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!
How Does an Injured Wyndham Worker Return to Work?
WorkComp Epic Fail! WCAB, DOI, CAAA won’t help; FBI can’t help…so…Social Security makes legit medical care possible now – How do other companies facilitate return to work for injured workers? Let’s ask on Social Media, shall we?
As repeatedly attempted, and per the most recent leave accommodation, it is my intention to return to work on or before July 27, 2015.
Remember, I have not worked since date of injury, 1/9/12, and medical care provided by the insurance carrier has been minimal indeed. Chiropractic and physical therapy and a few first year clinical psychology sessions, and a few more neuro-psychology evaluations do not meet MTUS, ACOEM or common sense guidelines. Self-procured treatments were interrupted with threats, and MPN designated Orthopedic Surgeon Primary Treating Doctor for a diagnosed brain injury was allegedly threated with termination of referrals to his multiple offices if he did not cease and desist attempts to secure medical care for me. A leading industry experts discusses this very practice as common place in California.
This may further sound alarms in my particular case, to add to various agency investigations. One doctor, in my case, apparently succumbed to the extortion type practices, although his office did try for nearly 2 years to help me get legitimate brain injury medical care. Another doctor “lost my file” and could not even write the self-procured report, and falsely alleged a visit that never happened months later, and refused to correct the records or refund the fees paid for the consult with his verbal recommendations for immediate (2013) admission to the Casa Colina Brain Injury Day Treatment Center. The doctor did, in 2012, do a short evaluation on behalf of the insurance carrier to prevent the revocation of my driver’s license at that time. EEGs were not done by the carrier until April 2014, and follow up with medical records was also not done, as recommended by the INDUSTRY appointed neurologist. Goodness. CNA seems to think treating brain injury with a few (limited) chiropractic, acupuncture and physical therapy sessions are all that is necessary. In reviewing the pages of CorVel denials, it seems that the only times doctor’s are not required to sign a report for a modified recommendation are for those modalities–chiropractic, acupuncture and PT. D’oh.
There were neuro-psychologist sessions for a while since April 2014 with an authorized exception to the alleged MPN. The diagnosis and testing facilitated a request for 3-6 months of interdisciplinary treatment and what was authorized was 16 sessions of speech therapy, occupational therapy, and physical therapy, and 8 more sessions were authorized on zealous appeal. The cost to CNA was approximately $50,000, not discounted due to interdisciplinary guidelines, not subject to heavy WorkComp discounts, much to the apparent surprise of the defense counsel during a sandbagging session and further delays that preceded treatment.
In April 2015 the authorized non-MPN provider resigned since nearly all recommendations for medically necessary treatment were egregiously denied, with false allegations made against the doctor as well, by the carrier continuous attempts to deny medical care.
My out of pocket expenses to survive the Wyndham WorkComp claims handling exceed $43,350.44now, unreimbursed, and I lost professional credentials (CA Real Estate Broker’s License, California Notary License and Hawaii Real Estate Sales license) due to the injuries and failure at obtaining medical care.
My CA Real Estate Broker’s License has been reinstated and the CA Notary license is being reinstated. Self-procured medical providers were repeatedly threatened by defense, treatment interrupted, and none completed, from vision therapy, auditory therapies, MRI’s for the brain were self-procured, speech therapy was finally authorized in 2014 for merely 24 sessions, that would have been more beneficial in the first year, but some TBI (Traumatic Brain Injury Survivors) have up to five years of intensive speech and occupational therapies. I have lost nearly 4 years of earnings in an industy that tout’s newcomer’s can make six figure incomes and my current earning capacities are now a serious unknown factor. Return to work will clarify that, won’t it? Nobody at Big Bear or Indio knew about how to deal with a work place injury, so while the Admin Manager told gave me an incomplete DWC-1 Form and told me to “see any doctor that takes work comp insurance” and didn’t even offer a ride to the Emergency Room, so I drove down a snowy mountain WITH A HEAD INJURY…. It’s another Miracle that I survived that!
Employee Assistance stepped in and got me to some doctors, although defense lawyers repeatedly mis-state that injured worker was “properly served” info about an MPN. There were no treating neurologists, neuro-psychologists, clinical psychologists or others in the know about Brain Injury on the alleged list (that I didn’t receive a link to until JANUARY 2013!) AND JUST RECENTLY CNA CONFIRMED THEY STILL HAVE NO LOCAL TREATING NEUROLOGISTS OR NEURO-PSYCHOLOGISTS OR BRAIN INJURY EXPERTS.
