Thank you again for the hotel discount vouchers. I am heading out to Newport Beach shortly, but I had promised Stewart Reubens of Grancell that I would respond to his recent emails by today. That was compounded and exacerbated by the unbelievable denial of medical care out of Maximus, the California ‘end of the road’ agency. The doctor received ex-parte records and he was either off-his-meds, had too many martinis, or might be subject to drug testing or else? I found other reports by the same doctor on the internet.
Maximus personnel was very nice when I told them we have a problem with the report as the fraud is egregious. They told me on Friday to send a request to them for reconsideration before sending it to the the WCAB appeals people. This is it. It is my experience that when dealing with WorkComp legal/medical fraud, facts mean nothing to the perpetrators, and legal chicanery prevails. Taking matters to the Virtual Streets seems to be the one and only hope for injured workers. My list of fraud allegations and perpetrators is long indeed, provided, in part, already to the FBI – Palm Springs Office.
Well, that’s another quandry, as it is somewhat out of synch. Before I hit the road, I will try to respond in this letter to both Stewart Reubens and the Maximus help people, and copy “supplemental people” as Stewart calls them, and I will put it on the internet as well.
As I looked through it all, I remember that in 2013, CorVel had authorized modified care to include a couple acupuncture and chiropractic treatments, but Grancell again refused to set up those appointments and the Judge had to tell Ms. Mall to just do it….that took about 9 months. Ms. Mall, the first Grancell attorney, has a knack for telling whoppers, and she is the first to incorrectly tell doctors that I had a head injury in 1993 and another in 2008. No doctor until January 9, 2012, Dr. DeGoede whom the CIGNA Employee Assistance Program sent me to is the first I had ever been diagnosed with a brain injury. In the reports to doctors that Grancell is now attempting to have me evaluated by, Stewart is telling them of his opinion (non-medical, based on no medical evidence) that I have had previously diagnosed brain injuries and treatments. They both, Kim and Stewart, lie when they say I withhold info of a car collison of 1993 and 2008. Both I recovered from, and neither had ever suggested a head injury. Kim and Stewart seem to like to practice medicine at my expense. They also like to put the 2012 EEG report of head injury to falsely show it as a 2010 report of head injury, although the doctor apologized for the mis-dated report, but any thinking person could read the report and see it was in fact done in 2012. The doctor was not even in California in 2010, when Grancell attempts to mislead doctors.
The Maximus report I received last week falsely states numerous things, including what appears to be a set up for a fraud investigation at my expense. Somehow that doctor says the right shoulder was the primary industrial injury and that the injured worker [me] did not report a head/ brain injury until weeks later following an incident at home. They disregarded the medical records I provided, and just seemed to follow exparte communications,
Well, that’s further insult to further injuries. Take a look at the DWC-1 form that I was given on January 9, 2012, without any insurance information on it and see what it says about hitting my head real hard.
These actions are quite similar to the deceptions caused by Ms. Mall when she omitted approximately 300 pages of medical records to QME/AME doctors in 2013, and encouraged them to falsely opine prior head injuries, moving the date of reported injury not weeks, but into the future of 2013, and they used medical records of 2012 as ‘evidence of pre-existing head injury’. When brought to THEIR attention, those corrected the date of injury on their report, but not their false allegations, nor did I get any of the recommended since January 2012 medical treatments. UFB, for sure, but it has kept me from medical care over 3.5 years, and has kept the legal/medical files churning, to the point somehow Grancell got the Judge to authorize even more evaluations.
The Exclusive Remedy and Labor Code of California does not say insurance carriers are to provide evaluation after evaluation….it is allegedly about providing medical care as an exclusive remedy to civil rights and law suits. It apparently requires DOJ/FBI/DA intervention to help companies like Grancell with proper interpretations of the law, and perhaps RICO support.
Now, I have provided the Maximus report to my State Senator and have asked for intervention to involve the District Attorney – Corporate Fraud Unit and the FBI for similar task force. I am hoping that Michael Grabell of ProPublica is tracking what I send, or perhaps Ana Garcia of Los Angeles is another investigative reporter that may become involved.
So, for the record, I have asked Fred Sachs, CNA Adjuster and Stewart Reubens, Defense counsel of Grancell Stander to cancell all the appointments that were in violation of my right to be heard by the Judge at WCAB with ADA accommodations (first they said they would not accommodate for ADA, then they changed the date of the hearing, then they cancelled the hearing, then I started receiving notices of appointments with non-specialists in the field of brain injury, auditory processing, vision processing and chiropractic and acupuncture have been denied again.
My total out of pocket expenses to date because CNA refuses to provide medical care now exceed $43,350.44 since date of injury, 1/9/12. While all the medical reports indicate that I received medically necessary treatments, they don’t seem to account for the fact that I paid for most all of it myself. CNA, for a brain injury, paid for a few clinical psychologist sessions in 2012 along with some chiropractic; in 2013, they paid for 6 physical therapy and a few more chiropractic, in 2014 they paid for some acupuncture and 24 sessions of speech therapy, physical therapy and occupational therapy, cut short from the 3-6 months of care that was requested.
The current CorVel modified recommendations included neuro-optometry eval, neurology consult as requested last April 2014 to review the EEG with corollary medical evidence. Let’s get those issues handled, sort out the inaccuracies of the Maximus report, let’s get the FBI and DA-Corporate Fraud units involved with the CNA Fraud Unit representative and let’s organize a claim audit once and for all.
