Hurt on the Job? Uh Oh! HOPE FOR THE BEST — PREPARE TO FIGHT FOR YOUR LIFE
Lawyer Up or Self-Represent?
How does it work?
Who are the Key Players?
How do you get medical care? Hint: Cross your fingers and hope you don’t die first!
What to Track: Money In/Money Out/Money Stopped; Doctor appointments — arrival, names, notes, tests, directions, prescriptions, off work notices; Get and read copies of all medical reports and appeals, get business cards of all parties.
What to do if treatment is denied (and it will be denied, FACT! APPEAL, SQUEAL AND SQUEEK — JUST WHISTLE)
Why Blog? What to blog — What not to blog?
Suspect Fraud? Uh oh! FIGHT BACK!
Suspect Collusion? Uh oh! FIGHT BACK!
Did HR send a Get Well Card and Speedy Recovery Wishes?
Are you disabled? File for Social Security Disability immediately if you expect to be off work 1 year or more (Hint: If it’s work comp, count on it! File churning, obfuscation of facts, fraud and chicanery often caused delay, denial, deceptions and death. FILE TODAY; If you’re lucky enough to get legit medical care and return to work, welcome to that “1%” crowd!
Follow THESE Blogs – Comment on Industry Blogs
Join the #CommitteeOfBloggers – WE WORK LIKE ANTZ – Use these memes and hashtags too!
Lost your sanity, job, home and health? Uh-oh! Find an advocate to help you fight back – LEARN TO WHISTLE! #JustWhistle, #Tweet, #Blog, #Post, #Pin etc.
How? Have untrained staff, incapable of handling a work place injury, unable to offer medical support, transportation to an emergency room, or call 911. Ensure that staff do not know how to complete a DWC-1 form, know nothing about alleged MPN-Provider Networks, never send a get well card and never inquire over the years of denied medical care how the employee is doing; above all, never extend a get well wish, and threaten abled working staff to NEVER SPEAK TO AN INJURED WORKER, under any circumstances. Refer always to HR.
Then, hope for a newbie Adjuster who can “just follow orders” and rely upon EAP referred doctors for referrals to other specialists. Hope that adjuster seriously follows PLAY BOOK that apparently deems it necessary to terminate all benefits upon diagnosis of serious injury, including Brain Injury and commence acts of emotional, mental and financial terrorism.
Hope for a designated defense counsel that will go to any means necessary to “win the case” with plenty of Court time and other billable hours on matters related to legal chicanery and obfuscation of facts. When both are replaced after a few years, hope for seasoned, jaded professionals without hearts or souls. Higher on the food chain, the more intense the outcomes.
Count on AME/QME/IMR doctor reports written by non-medical staff, signed by industry leased/owned professionals for the big bucks, and know that legitimate doctors will also be cheated out of agreed upon fees and more.
Hope for a Risk Management team to successfully shift all risk and cost burdens to State and Federal agencies, without fear or caution. If necessary, hope for a fraud unit that will call injured workers and ask, “So tell me, ______, when ARE you going to die?”
Count on total violation of Civil Rights—-because WorkCompsters appear to be above the law, with no regard or respect for the Constitution of these United States of America and callous disregard for life and liberty.
WorkCompCentral 4th Annual CompLaude Awards Gala is coming up…. Mark your calendar for Saturday, December 5, 2015.
BTW, August 31, 2015 is the deadline for submissions of YOUR nominees for the WorkCompCentral CompLaude Awards. After the recent news about Director Christine Baker, it seems that the need for your to dig deeply into your database to find good people doing good stuff in America’s work comp system has never been greater. Here’s the link again.
On the who’s been naughty and who’s been nice, WorkCompCentral has the ‘nice” list being covered, and looks like ProPublica and #InjuredWorkersUniting will simply have to continue cover the ‘naughty’ lists and enlist support, #TEO!
HAVE YOU BEEN ALSO BEEN CHEATED OUT OF DISABILITY BENEFITS AS WELL AS DENIED MEDICAL CARE FOR YEARS, CAUSING PERMANENT DISABILITIES TO YOU, TOO? WE’RE NOT ALONE.
BUT WAIT! THERE’S MORE! AM I MISSING SOME CALCULATIONS HERE??!!! NOBODY AT EDD/SSA/CNA/MATRIX/ADVOCATOR/WYNDHAM SEEMS TO BE ABLE TO HELP OUT EITHER. IT’S IN THE ‘TOO HARD’ PILE EVERYWHERE….
The skewed and repeatedly mis-stated numbers have Social Security Administration in a super quandry over retroactive Social Security Disability benefits. First, they sent $_____________ to a dead bank account, and the Treasury Department kindly intervened. Then they sent a letter saying, whoooops, miscalculated, send us back $______ (more than the original amount) within 30 days, or else we’ll terminate all your benefits, but you can appeal it.
Then it was discovered they generously overpaid the law firm by $1,500 which was reimbursed immediately in June back to SSA, but SSA had apparently just processed that repayment, so they sent a follow up letter acknowledging the reimbursement and reduction in the demand for funds from Injured Worker by same amount.
Weeks have passed and SSA has been unable to return calls to the Advocator handling the case. The time to appeal is fast approaching, hence, this outreach via the internet. ARE THERE ANY FORENSIC ACCOUNTANTS OUT THERE? OR CAN THE STATE CONTROLLER’S OFFICE HELP? (3 OF 3 WILL FILL IN THE BLANKS ON AMOUNTS FOR SSA/EDD/CNA FIASCO…IT’S A TOUGH SHELL GAME TO FIGURE OUT—–> PARTICULARLY WITH A BRAIN INJURY.
I JUST KNOW IT AIN’T RIGHT…. and it’s in the “too hard” pile on too many desks, another example of ‘obfuscation of facts’ with intent to deny benefits and further harm injured worker? Sure looks like it, huh? Not even experts can sort it out.
CNA aka American Casualty refused to pay TTD from 4/15/12 – 2/14/13 — and there are extenuating circumstances involving not only WCAB Courts, but Information and Assistance Officers and EDD parties. Adult Protective Services, State Senator and Assemblyman’s office helped to break the stranglehold that resulted in Injured Worker having to apply for Social Welfare, Public and Private Assistance, including help from the Salvation Army for utilities in early 2014 because of this practice which is apparently “done all the time” according to CNA Adjuster, Daniel Elliott.
Reimbursement discount was ‘negotiated’ by defense firm with EDD, apparently without any State oversight, and a Judge on appeal said it was ok. Apparently, some Judges think it’s ok for the State to give away taxpayer dollars to big insurance companies.
[Yikes, CNA has racked up some penalties, haven’t they? Is there anybody enforcing these rules?]
____ Weeks Late; 25% penalties +++
___ Weeks late; 25% penalties +++
C NA PAID TO IW
104 weeks per Labor Code, weekly rate questioned, but at $1,298.82 x 52 checks = $67,538.64
C N A Reimbursed $31,400 to EDD on 4/29/14 for paying IW $49,49,422 from 2012-2013 because C N A refused to despite Court demand:
99/weeks effective payment?
Lump Sum Permanent Disability Advance
(subrogated by private LTD carrier?!!)
