to best compensate for situations that would be most relevant for her return to work in the future; …defer to her treating physician for her physical therapies; she should be re-evaluated in six months following her treatment regimen to assess her permanent and stationary status….’

 

ALL IN ALL, TO DATE, SHE HAS SEEN:

 

34 specialists, and has had 2 MRI of the head, one of the Cervical Neck, and one of the Right Shoulder.  Several of the doctors were referred by attorneys, her legal representation or by treating doctors.

 

She has been seen by neurologists, psychologists, psychiatrist, neuro-optometrists, neuropsychologists, physiatrist, 4 orthopedic surgeons, multiple therapies, including speech, physical for neck, acupuncture, vision and cognitive rehabilitation evaluation (please refer to attached list)

 

Retained and dismissed 4 attorneys due to incompatible goals; Injured worker has been represented approximately 14 months out of the 2 years 5 months since date of injury.   Each attorney did increasingly greater harm compounded by further failures to facilitate medical treatment than prior representatives.

 

The most care/evaluations were authorized when injured worker was in-pro-per after dismissing law firm #1. (Treatment with Dr. DeGoede, Dr. Kang and Dr. Whitlock Jan-Apr, 2012)

 

Due to brain injuries, and consequent communication and cognitive deficits, injured worker has been unsuccessful in retaining competent legal representation, knowledgeable about proper handling of a brain injury claim and necessary treatments and treating team, in accord with ACOEM guidelines. ADA requests for accommodations at WCAB – Riverside have been repeatedly violated.

 

1) <30 days (1/21/12);      Castillo & Associates

2) >9 months (Mar 2012 – Nov 2012)   Mike Durich, Esq. 

3) < 3 months  (Jan 2013 – Apr 2013)  David Lynch & Associates

4) < 1 month  (mid-Dec 2013 to mid-Jan 2014)  Clayton Perry, Esq.

 

Treatments of chiropractic, acupuncture, neuro-optometry, neurology, functional neurology, speech therapy evaluation, on-line brain-training, EEG, and Brain MRI’s were medically necessary, as requested by multiple doctors, and in light of the medical necessity, and continuous bad-faith actions of employer and it’s insurance company and defense counsel, have been self-procured and more than approximately $23,500 in outstanding medical costs remain unreimbursed since 2012.

 

To date, authorized treatments have only included:

2012 – 14 chiropractic, 17 psychotherapy

2013 –  6 physical therapy

2014 –  6 chiropractic, 12 acupuncture (right shoulder only for first 6, second set of acupunture requested as “959.01, 784.01 Multiple Head Injury, Multiple Neck Injury, Multiple Upper Extremities, Upper Back Area” and was modified by non-doctor to “959.01, 784.0 Multiple Neck Injury, Upper Back Area”  

[All urgent medically necessary treatments have not been authorized, many denied by non-physicians, and in 2013, Corvel became involved in further denials, primarily not-authorized by their Orthopedic Surgeons denying further evaluations and treatment by specialists in Traumatic Brain Injury.  Distortions by QME/AME doctors, compounded by Defense pattern and practice of omission of medical records have further contributed to the lack of medically necessary treatments. The 38 page April 2014 evaluation by Forensic Neuropsychologist has been objected to by Defense, apparently in order to further delay treatment and cause further harm.]

 

 

THEREFORE:  

#1  Wyndham Worldwide and it’s agents neglected to provide medical treatment and proper evaluations since date of injury.  Managers at Wyndham Worldwide resort – WorldMark by Wyndham at Big Bear – were negligent and apparently untrained in proper handling of an industrial injury, particularly one including a head injury.  The failure to have transported the injured worker to the closest Emergency Room or advise injured worker to seek immediate medical treatment to avoid further injury is extreme negligence.

#2 Not given proper Workers Comp info on MPN Providers and List of Providers and 1st report insurance information was lacking, causing need for use of  employee CIGNA insurance through February 2012.

#3 Allowed to “drive self home” six hours after Wyndham managers saw her fall and lose consciousness.  Allowed her to continue working even though she complained immediately of confusion, pain in her head, back and neck and right ankle.

#4  No immediate treatment authorized for head injury / MRI / EEG.

#5  Continuous negligence from lack of authorized treatments sent on a path of self-procured medical treatments (requested by multiple providers, ignored by carrier).  Out of pocket expenses for doctors, appointments, treatments and equipment needed for prognosis and ongoing care of brain injury and rehabilitation, and orthopedic injuries.

 

SEEKING IMMEDIATE RESOLUTIONS

A) Monetary reimbursements of medical mileage, treatments, and equipment.

B) Lump Sump Settlement for life-time medical treatments including certified Brain Injury Rehabilitation including but not limited to cognitive rehabilitation for high level Loss of Executive Function of Hi-IQ TBI survivor, vision therapy, vestibular therapy, speech therapy, vocational rehabilitation and retraining, with compensation for extreme loss of future earning capacity,

 

EXHIBITS:

(to be listed)

(Unreimbursed medical expenses and miles since 2012 exceed $23,500, submitted repeatedly and complaints filed with WorkComp Audit Unit for further investigations and penalties.)