The allegations by Maximus that I sustained a shoulder injury at work and a head injury at home…. well, that seems to be a last straw, doesn’t it? The Maximus report also alleges there is no evidence for continuation of any of the ACOEM/MTUS guideline recommended treatments for traumatic brain injury. I think that doctor also suggested I failed to return to work at some point.
Holy Moly…. Tina, tell them how hard I have been trying to get back to work and that your hands appear to be tied by the defense counsel and carrier? Remember, in November 2012, my attorney of the time, in collusion with Ms. Mall of Grancell, attempted to coerce me to accept a $100,000 settlement, forfeiting all future medical, disability and it required that I quit my job (oh yes, it also mentioned the shoulder injury along with the closed head injury, but Ms. Mall’s team apparently threatened my primary treating doctor’s office more than once with dismissal from the alleged MPN if the early records regarding the right shoulder were not changed to ‘non-industrial’ ….they tried to call me MMI orthopedically last summer and did so this December, deferring to Neuro/psych doctors for head/braininjury after cancelling my appointment for their final report.
I have had no Primary Treating Doctor since December 2014, and Dr. Hilda withdrew from the case in April 2015, and Stewart says it’s not his job to help me get medical care, and that I can choose my own doctors. If that was so, why did I get stuck with an Orthopedic Surgeon since April 2013 with no knowledge of brain injury, and every referral was dismissed, and finally Ms. Mall said his referrals didn’t count because he is bone doctor not a brain doctor. D’oh — not verbatim, but words to that effect.
Because I retained incompetent legal help for 30 days in 2012, then 9 months in 2012 (that guy tried to get me to accept $100K, less attorney fees, with the above restrictions and said, “Nobody will believe you have a brain injury” and I said that’s because he didn’t get me to any brain doctors as everybody recommended, and I assured him I am INJURED NOT STUPID. The next attorney was retained in January 2013 because of the pattern and practice of Ms. Mall (and now Mr. Reubens) to omit medical records with intent to deny medical care—- and fortunately for other injured workers, that attorney who mis-represented me for merely 90 days, is allegedly retiring and just returned my file. He, like the other 3, refuse to release their liens, and as their staff says,. “Oh don’t worry, the 15% doesn’t come out of your part”…. They seem to fail to grasp that no competent attorney will clean up their … failure to represent and failures to do their jobs…. and be willing to split a fee. These applicant attorneys seem to be bottom feeders, yet Ms. Mall and Mr. Reubens like to suggest that there’s something wrong with me for having dismissed 4 incompetent representatives.
I have to head out to Coastline Acquired Brain Injury Program and I have found a local psychologist who will meet with me and help me, I hope, sort out the rest of my life since it also does not not promising that I will be able to complete the Coastline ABI program, and will have to find a way to return to work at the conclusion of the Summer Session.
I have asked Fred Sachs, CNA Adjuster, again for a treating doctor of neurology and neuro-psychology in the Palm Desert/Palm Springs area. Dr. Seymour Young, neurologist who ordered the EEG last year doesn’t take WorkComp, but he may be willing to be on my team via Medicare. The vision and auditory processing issues are not going to be resolved because Kim and Stewart get people to lie about the case; Wyndham didn’t hire me in multiple locations nor send me to Big Bear to help out in that mess because I was not a valuable employee…. I used to help managers even in Hawaii with management reports, including employee retention and motivation and training.
I suggest you ask Michael Dougherty to immediate get going with a Claim Audit and I will follow up next week with the Senator’s office, the DA-Corporate Fraud Unit, the FBI, Maximus and Grancell. I will also prepare a DOR to get back in front of the WCAB Court, to be heard on these issues of fraud and failures to provide medical care and other violations.
I just can’t do anymore than this today, and it upsets me just having to think about the criminal fraud I have been subjected to by this swath of apparent white collar criminals.
Are these matters of the FIFTH AMENDMENT or can they resolved with a FIFTH ATTORNEY.
TIME WILL TELL, HUH?
Let’s plan to meet in accordance with interactive process guidelines, some Thursday or Friday in Palm Springs and I will ask the new doctor in Palm Springs if you can be included in a session where we talk about return to work accommodations planning. One time, in January 2012, Daniel Elliott, then adjuster, spent a full session on the phone with Dr. DeGoede, who explained back then the seriousness of my brain injury and the need for immediate medical care. CNA did not have a neurologist or neuro-psychologist to send me to then either, and Daniel relied on Dr. Goede’s contacts to get me to some specialists, then all hell broke lose when the extent of my injuries was evident. I have a long drive ahead, so, we’ll deal with more of these details later in the week.
Help me now?
LINDA AYRES, IN PRO PER
#WorkComp and Brain Injury Survivor
760 368 7236
PO Box 835
Yucca Valley CA 92286
PS Linked In is getting a little spooky….. In recent weeks, people with profiles alleging to be high ranking military officials are sending private messages that are less than professional. I would like to write a happy ending to this horror work comp drama and close up my LinkedIn open-ness, and get on with my life.
web version to be found at:
ASK ABOUT WORKERS COMP GRAVY TRAINS
From: “Jordan, Tina R”
Date: Tue, 2 Jun 2015 18:24:43 -0400
To: Linda Ayres; Linda Ayres
Subject: Wyndham Employee Discount Vouchers
Please find attached the signed discount vouchers for Wyndham hotels provided to you so you can secure accommodations at your expense. Let me know if you need more in the future and I would be happy to assist.
Regional HR Director – Southern California
Wyndham Vacation Ownership
7610 Hazard Center Drive Ste. 301
San Diego, CA 92108