52 additional weeks of disability benefits to have been provided by the State, when the WorkComp system fails after the first 104 weeks, would have meant an additional benefit of 52 weeks x $961/week or $49,972.
So, if CNA had paid 104 weeks at $649.41 (eow check $1298.82) that would have been: $67,538.64
And if EDD has paid 52 weeks at $961/week that would have been: $49,972
Not counting the extreme hardships caused by months of non-payments by anybody, the total TTD benefits that were due between 1/9/12 and 1/9/15 seem to be around about $117,510.64 Injured Worker was actually paid 49,393.52 from CNA and $49,422, for a total of $98,815.52 for the 3 years (approximately $33K, that came in sporadic payments, causing extreme stress and hardship).
This appears to be a shortage of $18,695.12 (yikes, how close is that to the reward CNA received from EDD for refusing to pay TTD and for refusing to provide medical care? Is that a mere coincidence? These numbers alll jumble all over my brain. Social Security Disability was awarded in May 2015, with retroactive pay back to date of injury, 1/9/12, with the 6 month waiting period to 7/2012.
This is where it gets real real fuzzy…. that will be documented, with PDFs of all of ths in 3 of 3 – WorkComp MAGIC Money Math…
This seems to happen all the time, to many injured workers…..nobody seems to know how the sad tales end.
You’ll know how this one ends, count on it! Maybe you will even read about it in a ProPublica Report! ;D
Back pay caper of May 2014 RE
WC from SSA print out
C N A paid me
EDD paid approximately
difference EDD gave to C N A, not IW
EDD discounted back to C N A, collecting:
of the $31,654 EDD sent me approximately ($21,000.00)
C N A 5/8/2014 Notice states they paid a total of $82,092.04 – they did not. See above and figure in discounted payback to EDD
See also 9/23/14 statement from C N A
Weeks * $
1-9-2012 to 4-15-2012 TTD at $652.15 per week
2-5-13 to 5-8-14 TTD at $649.41 per week
Reimbursed EDD for period of 1/28/2012 – 3/4/2013 for a total of $31,400.
Fred Sachs, C N A
C N A alleged total paid $82,092.04 for 1/9/12 – 5/8/14
C NA alleges “We have paid the 104 weeks of benefits”
(law says 104 weeks + additional 52 by EDD afterwards as required)
THE MATH DOESN’T ADD UP
The question arises, how many unclean hands did that “negotiated discount” pass through before making it’s way back to EDD? If this is done all the time, how many times must that discounted $18,000 be multiplied to determine how much money leaves the State in favor of Insurance Profits??
If every State provides such “negotiated discounts” (aka “kickbacks”??!!)…. how much money is lost by such cost shifting by the State?
Further cost shifting involves shifting to Social Security Administration, also implicated in this convoluted mess, and they are spending weeks and weeks and weeks of labor hours trying to sort out the calculations. See below for more on that. Treasury Department has even had to become involved in May, and will likely need to jump in again before all is said and done?
According to the State of California Department of Industrial Relations, here’s the ideal regarding Temporary Disability benefits:
But wait! Is CNA aka American Casualty, THE ONLY INSURANCE CARRIER WITH SPECIAL PRIVILEGES AND DISCOUNTS afforded by DIR no matter what harm is caused to California Injured Workers? Have any politicians approved these little … what do we call it…. incentives???
Here’s what they say about attorneys: http://www.dir.ca.gov/InjuredWorkerGuidebook/FAQsAttorney.pdf (The warnings are quite inadequate–InjuredWorkers will create some new information for those new to the system. If you make a mistake retaining an attorney who freely violated the ABA Code of Ethics, you’re in for an awful ordeal, and they hang on like leaches to a file, preventing legitimate/competent attorneys from taking over their messes.
The In-Pro-Per community is a market overlooked by most WorkCompsters…. #InjuredWorkersUniting — perhaps with teams of Paralegals, the WarOnWorkers can be won, SunTzu style, with a Rag-Tag Army of Injured and Disabled Patriots and Others. Just sayin…THINK OUTSIDE OF THE WORKCOMP GHETTOS.
See the gaps in which CNA failed to pay a Wyndham Worldwide Injured Worker? Does that mean 25% of each late payment, up to $10,000 is now due and payable, with sanctions? Who absorbs that extra cost?
That looks like 45 weeks and 4 days? So would that would be 25% of…. ($1298.82 divided by…. times 45… no, times 22.5 which equals $29,200) so 25% of $29,200, or $7,300. Is that correct? So, if you multiply a practice of cheating injured workers like that times how many million injured workers are there, the plot thickens, huh?
There’s a rule about penalties for failures to reimburse medical miles which CNA also scoffs at. Complaints have been filed repeatedly with the Audit Unit; hopeful that Wyndham/CNA’s turn is coming up soon on auditors. Out of pocket medical expenses for this injured worker have exceeded $43,000. It seems to be a standard that injured workers who are able to, will often spend more than $50,000 in personal funds to survive the WorkComp system. Some grand bargain, huh? Wish for WorkComp only on your most despised enemies, huh?
“TD payments begin when your doctor says you can’t do your usual work for more than three days or you get hospitalized overnight. Payments must be made every two weeks. Generally, TD stops when you return to work, or when the doctor releases you for work, or says your injury has improved as much as it’s going to.”
APPARENTLY NOT IN CALIFORNIA! Does the State Controller know how EDD assumes risks for insurance companies then deeply discounts payback, which also deprives Injured Worker of the additional 52 weeks of State Disability, assuming that the first 104 weeks without medical care failed to result in employee death?
“ If you were receiving temporary disability (TD) benefits, the first PD payment is due within 14 days after the final TD payment” Ooooops, last TD payment was when? Shown as 5/8/14? Does that mean that some sort of estimated PD vs. receiving nothing for months and months and months was due?
Is the claims administrator required to pay a penalty for delays in PD payments? Yes. If the claims administrator sends a payment late, he or she must pay you an additional 10 percent of the payment.
“Is the claims administrator required to pay a penalty for delays in TD payments? It depends. The claims administrator must pay you an additional 10 percent of the payment, if: • The claims administrator sends a payment late; and • You filed a claim form for your injury more than 14 days before the payment was due. This is true even if there was a reasonable excuse for the delay. However, there’s no penalty if the claims administrator can’t determine, in the first 14 days after your employer learned about your injury, whether TD benefits must be paid and sends you a delay letter as explained above. You could be awarded a total of 25 percent of each late payment, up to $10,000, if there was no reasonable excuse for the delay…”
• Your treating doctor says you can return to your usual job (whether or not you actually return to work); or
• You return to your usual job or to modified or alternate work at your regular wages (or at wages associated with a maximum limit on TTD payments); or • You have reached a point where your condition is not improving and not getting worse. (When this happens, your condition is called “permanent and stationary.”); or
• You were injured on or after January 1, 2008, and received up to 104 weeks of TD benefits within five years from the date of injury, or you were injured sometime on or after April 19, 2004, through December 31, 2007, and received up to 104 weeks of TD benefits within two years from the start of payments. (Workers whose injuries involve acute and chronic hepatitis B, acute and chronic hepatitis C, amputations, severe burns, human immunodeficiency virus, high-velocity eye injuries, chemical burns to the eyes, pulmonary fibrosis, or chronic lung disease may receive up to 240 weeks of TD benefits within five years from the date of injury.)