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LIST OF DOCTORS INVOLVED SINCE 1/9/2012…

Dr. Khalid Ahmed MD, Orthopedic Surgeon
Dr. Darren Bergey MD, Orthopedic Surgeon
Dr. Hilda Chalgujian Phd, Neuropsychologist
. Crystal Crites MPT, Clinical Director
Dr. Daniel DeGoede Phd, Clinical Psychologist   $
. Jennifer Diemart MA, CCC-LSLP    $
Dr. Ernesto Gallegos DC   $
Dr. Christopher Hancock MD, Neuroradiologist
Dr. Tiffany Hoang OD   $
Dr. Eric Ikeda Neuro-Optometrist   $
Dr. Gilbert Jaudy DC, FACFN, FABVR, CCST   $
Dr. Eileen Kang Phd, Neuropsychologist
Dr. Ronald Kent ** MD, Phd, Neurologist
Dr. John Lambros MD, ER
Dr. Michael Lobatz MD, Diplomate, American Board of Psychiatry & Neurology   $
Dr. Lynn Lowell OD, FAAO, FCOVD  $
Dr. David McCollum DC
Dr. Joseph Nguyen OD   $
Dr. Brandon Nielsen OD   $
Dr. James O’Brien ** MD, Forensic Psychiatrist
. Debra Ouellette MS, OTR/L  $
Dr. David Patterson MD, Physiatrist, Medical Director of Rehabilitation  $
Dr. Marcel Ponton Phd, QME, Clinical Director
Dr. Jacob Rabinovich MD, Orthopedic Surgeon
. Don Risser Licensed Acupuncturist   $
Dr. Jay Sanvictores MD, Family Practice   $
Dr. Esmaeil Sebti MD, Neurologist
Dr. Julie Simmons MA, PSY.D
Dr. Gurvinder Sunny Uppal MD, Orthopedic Surgeon
Dr. Stephen Waldman MD, Phd, Neurologist
. Diane Wallace Licensed Acupuncturist   $
Dr. Lynda Wells PhD, EEG Neurofeedback Practitioner   $
Dr. Jaime Whitlock DC   $
Dr. Bijan Zardouz ** MD, Neurologist

 $  “Paid for by Injured Worker or/and co-pay with CIGNA Health Insurance, referred by EAP Provider

 

**  All but three doctors (Kent, O’Brien & Zardouz) recommended further medically necessary treatments and evaluations for #TBI/Closed Head Injuries and orthopedic injuries; only a few chiropractic, a few clinical psychologists, and 6 physical therapy sessions were authorized the first two years.  The fight continues for medically necessary brain injury rehabilitation as well as for orthopedic injuries; clearly documented; Wyndham’s agents have continuously refused to and failed to authorize.  

 

If the ‘injuries are so minimal’…. does it make sense that this injured worker would be off work for nearly 1,000 days… ‘for a headache and poor anger management skills when subject to intimidation, terrorism, and systematic bad faith and negligence?”

Capture WYN COUNT ON ME PROGRAM

How can the defense continue to refuse to authorize medically necessary treatments, and how can the defense further allege that these injuries, exacerbated by refusal to deny medical treatments since date of injuries, were somehow ‘pre-existing’…..???  Mr. Reubens, any further questions??

MAKE SENSE??

 

brain concussion tbi

If you’re like me, you want to know: What can YOU do Today?

 

(1) Well, BE AWARE OF THE HORRIFIC CRIMES AGAINST INJURED AMERICAN WORKERS BY FELLOW AMERICANS IN COLLUSION WITH THE BILLION DOLLAR INSURANCE INDUSTRY.

(2) Share this blog with someone…………by email, fB post, tweet, snail mail, etc.  BE CREATIVE.

(3) Share YOUR #WorkComp story and resources as comments on this blog or and http://www.NAIDW.org, National Association of Injured & Disabled Workers “NO WORKER LEFT BEHIND”  888.788.naidw (6243)

(4) Send your letter of support to  wynLINDA@gmail.com with encouragements to continue to FIGHT THE GOOD FIGHT; The SuperLawyers and Other Legal Experts and Government Officials interviewed have indicated that THIS STORY IS NOT UNUSUAL…. and that it has a ‘too bad, how sad’ ending, always.

(5) TELL YOUR FRIENDS AND NEIGHBORS; YOUR GOVERNMENTS ALREADY KNOW.

WC WorkCompFraud and Money

REMEMBER REMEMBER:  WE ARE THE MEDIA NOW.

ONE PERCENT  99 PERCENT

WE DO NOT…FORGET.

BUT IF WE DO FORGET DUE TO #TBI, FRIENDS DON’T LET FRIENDS STAY IGNORANT!

 SMALL ACTIONS BIG CHANGE

THINK LOCALLY.

ACT GLOBALLY.

OCCUPY VIRTUALLY!

EXPECT US!