I asked the EAP Clinical Psychologist, “What will I do if I don’t get my brain back?” He shrugged and said something to the effect of, ‘Well, if you don’t get it back, you can probably assemble widgets.’ Social media efforts while off work have been much like putting puzzles together and ASSEMBLING WIDGETS. I never aspired to be a WIDGET ASSEMBLER.
So, how do we move forward for return to work or about July 27, 2015? By copy to the Industry and Workers At Large, let’s ask for greater input, since Wyndham apparently does not have a RTW program? ASKJAN.ORG is the Job Accommodations Network which may help HR Staff comply with the laws. Here is the link for a search of their database on brain injury accommodations. Remember, CNA originally accepted the claim, as the records note, as a CONTUSION. JAN defines Contusion: “A contusion is bruising or bleeding of the brain (Brain Injury Association of America, 2006a; TBI Recovery Center, 2006).” Nice, they knewor suspected my injury was that bad, and upon diagnosis, terminated all benefits and hoped I died.
Here is a JAN.org list of accommodations for employers: http://askjan.org/media/BrainInjury.html Feel free to peruse the site further and we can explore as we commence the interactive process, hopefully this week.
I anticipate engagement in the FEHA required Interactive Process shortly, to explore and determine a timeline of necessary accommodations. In addition to previously submitted accommodation requests, which I will have to find, I will need to submit the finalized plan to my treating doctor and to the Coastline Acquired Brain Injury Program team as a “transition to work in Palm Springs sales office” plan for final approvals. Tina Jordan is fully aware of our need to meet as soon as possible. My next doctor’s appointment is Thursday, July 9, in Palm Springs and I could meet with Human Resources after noon on the same day.
Unknown variables include the dates of the next 2-week sales training classes, which will be factored in to a return to work transition plan from Coastline Acquired Brain Injury Program. When are the next two Indio Sales Training classes? What are the hours of work these days, and how are “breaks” handled when tour flow is heavy? I have been listening to the Steve Wilcox AFFIRMATIONS FOR SUCCESS (In-House and Front Line editions) along with the “AS A MAN THINKETH” presentation “With an Extra Track: Affirmations for Success” from July 2011. I AM MENTALLY PREPARING TO REJOIN THE SALES FORCE.
For example, if the training begins July 27, I will request authorization from Coastline to attend the full two weeks of training, knowing that it may be necessary to “repeat” the class at the following class. My processing capabilities are much slower than previously, but with hard work and repetition and systematic training, I may be able to succeed again. After completion of the 2-week training sessions, I am thinking that in order to complete the Coastline Acquired Brain Injury Program, a “work-schedule” could be reduced days at Coastline to “TWO” days … Mon/Tue or Wed/Thu. That would facilitate “THREE DAYS” return to work at the Palm Springs Office, on the busiest days, the weekends… Friday/Saturday/Sunday.
Real doctor appointments for medically necessary but denied for nearly 4 years will be made during non-working times whenever possible, and any WorkComp legal chicanery and further “evaluations” must be paid-time-off, with miles and lodging, if out of the area.
Quiet (low decibel) work area.
Work schedule to be determined based on actual start date, training (may need to take sales training class TWICE, TBD) while completing the Coastline Acquired Brain Injury Program via an approved “Transition Plan” to be submitted prior to doctor’s release so that informed decisions can be made by all parties.
Lumbar Support Chair
Ability to use memory devices for compensatory strategies (smart phones, livescribe smart pen, photos, notes, audio recordings etc. See ASKJAN.Org.
Designated go-to-person/manager for liaison on any TBI/Work/Accommodations/ADA compliance chain of command clearly described (In one conversation I was advised that a go-to/coach type person would have to be the sales manager, and it’s highly unlikely that any Wyndham Sales Manager is versed in Employment Law and ADA compliance to serve in that function, and would only exacerbate the issues. I would like a phone contact in New Jersey with someone like Patricia Lee to keep matters from escalating further. I will never forgive the callous disregard for my very life, but in timeshare sales, I have learned that we ‘leave our problems at the door” and it’s JUST BUSINESS. I don’t get all my brain power back, that’s a given; I do not intend to live in poverty any longer because of the epic fail of the slip and fall I experienced when I was just trying to help my manager find an open window so the Big Bear Team could get INTO the locked office in the middle of a snow storm. For being a team player, and putting the needs of others first, my life should be destroyed? I don’t think so.
Wyndham executives may need to speak directly with Norin Grancell, CEO of the law firm mis-handling my case since the beginning to ensure that the abuse stops immediately. This blog may be included in further evaluations by the insurance company leased/owned doctors, so they can have a better chronology of the abuses experienced and documented. In a discussion with one work comp expert, it was indicated that some of these people give “organized crime” a real bad reputation, and expose many of their minions to legal consequences.