When TD payments end, the claims administrator must send you a letter explaining why the payments are ending. The letter must list all TD payments sent to you. This letter must be sent within 14 days after your final TD payment. If your treating doctor says that you will never recover completely, you may be eligible to receive permanent disability benefits or a supplemental job displacement benefit. See Chapter 7. Permanent Disability Benefits, and Chapter 8. Supplemental Job Displacement Benefit [Ooooops, CNA didn’t do that either…. ]
[Yikes, CNA has racked up some penalties, haven’t they? Is there anybody enforcing these rules?]
“Most workers recover from their job injuries. But some continue to have problems. If your treating doctor says you will never recover completely or will always be limited in the work you can do, you may have a permanent disability. This means that you may be eligible for permanent disability (PD) benefits. You don’t have to lose your job to be eligible for PD benefits. On the other hand, if you lose income because of a permanent disability, PD benefits may not cover all the income lost.”
“Other Benefits Besides PD If you have a permanent disability, you may also be eligible to receive: • Medical care for your injury, described later in this chapter. • A supplemental job displacement benefit. To learn about this benefit, see Chapter 8. • Other financial help, such as Social Security disability benefits and benefits offered by some employers and unions. To find out about these benefits, use the resources in Chapter 9”
When do I receive PD payments? If you have a permanent partial disability, you are eligible to receive the total amount of your PD benefits spread over a fixed number of weeks. If you have a permanent total disability, you are eligible to receive PD payments for the rest of your life. PD payments are due as listed below, except as follows: If your employer offers you work that pays at least 85 percent of the wages and benefits that you were paid at the time of injury or you are working in a job that pays at least 100 percent of the wages and benefits that you were paid at the time of injury, you will not receive PD payments until after a workers’ compensation judge approves a settlement of your case or decides on the PD benefits you will receive. If neither of the above is true:
• If you were receiving temporary disability (TD) benefits, the first PD payment is due within 14 days after the final TD payment.
• If you weren’t receiving TD benefits, you should receive the first PD payment within 14 days after the claims administrator learns that you have a permanent disability caused by your injury. After the first payment, PD benefits must be paid every 14 days. PD payments end when you reach the maximum amount allowed by law or when you settle your case and receive a lump sum. Note: This lump sum is reduced by the PD benefits that you already received, including any lump sum advances.
Is the claims administrator required to pay a penalty for delays in PD payments? Yes. If the claims administrator sends a payment late, he or she must pay you an additional 10 percent of the payment. This is true even if there was a reasonable excuse for the delay and even if the claims administrator sends a letter explaining the delay. (Note, however, that this penalty is not required if you did not file a claim form for your injury.) You could be awarded a total of 25 percent of each late payment, up to $10,000, if there was no reasonable excuse for the delay.
EDD PICKED UP THE COSTS FOR TEMPORARY DISABILITY BENEFITS FOR THIS INJURE WORKER BECAUSE CNA REFUSED TO PAY TTD, ALTHOUGH AGREED UPON IN A COURT HEARING. THE ADJUSTER INDICATED THAT THEY DO IT ALL THE TIME. REALLLY?? THE INFORMATION AND ASSISTANCE OFFICER COULD ONLY SAY, ‘Look, the order says they would resume paying “if necessary” so apparently your Dr. Ponton didn’t think it was necessary.” Really, he continued to call me temporarily totally disabled in every reported, omitted and not, to the Carrier and to WCAB and to EDD, so what part of that could be misunderstood as being “not necessary”????!!!
For the records, EDD paid over an intermittent period, ending in mid 2014 for final reconciliation, after numerous appeals, a total of approximately $49,400 ….negotiated a discount of Injured Workers Benefits or Your Tax Dollars, providing the WorkComp carrier what appears to be an award for approximately $18,000 for REFUSING TO PAY TEMPORARY TOTAL DISABILITY PAYMENTS IN ACCORDANCE WITH LABOR CODE, AND FOR CAUSING PERMANENT TOTAL DISABILITIES BY FAILING TO PROVIDE MEDICALLY NECESSARY TREATMENTS WHILE RACKING UP WHAT APPEARS TO BE A DRAMATIC MONEY LAUNDERING EFFORT WITH MORE THAN APPROXIMATELY 40 FACE TO FACE MEDICAL EVALUATIONS.
NUMEROUS CorVel medical evaluations with supportive chicanery continuing the pattern of egregious harm with callous disregard for life and WITH TOTAL DISREGARD FOR RECOMMENDATIONS FOR TREATMENT.
This is the American Workers Compensation System? Everybody knows. What’s wrong you people putting up with these most vile practices that are mere profiteering by the maiming and experiments and exterminations of your fellow Americans? Is it really worth your soul to sell out humanity?
Well, we know that psychopaths have no remorse, compassion or soul—-is that what we have here, WorkComp is operated by a SWATH OF PSYCHOPATHS? SOS, MY FELLOW AMERICANS! SOS!
“If not you, then who? If not now, then when?” YOU COULD BE NEXT!
Date of Injury: 1/9/2012 — Brain Injury Survivor still on the rest and wait and wait and wait for benefits and medical care program. WorkComp Carrier has successfully shifted risks and burdens to the State and SSA, IS THERE A FORENSIC ACCOUNTANT READING THIS? OR DO YOU KNOW ONE TO SEND IT TO?
‘C N A Reimbursed $31,400 to EDD on 4/29/14 for paying IW $49,422 from 2012-2013 because C N A refused to despite Court demands and Injured Worker Objections”
” Not counting the extreme hardships caused by months of non-payments by anybody, the total TTD benefits that were due between 1/9/12 and 1/9/15 seem to be around about $117,510.64 Injured Worker was actually paid 49,393.52 from CNA and $49,422, for a total of $98,815.52 for the 3 years (approximately $33K, that came in sporadic payments, causing extreme stress and hardship).
This appears to be a shortage of $18,695.12 (yikes, how close is that to the reward CNA received from EDD for refusing to pay TTD and for refusing to provide medical care? Is that a mere coincidence? These numbers alll jumble all over my brain.
Social Security Disability was awarded in May 2015, with retroactive pay back to date of injury, 1/9/12, with the 6 month waiting period to 7/2012. This is where it gets real real fuzzy…. that will be documented, with PDFs of all of this in 3 of 3 – WorkComp MAGIC Money Math… This seems to happen all the time…..nobody seems to know how the sad tales end.
You’ll know how this one ends, count on it! Maybe you will even read about it in a ProPublica Report! ;D “
How many unclean hands do how many such ‘negotiated discounts’ pass through for the ultimate profit and bottom line of insurance carriers across America doing nothing but maiming and permanently disabling injured workers, cheating remaining legitimate WorkComp providers out of their fees, while supporting operations of sonderkommando type doctors willing to write fraudulent reports on behalf of their benefactors?
There is no mechanism in America’s workers comp system for Injured Workers to report Doctor, Attorney, Provider and Employer Fraud. DA only goes after groups like “Hell’s Angels” …..for what, cutting into the WorkCompster Drug Trafficking?
D’oh! At least the HAs are honest about their motives and practices of PROFITS BEFORE LIVES. Very few peeps in WorkComp can claim such honesty.
Why would a doctor prescribe a stomach drug for a brain injury survivor and why would a doctor prescribe an expensive creme for brain injury survivor, or why would a doctor prescribe (and mail without knowledge) a hand held ultra-sound device, without instructions for which brain lobe to use it on? That’s WorkersCompensation.
My Fellow Americans. Boomers! Heads up! The younger people do not have a chance in hell to survive American’s WorkComp rackets! Mamas! Don’t let your babies be doctors and lawyers and thugs! #SOS! #CommitteesOfBloggers needed ASAP! #WATMN
Why would a doctor prescribe an ‘epilepsy medication with mood elevators as a precaution for a few years’ for a slip and fall head injury, after a 5 minute meet and greet?
The more conservative, well-paid industry leased/owned WorkCompsters will prescribe ‘over the counter analgesics’ for brain injury, and some that, in the 60’s would have been categorized as “MCPs,” shrug and indicate that a woman over the age of 35 is not entitled to medical care for a brain injury, particularly after medical has been denied by the carrier for more than 2 years.
Subject: VOICE MAIL RE: LINDA AYRES VS. WYNDHAM WORLDWIDE CNA 33269102WE – COASTLINE LODGING, SSA RECORD OF PAYMENTS, MEDIATION (Fred Sachs voice mail)
Hi Fred, Stewart, Tina and Michael and Shane:
People keep telling me not to take these atrocities personally, that CNA is doing this to all injured workers. They say the law allows it. I don’t think so. Fraud is a felony, that means it’s against the law.
Anyhow, attached is a voice mail message with Fred Sachs.
IF you guys can organize comp rooms at the Ramada Inn-Newport Beach on Superior Avenue, starting next week, I still have a chance to resume Coastline Acquired Brain Injury Program. Without such help, I cannot return. I’m not asking for an advance on anything because the $5,000 you provided in January to pay for lodging, Matrix called it “income” and says it gets ‘subrogated’ and I am paying that back to them. I tried to explain that it for treatment, so in essence, you gave Matrix $5k, not me, I was apparently just the intermediary. I hope that doesn’t make me complicit in some sort of insurance con-job. Yikes. So, Tina Jordan or Michael Doughtery may be able to provide lodging so I can return to Coastine and you can figure out how to pay.
Without Coastline, I would have to say you have succeeded in fully destroying my life. I know you don’t care, Shane Reideman made that very clear last fall when he called and asked me, “Tell me, Linda, when ARE you going to die?”
So, are we going to mediate with Judge Siemers? I understand he is the only Judge who can deal with a case of this complexity?
If I’m not going back to Coastline, we can mediate with Judge Simers any time. Looks like I have the rest of my shortened life span to fool with Workers Compensation, and perhaps make a difference to my fellow Americans. If not, I die trying, huh? (Shane, happy now?)
I told the intermediary that I don’t fly,[radiation levels way too high, if you read the news] but I could drive to SFO (would need a rental car, per diem, and lodging) but that would be my compromise, or perhaps the Judge come to Los Angeles. His CV is outstanding. I might be able to trust him.
I need the CNA list of what has been paid to me. I’m almost out of time to appeal their demand for a return of more money than even they gave me. They have edited their calculations a few times. Le’s find out where that allegedly monthly payment of approximately $4,000 since May 2014 has been diverted to? (Shane, is that the type of fraud your department handles??) Would you believe they even sent the initial retro-pay to a dead back account, even though my SSA retirement money had been coming to a different account for over a year? The Treasury agent found that of extreme interest.
OK, let me know where we are.
Have a great day, and “Dodge those Rads – It’s Dangerous Out There!”
ps… So, if the below is true, then there is some validity to the CNA rest and rest and rest and rest and wait and wait and wait approach to ‘treating’ a traumatic brain injury for more than 3 years 7 months, huh? No wonder I wake up ready to take on the world for the first hour or two of the day.! Thanks guys and gals!
C’mon, I want out of WorkComp, I want the 15% legal fees to be donated to Coastline Acquired Brain Injury Foundation, and I want a reasonable settlement to enable me to forget I ever crossed paths with any of you Oh, yes, I want some sort of restitution program by Wyndham/CNA/Grancell to ensure they never have the opportunity to harm another injured worker like this again. Maybe I can be on the Board of Directors of such an organization.
Stewart, can you have someone look into setting something like that up? Thanks. No rush, looks like we’re going no where toward settlement, so there’s time…. since no treatment cut my life span by more than the 8 initials years estimated by the Brain Injury Association of America, looks like we have maybe another 10 or 15 to use the media to make a difference in America? We’ll, let’s try. COUNT ON ME to do my part!
Have a great day, Everybody. I have no place to be…oh ohhhhhhhhhh…. the piano tuner is coming today. I read that playing the piano is supposed to help with brain recovery so as Stewart and Fred know, I bought a piano last year, or maybe 2013, I don’t remember. I didn’t realize, at the time, I had to learn to play it for it to be effective. A local piano teacher had me is some very simple VERY SIMPLE VERY SMALL CHILDREN’S BOOK. She was kind, but aghast at my cognitive impairments. Most of the kids she teaches start with two very simple books. We had to break it down to just one book for me. I guess if I don’t really get to return to Coastline, piano lessons are back on the agenda.
Fred, wanna pay for them? There’s also a company called LearningRx… There’s help out there for people with brain injuries, I just don’t know how Thomas Motamed can run an organization with people in the dark ages about something as simple as NEURO-SCIENCE. He takes in $10.7 million plus a year for harming people like me? Yecccch. At least at Grancell, peeps get “Bagel Fridays” and at Wyndham, well, if you’re on the A-list, you get credit-worthy tours. It all comes out in the wash, doesn’t it.
Ooooops, that was not intended to refer to ‘money laundering’ that seems to be a part of the workcomp biz models! People tell me to refrain from slinging around words like felony fraud, RICO, corruption…. I don’t swear half as much as I used to…swearing is another consequence of brain injuries. Shane, remember how I ended our Fall 2014 conversation, when you asked, “Tell me, Linda, when ARE you going to die?” Yeah, that F**k YOU! was a knee jerk reaction due to TBI.
FOLLOW THE MONEY! America? Just doesn’t seem right to send a sweet little ol’ Baby Boomer to the Welfare Lines and Homeless Kamps….and early death, does it? #Zombie Alerts!
America? Do you know, really know, how the #WorkComp Multi-Billion Dollar Insurance Scams work, to maim and kill us, while “they” laugh all the way to the bank? Here, check this out. If you have a similar story, let us know. We’re more than a little annoyed at the moment…. Follow the blogs too… more on that horizon coming right up…
#MicCheck. CAN YOU HELP ME WITH THESE GOALS?? Does it Make Sense to you Financial and Math Wizards?? Any other #InjuredWorkers experience this sort of madness, while waiting, waiting waiting for medically necessary treatments for over 2.5 years?
What’s YOUR story regarding #WorkComp and money and medical benefits? Anybody else experiencing full scale BREACH OF FIDUCIARY DUTIES by the Insurance Carriers? One goal is to shed light on these issues, in each of these UNITED STATES OF AMERICA, and helping the insurance companies mend their ways…their ways that are maiming and killing injured workers everywhere.