Return to work, of course, requires a doctor’s release to work, which will be a possibility upon presentation of a viable plan in accordance with FEHA guidelines. Since Wyndham seems unaware of corporate responsibilities, and legal counsel provides inaccurate information (remember I attended a Public Career Night in December 2014, in hopes of learning more of how Wyndham has grown since I’ve been trying to recover, and the Project Director told me that Human Resources advised that he could not talk to me. Well, I still have an unresolved WorkComp Claim, how will that issue of communicating with me be resolved upon return to work? These are issues that must be clarified TO ALL PARTIES CONCERNED, wouldn’t you agree?
BRAIN INJURY HANDBOOK A Resource Guide for Employers may help in the creation of a return to work program. I have been diligent in collecting information that may help me successfully return to work. I would like a contact upon return to work to help make such a transition transparent and successful. Again, asking an untrained timeshare sales manager or human resources manager to fill that role does not seem reasonable.
Pro’s and Con’s and accommodations must be explored, in addition to those already submitted, so that we have a finalized plan that my team can approve and release me to. An assignment for my next doctor appointment includes writing a Pro/Con list for return to work, and while the doctor seems to hold significant reservations about my ABILITIES to return to work, he will consider the case for return to work that I will attempt to present this week. I wrote FOUR PAGES of PRO’S FOR RETURN TO WORK, and merely 3 statements for CON’S:
The abuse I have experienced at their hands is criminal.
The risk of further abuse and further attempts at financial harm is possible and probable.
Their actions have been incompetent and in bad faith repeatedly, and without integrity, to the top of the heap.
Those are weighty experiences and accusations, and my outrage is a legitimate response to the horrors of the Epic Fail. With the protection of Federal Laws, ADA, and FEHA, along with EEOC, I do believe that we can work together to transcend the life destroying legal-chicanery I have been subjected to, put WorkComp on the back burners, and let the proper authorities sort that out, while we move forward with a RETURN TO WORK PLAN.
At the top of the return to work at Wyndham list is not personal, it’s strictly business. The employability of the brain injured community is low, and continued employment of the brain injured community is even lower. One need only ponder the question, “What Hiring Department would knowingly hire an older worker with a brain injury and an open and public Workers Compensation claim?” Makes sense?
Other Pro’s listed on my ‘project for the doctor’ include (unedited)
It’s a job I already have
Risk of (further) job discrimination due to age, disabilities, gender, work comp is minimized by the existing work comp case (and protected against by ADA law)
There is slow/down time that will enable me to “perfect my craft” as the company has grown dramatically in the 3.5 years since my injury (and lost wages and earning capacity) — so I will have time to get up to speed in time for the Winter High Season.
Necessary accommodations, including a proper back support chair and a quiet (low noise decibels) environment are more likely at Wyndham that at a competitor, because the patterns of continuous harm have already been well documented, and now is a chance for Wyndham to right the wrongs and create a safe, positive and non-adversarial, bullying and discrimination free, non-hostile environment for my right to return to work.
Palm Springs is approximately 35 miles away, straight down the hill.
My Medicare provided doctors and interdisciplinary treatment team is now beingbuilt in Palm Springs, and the Palm Springs Wyndham Sales Office seems to be most conducive to any hope for a successful return to work that:
Allows opportunity to restore income and possibly compensate for nearly 4 years of lost income and earning capacity and professional licenses;
If successful, great; if not, it must be considered in ultimate case settlement;
I can either relaunch my sales career from Palm Springs, or springboard to new realms
On-Going Fraud Investigations – they will either right their wrongs or commit further documentable crimes
“Screw me once, shame on them; screw me again, shame on me.”
HR and RISK MANAGEMENT staff is untrained and consistently violates Labor Codes; I could be an asset in clean up, nationally.
RTW gives me time and opportunity to update/revise/clean up social media sites and records to return to more positive professional, and update my resume to reflect the changes in personality and abilities due to the Brain Injury and legal and medical mishaps.
A new position could be created to utilize my experiences for the benefit of many working people, worldwide. Not many Injured Workers have the ability, wherewithall or voice to expose the atrocities of America’s Work Comp system, of which this case is just one of millions.
Structure is critical to a TBI Survivor — Functioning capacity is currently at 3-4 hours and increasing.
If necessary, I can rent a guest room to “reboot” at the resort in the events of long days of successful selling, in order to minimize “Cognitive Fatigue” and ‘crash and burn’ from cognitive fatigue.