Here’s a MATH word question, for anybody with a brain, a job, or a work injury related to #WorkComp.
In California, Work Comp works like this (allegedly):
TTD – 104 weeks (paid by carrier, while providing medical care)
EDD – 52 weeks (paid from employee’s fund, for long term disabilty)
Social Security – Long term disability – can take more than 2 years for approvals after pattern and practice of delays, denials, hearings, denials, delays…. similar to Work Comp practices of the State, just on a Federal Level.
Optional: LTD – usually an employee purchased option, available after 6 months of injury, as a supplement, not ‘crazy money’….payable until age 65 or recovery, whichever is sooner, and apparently part of a pay-back/offset scheme in the event Social Security benefits are approved. Policies vary.
In my case, the long term disability policy contributed $100.00 a month while TTD benefits were being honored. When benefits by insurance carrier were illegally terminated, the LTD policy provided, briefly, $1,800 a month. When TTD resume, LTD wanted their money back. (Need an accountant just to deal with the cash flow, huh? D’oh!)
Social Security indicated that yes, they know I have a traumatic brain injury, but their finder of facts indicate that it is not bad enough to prevent me from selling timeshares. 😮 Does that mean they think …. nevermind…..it’s on appeal. One of their doctors suggested that I might be ‘crossing guard’ even though neuro-optometrists recommend vision therapy so it is safe for ME to cross the streets! Why on Earth they would want someone with vision impairments to help kids cross streets is BEYOND BELIEF, ISN’T IT?
So, here’s the puzzle. IF THE INSURANCE CARRIER DEFIES THE LAW, AND REFUSES TO PAY TTD TO INJURED WORKER, THE STATE SWITCHES PLACES AND PAYS THE INJURED WORKER, USUALLY AT A HIGHER RATE, FOR THE FIRST 52 WEEKS, AND PLACES A LIEN ON THE CASE FILE.
Then, as in my case, the insurance carrier picks up the TTD at a mis-calculated and substantially lower rate of pay, for another 52 weeks, then says, “OH MY. THERE YOU HAVE IT. 104 WEEKS. YOU’RE DONE!” When objected to by injured worker, the carrier response to the omitted 52 additional weeks was, “Oh, I do this all the time. You’ve been paid 104 weeks, and that’s all your entitled to.”
Then, resources recommend that the injured work file for General Relief as a burden to the State’s coffers. Some of you may have seen my February 2014 rants about the generosity of the Salvation Army to keep my lights and heat on in the cold winter, and they directed me to Food Banks and CRISIS CENTER COUNSELING. That was helpful.
Upon injured worker requests, EDD filed a demand for reimbursement from the Insurance Carrier for the $47,922.00 paid by the State in 2012/2013. On 4/24/14, the insurance carrier reimbursed the State of California $31,400.00 for the free loan provided due to the carrier’s willful and malicious refusal to pay TTD, an action supported by WCAB Information and Assistance Officer, and was not heard by a Judge since requested to be heard repeatedly, since December 2012.
The State, in further investigations, found that the carrier had underpaid the injured worker for approximately 416 days, and The State forwarded approximately $23,000 in May 2014 to cover that mess up, and resumed twice monthly payments of $1928 until last week. Upon further investigation by Injured Worker, even the State indicates that it is a common practice that they have to protect citizens and injured workers when insurance carriers fail to pay, and breach those fiduciary responsiblities.
The severe discount in the payback of the $47,922 loaned to the insurance carrier to only $31,400.00 back to the State…. is a huge profit to the insurance carrier…. and a huge loss of nearly 6 months of benefits the injured worker has paid into and is entitled to.
SO, DOES ANY OF THIS MAKE SENSE TO YOU EITHER?
That Mr. Thomas Motamed of CNA, their CEO, makes $10.7 million a year off the multi-billion dollar insurance rackets in America. Just doesn’t seem right to send a little ol’ Baby Boomer to the Welfare Lines and Homeless Kamps….
Any way you do the math, 104 weeks + 52 weeks = 156 weeks, which is 3 years.
I have been waiting and waiting and waiting for medical treatments for 2 years, 6 months, 22 days….. DO THE MATH, AND WONDER WITH ME, WHERE’S THE MONEY?
I have contacted staff people at #CNA, #GRANCEL, #WYNDHAM and #RELIANCE and I hope for good news and money shortly. KEEP THE FAITH.
WE ARE THE MEDIA NOW. WE DO NOT…FORGET.
IF YOU HAVE EXPERIENCED THE SAME OR SIMILAR PROBLEMS, SEND ME AN EMAIL AT WYNLINDA@GMAIL.COM OR COMMENT ON THE CURRENT BLOGS AT:
….there may be other thought provoking ways to reduce #WorkComp costs….like eliminating Defense Attorney’s and having clear investigations by the Departments of Insurance on violations of fiduciary responsibilities that involve State and Federal Funds.
TOGETHER, WE’LL GET TO THE BOTTOM OF THIS. MAYBE THEY ARE SIMPLE MISTAKES, HUH?
EASILY CORRECTED BY OVERNIGHT DELIVERY! WE’LL SEE. I WILL KEEP YOU POSTED. KEEP ME COVERED WITH LIGHT AND GOOD POSITIVE POWERFUL THOUGHTS…..THESE BOYZ DO NOT LIKELY SING IN THE CHOIR.
#INJURED WORKERS UNITED: SILENT NO MORE
WE ARE THE MEDIA NOW. SO BE IT, AS IF LIVES DEPEND ON IT.
August 24, 2015 – CNA, with the help of Grancell’s law team chicanery, has successfully shifted cost burdens to the State of California, Social Security Administration, and Medicare? Wyndham paid how much for that useless WorkersCompensation policy? Appears to be more like a money-laundering racket.
In May 2015, after multiple appeals, Social Security Disability was awarded, and Medicare established. SSA calculations are apparently like a rat maze based on false and incorrect information repeatedly provided by CNA, along with the Courts “negotiating” rewards to CNA for breaking the law and refusal to pay TTD, even when a Judge told them too. A more indepth blog will be forthcoming….. this will give you a clue of how they set the ‘SHELL GAME’ for your taxpayer dollars up…
Other paperwork falsely alleges CNA paid me and still pays me approximately $4,000/month. Holy Moly! Call the District Attorney. Sounds like grand theft because such funds don’t make it to my bank account. I wonder where they go? Actually, I wonder if the State Controller has a clue on the money that EDD and SSA seem to ‘kick back’ to big companies like CNA aka AMERICAN CASUALTY
FOLLOW THE MONEY…. Vote the Poll, “Dodge the Rads — It’s Dangerous Out There”
[Last edited on October 3, 2014 at 10:34 am]
From: Linda Ayres <email@example.com>
To: sreubens <firstname.lastname@example.org>
Cc: wynlinda <email@example.com>; lindaayres <firstname.lastname@example.org>; ReoLinda <email@example.com>
Sent: Fri, Oct 3, 2014 10:25 am
Subject: Fwd: Linda Ayres — CNA 3269102 TTD Termination of Benefits, Authorization for Medically Necessary Treatments, and Reimbursements, QMEs and “Practice Effect” violations
Hi Stewart, Courtesy Copy to you and others. Have a nice day.
Thank you for your email of September 23, 2014 with your thoughts on monies paid and terminated TTD. Matrix advised that they did contact you, but have not yet received a response to their request for a copy of the actual termination notice. Can you help now? I have bills due NOW. TOP PRIORITY…..CASH FLOW issues since you have sent any money since July 2014, and you believe there is none due because of the deep discount provided to CNA by the State of California, relinquishing my rights and benefits.
Prioritized points below, 1-7. Thanks. Stress messes with my brain and too many things are coming at me right now. Sorry for the length of this. I also remembered I migh be able to do the housekeeping thing… I have supervised Estate housekeeping staff. More on that below.
Stewart is being mean again, says he is not going to email me anymore, just snail mail. That’s another ADA violation, but he doesn’t care. I have had to keep switching email accounts because Grancell blocked me on this account, so I’ll send him a copy in a bit….not jumping through any more hoops for him. He is tooo mean and he scares me.
Let’s not again burden the State because Wyndham doesn’t like to help injured workers return to work, and wants them kicked to the curb and or dumped into the SSDI and welfare roles. One friend said if Tina wants me to be a Housekeeper as the only way to return to work, then the panel QME with Dr. Holmes will be imperative. Even he might have to call for “light duty” for Orthopedic reasons. Social Security also does not think brain rehabilitation or brain injury is an imediment to selling timeshare. Hard to figure. Here’s more on what a doctor told me in January 2012 regarding possiblities of return to work, if’s and thens:
One of the big take-aways from SCRIPPS was further clarification on how messed up my brain is, and how desperately I need more Speech and Occupational and Vision Therapy to be able to rejoin the work foce. Let’s work together to get me to Coastline….. It seems the cheapest way for you to go…unless you like paying Grancell to torture and terrorism disabled workers, then, I surrender.
I’ve received your request and forwarded to our recalculation department for review. Please note that we would need an actual award notice / termination notice from your workers’ compensation carrier indicating you are no longer receiving the $649.41 / wk. As it stands it appears that you continue to receive the $649.41 / wk (2,814.11 per month) and that offset would still apply. Once the overpayment is recovered, you would only be entitled to the $100 per month minimum benefit unless a termination of benefit notice is received on the workers’ compensation carriers’ letterhead. – Matrix
Please send me and Matrix a copy of the TTD Termination of Benefits document today, please and thank you.
As you can see by the email from Steven Acevedo below, I’m not the only one confused by the complications caused by the CNA refusal to pay TTD the first year, and by the severe discount of my benefits negotiated with the State of California, to my loss of $20,000, and putting me in the position again to rely on public charities and State Funds, that were given to CNA rather than to this injured worker.
Before I get busy with emails on this matter today, will you kindly forward a copy to me today of the actual “termination notice” indicating that you are no longer paying me, effective when and why. As you can see, it appears to even Matrix that yep, you’re still supposed to be and are paying me, so therefore, they are unable to reinstate my LTD benefits.
The people at Matrix and Reliance are always very helpful and responsive. I appreciate your efforts to communicate with me, and I understand that Stewart Reubens has decided to ignore more ADA requests for electronic communications and will just mail things to me when he feels like it. Whatever. It’s noted.
The entire thread is again attached.
Please request from Stewart Reubens a copy of the summary of unreimbursed medical miles and expenses dating back to January 2012, submitted repeatedly, on paper and electronically.
Appeal to Scripps obfuscated by again failure to provide evaluating doctor with medical records as submitted on appeal, when it was obvious the first request was submitted with numerous omitted medical records.
Dr. Hilda Chalgujian agrees with pursuit of continued treatment at SCRIPPS and or at Coastline Cognitive Rehab, which starts October 20, 2014, if I am accepted to the program. More evaluations required. Her RFA is anticipated shortly. COASTLINE MAY BE THE WAY TO GO. DOESN’T LOOK LIKE WE CAN SETTLE UP AND I WILL NOT BE COMFORTABLE WITH ALLOWING MORE HARM TO COME TO ME BECAUSE STEWART DOES LIKE ME OR BECAUSE HE HAS HIS EGO INVOLVED IN HARMING A DISABLED WOMAN.
Stewart doesn’t want you to authorize any medical treatment, but he wants further evaluations at:
a) Orthopedic Surgeon – Dr. Holmes – PLEASE ENSURE I HAVE A COPY OF MEDICAL INDEX AND HARD COPY OF RECORDS SENT BEYOND WHAT I ALREADY PROVIDED; PLEASE CONFIRM THAT DR. HOLMES HAS RETAINED ALL THE RECORDS PREVIOUSLY PROVIDED. As it is a pattern of practice for Grancell to send me to appointments without providing the doctors with complete medical evidence, I will be unable to attend the QME unless I have received proper notice of the records submitted, and copies thereof. Otherwise, I am happy to comply with helping another doctor make holiday money with another evaluation.
b) PLEASE ASK STEWART TO ENSURE I RECEIVE A MILES CHECK FOR THE QME, AS THE ONE SENT PREVIOUSLY WAS EXHAUSTED AS I APPEARED FOR THE APPOINTMENT AS ORDERED BY THE COURT, AND IT HAD BEEN CANCELLED AND NOT REINSTATED. I have full documentation, so Stewart needs to send another check, to my post office, PO BOX 835 YUCCA VALLEY CA 92286
Stewart does not want you to authorize any brain injury treatment, following the footsteps of Kim Mall of Grancell-Corona, 24 days at SCRIPPS when 3-6 months were requested is hardly compliance with the responsibility of my employer and it’s agents to provide medically necessary treatment. Yet, Stewart wants another neuro-psych evaluation….. to add to the facts provided in 2012 by Dr. Eileen Kang and Dr. Marcel Ponton, and reiterated by Dr. Hilda Chalgujian. Their requests for medical treatment were all ignored, so, here I am. Coastline may be the way to go.
a) Please ensure that any such neuro-psych eval complies with the law and any such evaluator currently treats TBI in his/her practice. Please know that Matrix is sending me yet another neuro-psych for eval for my long term disability later in month, and practice effect in such exams is common knowledge within that realm of experts. Please ensure CNA is in compliance whatever laws may pertain to repeated testing in hopes of getting better results and being able to further deny medical treatment. I get the question about “What season is it?” right this time of year, and I am doing better at listing the presidents, and identifying what day, month, year it is, and what City and County I am in. I still have challenges with counting from 100 backwards by 7s, and spelling world backwards is hit and miss.
Wow, to think some work comp comp doctors are paid several thousand dollars to adminster those tests, or to supervise a non-licensed person to do so…. Wow, that’s America, huh?
Steward said he was going to contact Dr. Hilda and Dr. Bergey directly regarding ‘MEDICAL LIMITATIONS’… May I also suggest you re-review the records and statement of Dr. Marcel Ponton, psychologist and QME, and Pasadena treating doctors from April 2012 to December-ish 2012…. It’s in the blog, but here’s a quote, and since none of the recommended treatments happened, there’s little reason to believe anything has changed much on the limitations, huh?
Report to Employer:
Disability or Medical Limitations: (Physician must review employee’s job description and describe disability and/or restrictions from performing this job).
HAS PROBLEMS WITH ATTENTION AND CONCENTRATION WHICH WILL IMPACT ABILITY TO EFFECTIVELY PROCESS COMPLEX CLIENT INFORMATION AND OTHER DATA. Additionally, injured worker has a reactive depression to the conditions and neurobehaviorial symptoms. Medications Taken and Side Effects: N/A
Mitigating Measures or Assistance Devices Utilized and Degree of Effectiveness in Reducing Functional Limitation and Effect of Medical Condition on Major Life Activities, Description of Impact and Duration:
Injured worker needs ongoing psychotherpay and cognitive remediation. Ongoing Rx for neurobehaviorial symptoms as per Physiatrist. Patient has problems with money management at this time, however, is independent with all other ADL’s….. [Physiatrist recommended treatments and further evaluations were never authorized after initial consult. Initial consult did result in non-revocation of driver’s license after unfounded report by neurologist with a specialty in epilepsy and fibromyalgia (neither of which IW suffers from), not TBI, saga for another blog]
State Whether Employee Can Perform the Tasks in the Job Description in light of Medical Condition and identify any applicable restrictions and duration:
#Responsibility – will have difficulties with training and development and remembering information to convey to others…
Knowledge and Skills – patient will have problems tracking with company policies and procedures. Patient may also have problems with organization.
Identify Any Accommodations that Would Enable the Employee to Perform the Tasks that the Employee’s Medical Conditions Precludes from Performing
Modified duty – performing rote and repetitive tasks that do not require major decision making or constant interaction with the public.
As to the $27,000+, Stewart again reiterated that nothing I say will encourage him to look at the documents I provided in summary to the multiple requests for medical expenses as far back as 2012, medical miles to PTP, co-pay for the EAP directed doctor, treatment requested by physicians and utterly ignored by Grancell attorney Kim Mall which I then self-procured, and she interrupted with threats to the doctors. Is there no law against bullying injured workers?? When I look for the TTD TERMINATION, I will look for the summary again, and send it to you. The Audit Unit has copies, and while Stewart likes to say it’s all about ‘self-procured medical care for disputed body parts’…. the evidence, had he been willing and able to read it, will clearly show that’s not the case. For a fast fact check, see when the last time you paid me for medical miles to Dr. Darren Bergey and Dr. Hilda Chalgujian. Start there, and you’ll see a pattern.
You also mentioned that if SCRIPPS was not authorized for further treatment (which is was not, and again, they refused to review all the medical records I provided, and did not even have the SCRIPPS discharge records… omission of medical records with intent to deny medical care, or just another oooops??) Anyway…you mentioned, local providers you would recommend are at Eisenhower, Loma Linda or Casa Colina, for speech therapy for high level executive functions, vision, occupational and vocational therapies, but you did not provide the names of any such providers. Further, clearly you are unfamiliar with my file, or you would see that I have treated at Casa Colina, their Medical Director, Dave Patterson, organized by Daniel Elliott and Attorney Michael Durich (#2) sent me there for an evaluation and to debunk the request by Dr. Waldman to revoke my driver’s license in April 2012. I went to that appointment expecting a complete evaluation for their Brain Rehabilitation Program, and I got a 15 minute evaluation and Dr. Patterson filled out the DMV papers and said I was cleared to drive. He also referred me to Dr. Eric Ikeda, their Neuro-Optomestrist. I never saw a report on that meeting, I never was sent to Dr. Ikeda by PTP Marcel Ponton, QME, and in fact, only saw Ponton’s side-kick, Dr. Chung, for 4 session of psychotherpay (those may be some of the unreimbursed medical miles, too from 2012, we’ll have to look, it was a 2+ hour drive.) When I requested medical records, I saw there is a notice that I saw Dr. Patterson of Casa Colina in October 2012, which is false. It is a fake part of the medical records index of Ms. Mall. I did, however, self-procured medical evaluation and treatment with Dr. Patterson in April 2013, but alas, he lost my file, never wrote a report, and refused to see me again. However, he did refer me to Dr. Ikeda, wherein I received a prescription for the first treating theraputic lenses, and some Vision Therapy, that Ms. Mall also interrupted. Experts that I have spoken to find it very curious that there is a false notice of a patient meeting with Dr. Patterson, his abrupt loss of my files, failure to provide the promised, and oh yeah, he had recommended me for 3 months at their Brain Injury Rehab place in 2013, and they take work comp. WHAT DO YOU THINK ABOUT THAT??
I will look for and try to finish the schedule of physician request but attorney denied medical treatments since 2012. While Stewart thinks it’s not his job to help me get medical care, and he insists that he and his firm have nothing to do with whether or not I get medically necessary treatments for accepted body parts, including my brain, that just makes me wonder if he is suffering from a brain injury, too, or if it’s genetic.
Anyway, oh oh….. Do you read WorkComp Centeral blog? Guess who they wrote about recently? Yep! Let me know if you want the link….. it’s the one about Work Comp and Baseball….. ahhh, 30 seconds and fame on social media….. I hope that guy, Jack from the LA Times calls you and Stewart for some of his investigative reporting…
He looks like he is unfraid of deep digging….goodness, he even suggested that some LA Police and Firefighters fake work comp injuries. I had to comment that as a Citizen, I suspect they are made to wait and wait and wait for medical care just like the rest of us, while the profits are squeezed as the life is squeezed out of us.
Ok, that’s it for me for now. I think the summarized points brings us up to date. Still on my action list for you is:
Send you the summarized spreadsheets for the way past due $27,000+
Keep working on the PROPOSAL FOR SETTLEMENT (dropped to the bottom of the pile with Stewart’s continued bad faith and breach of fiduciary responsiblites)
Keep trying to make any ally out of you, since your Fraud guys told me that’s the way to go. But golly, I’m insured by you guys, why do I have to try to make an ally out of you. I’m not the enemy. Grancell is.
cc: Mary Falvey, Wyndham Worldwide Human Resources Executive VP
Tina Jordan, Wyndham Worldwide Human Resources – Regional Director
Melisa.Paramo Wyndham Worldwide – Manager, Indio, Palm Springs and Big Bear
Wyndham Leave Support
PS Note to Wyndham: PLEASE ADVISE THE DATE OF THE INDIO SALES EXECUTIVE TRAINING IN NOVEMBER. The accommodation request form was submitted by me, and delivered to Dr. Chalgujian and Dr. Bergey, anticipating further discussion and commencement of the Interactive Process, thank you.
cc: Jack Dolan…. PS You and your article were mentioned in the Ask About Workers Comp Gravy Trains blog: https://askaboutworkerscompgravytrains.com/2014/10/01/hello-america-can-we-talk-tbi-workcomp-wyndham-cna-grancell-edd-ca-dol-usa-etc-and-complete-systems-fail/ 😀 You’re welcome. BTW, Do you know Larry Kosmont? I used to work for him. He’ll probably say nice things about me, and how smart I was and how I was a great “right hand” to him and his. Peter and Stephen Lowy might remember me, but I did, at the end of my assignment as Executive Assistant to the Chairman of the Board, I help his Dad and Mum run their households in Beverly Hills and NYC, and I coordinated logistics when they flew in on their 747 or were off in the Mediterranean on their yacht. It was at the time they were buying up shopping centers in the USA.
I’ve received your request and forwarded to our recalculation department for review. Please note that we would need an actual award notice / termination notice from your workers’ compensation carrier indicating you are no longer receiving the $649.41 / wk. As it stands it appears that you continue to receive the $649.41 / wk (2,814.11 per month) and that offset would still apply. Once the overpayment is recovered, you would only be entitled to the $100 per month minimum benefit unless a termination of benefit notice is received on the workers’ compensation carriers’ letterhead.
NOTICE: CONFIDENTIALITY AND PROPRIETARY INFORMATION NOTICE: This email, including attachments, is covered by the Electronic Communications Privacy Act (18 U.S.C. 2510-2521) and contains confidential information belonging to the sender which may be legally privileged. The information is intended only for the use of the individual or entity to which it is addressed. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance of the contents of this information is strictly prohibited. If you have received this electronic transmission in error, please immediately notify the sender by return e-mail and delete this message from your computer or arrange for the return of any transmitted information.
From: Linda Ayres [mailto:firstname.lastname@example.org] Sent: Friday, October 03, 2014 10:06 AM To: Steven Acevedo Cc: RSLI-Stephen Buch; REOLINDA@AOL.COM Subject: Fwd: Linda Ayres REINSTATEMENT OF LTD Status of Money?? Policy LTD 121329 Claim 2012 11 13 0149 LTD 01 N
Hi Steve and Steve….
Any chance you can update me on the status of the reinstatement of my LTD $1800/month today. Panic is not a good mode for my brain functions.
FROM CNA/FRED SACHS: 9/23/14: Linda, Per your request below are the periods we have paid temporary disability. In response to your question regarding reserves, we do not discuss the reserves placed on a file with the injured worker or their legal representation if represented. 1-9-2012 to 4-15-2012 temporary disability at rate of $652.15 per week 2-15-2013 to 5-8-2014 temporary disability at rate of $649.41 per week Reimbursed EDD for period of 1-28-2012 to 3-4-2013 for a total of $31,400 Fred Sachs, CRIS MCU WC Claim Specialist 714-674-5886 FAX: 714-256-7630
Till then, I have bills due now.
Thanks much. I need to know so I can plan. (I’m looking for Steve A’s phone number and will follow up with phone call when I find it. Plllllllease advise. Thanks.
Do we have any word on the status of my $1800 a month, based on the info below? Bills are do again and I’ve been “holding on” with a hard-core “extend and pretend” strategy since July. I am reaching the panic point again, or went over the edge upon early termination of SCRIPPS care.
Could you kindly let me know when my LTD benefits will resume, and if there is any retroactive money coming to me, and when. If it’s NOT cominig, or there’s an issue, please just let me know. I will be in touch with Advocator to get additional records to them. If they do their job and help me get Social Security approval, I can rest a bit and get treatment subsidized by the State or the Military, whoever is behind the program I just found. Link below.
Bills are due tomorrow. If I know funds are coming, I can enroll in the Coastline Brain Injury program that starts October 20, 2014 (for 1-2 years) and could live frugally and get cognitive rehabilitation if I can count on that $1,800, and they I will fight like hell with CNA after sufficient rehabilitation, in a year or two. They apparently have no intentions of reimbursing my $27K spent for medical care they refused to provide, and they figure the State of California negotiated away my rights and gave them a fat $20K profit, so too bad how sad for me…. Call the Department of Insurance and register another complaint. D’oh.
I need to know what the status of my money is,amounts and when.
I see Dr. Hilda this morning, it would be great if I had a clue about the Matrix/Reliance before my 10:30 appointment with her. She knows I am seeing one of your doctors October 27 for further evaluations. It’s marked on my calendar.
Also, I need to know because I am trying to get accepted into a one-to-two year brain injury treatment program, with or without CNA. There’s no reason for me to believe they will do right now, as they have done such wrong all along, and they interrupted the SCRIPPS Brain Rehabilitation Program. It’s on appeal, and word is expected by the end of the week, on an expedited basis.
(I got a call “from Chicago” that suggested I had mis-directed my recent complaints of FRAUD, and suggesting that I make nice with the adjuster and be a little more patient…. 0.0
So I tried it again….with a short sweet polite plea for help to get into the Coastline Community College Acquired Brain Injury Program, a 1-2 year plan, that starts October 20, 2014, and would require that I relocate, or at least having lodging for 5 days a week till I get relocated. Fred said he couldn’t authorize it, but he can submit it if one of my doctors requests it…. My goal is to have two of my doctor request it, and at Coastline, they encouraged me to get “as much of SCRIPPS that I can” before coming to them.
Based on CNA statement of what they paid, can you now reinstate my LTD benefits and if so, how sooon??
Please let me know as soon as you can.
I may get to do a trial Return to Work soon…and I need to do the math.
Thanks a bunch.
Linda Ayres, In Pro Per
PS Just had a pretty good meeting with Wyndham HOUR regional Manager and Director.
To: Linda Ayres
Cc: Stewart Reubens
Cc: Stephen Buch
Subject: RE: Linda Ayres vs. Wyndham Worldwide et al Policy LTD 121329 Claim 2012 11 13 0149 LTD 01 N
Sent: Sep 23, 2014 11:11 AM
Linda, Per your request below are the periods we have paid temporary disability. In response to your question regarding reserves, we do not discuss the reserves placed on a file with the injured worker or their legal representation if represented. 1-9-2012 to 4-15-2012 temporary disability at rate of $652.15 per week 2-15-2013 to 5-8-2014 temporary disability at rate of $649.41 per week Reimbursed EDD for period of 1-28-2012 to 3-4-2013 for a total of $31,400 Fred Sachs, CRIS MCU WC Claim Specialist 714-674-5886 FAX: 714-256-7630
From: Linda Ayres [mailto:email@example.com] Sent: Thursday, September 18, 2014 2:32 PM
To: Sachs,Fred Cc: Tina R Jordan; Stewart Reubens; Stephen Buch; Linda Ayres; Linda Ayres; MBX – WVO Center Subject: Fw: Linda Ayres vs. Wyndham Worldwide et al Policy LTD 121329 Claim 2012 11 13 0149 LTD 01 N
Hi Fred, Below is an e-thread with LTD provider regarding income. They need to know if you will be resuming TTD retroactive or the actual dates paid and stopped. I will let Steve Buch know thaat Scripps was terminated but not completed, and is on apppeal and that discharge records are anticipated next week. By the way, what is the reserve on my claim? I don’t have the marbles to sort out the TTD money stuff on top of all else. I am in full survival mode and will be working on that “Proposal for ReSolution” for you and Stewart plus accommodations and interactive process. As you check on the TTD money and calculations, this reference to the letter from Daniel Elliott may shed some light. “And I found a letter from CNA dated 4/21/2014 indicating “Payment for temporary disability is resuming and sent separately for the period starting 02/14/2014 through 4/24/2014 and will continue until you are able to return to work or your medical condition becomes permanent and stationary. Your weekly compensation rate is $649.41 based on your earnings of $1 per week…..” (His calculations are aopparently purposely off and were off-set by EDD for the period they did pay. )….” If you could put
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