It’s totally a financial strategy — it’s a job I ALREADY HAVE.
Hours can be light – 8:30 to 1-ish or 3-ish.
45-90 minute spurts with guests, with “scripted” (re-learnable) sales presentation.
Repetitive stories, like my work-comp injury tales, have been repeated so often the telling is often without halting, dysfluent speech; therefore, it stands to reason that with practice of the sales presentation, and possibly become a Group Presenter, it would be win/win/win.
Palm Springs office is “hybrid” – owners and non-owners with 45/90 minute presentations.
Palm Springs, like Big Bear (where I was sent to assist during extreme management and sales turnover in January 2011, and where I was sales person of the month many times) is a smaller office, so, theoretically, there is more opportunity to earn (more opportunities for tours divided by fewer sales reps)
Small shops – can close my own deals.
Have California Real Estate Broker’s license (lapsed due to injury; reinstated) and Notary License (lapsed due to injury; reinstating) but Hawaii Real Estate Sales license was lost due to injury, no hope for reinstatement. If attempts at sales fail, perhaps a salaried + bonus “contracts person/VLO position can be accommodated in Palm Springs.
Wyndham is the largest hospitality company in the world.
Great benefits (unless hurt on the job) and benefits resume practically immediately – health, vision, dental, matching 401(k), discounts [on-going medical care includes continuation at Coastline ABI program, Cognitive therapies, RTW counselling and coaching, Acupuncture (weekly), Neurology (further exams denied by carrier for nearly 4 years), Chiropractic, Vestibular Disorder (balance), Auditory Processing, Vision Processing, and medically necessary devices to compensate.
Base pay is a “draw” against commissions and would not count against Social Security “trial return to work” guidelines if income does not exceed $___. (I forgot how much that is, less than $1,000 a month I think they said.)
Tuition reimbursement (could complete a degree program and or a Certificate Program in Sales/Social Media)
It’s a job I already have, already paid dues in full, and since the injury and permanency of the injuries was caused by Wyndham, seems only right that my working career resumes there, and we’ll see it goes from there.
Always better to leave a place on a successful high note than bleeding from a conk on the noggin;
Quitters never win and WINNERS NEVER QUIT.
If my injuries prevent success as a salesperson, as you know, I am willing to work with the Human Resources Top Executives in New Jersey to establish a position as Advocate for Injured Wyndham Workers, worldwide, and/or be of assistance with social media policies and procedures. When some key managers have LinkedIn profiles that show website links to their former employers, well, there’s another “quality control” issue, that directs candidates to competitors? Armed with two monitors, I could provide valuable input to assist Wyndham, imho.
A WorldMark by Wyndham owner recently advised that the Queen Mary is now part of the Wyndham portfolio. I had to laugh as it made me think of the Wyndham WorkComp policies, practices and providers, and how an Injured Wyndham Worker can be treated like a “Woman Overboard” as the life preserver (allegedly WorkComp) is ripped from her clutching fingers, falling into the sewer of WorkComp, with providers simply asking, “…when ARE you going to die?”
Despite the obstacles and hardships, I have worked very hard at Coastline Acquired Brain Injury Program since October 2014, and I am still gaining more and more compensatory strategies that may facilitate a successful return to work. As mentioned to Tina Jordan, Regional Human Resources Director, with the brain injury, my success as a timeshare sales executive might be like “The First 50 Dates” movie…. with a fresh title, “The First 50 TimeShare Presentations.”
While the movie is a Hollywood version of a brain injury, there are some insights to be found, and bear in mind, multiple lobes of my brain were involved, not just the temporary lobe as in the movie, in the initial and second impact traumas. Again, had treatment been immediate, reasonable and appropriate, my injuries would not likely be as severe and debilitating as they are. Muddling was never before a ‘life strategy’.
Since the WorkComp experience was an epic fail, let’s move past that, and let the proper authorities deal with CNA and Grancell and related complicit parties and move forward with Return To Work planning. Obviously, Wyndham has little-to-no experience in helping someone with an untreated brain injury return to work, so whether or not my return is successful, let’s work together to ensure that a return to work path is created for other Wyndham Workers who follow.
The interactive process required by ADA and FEHA must commence immediately so that we can work out the variables and so that I can obtain “trial return to work” authorizations from my treating doctor, and also approval from the treatment team at Coastline Acquired Brain Injury Program (both are self-procured since CNA willfully and callously and apparently by a web of fraudulent means, with complicit doctors, succeeded in failing to provide medical care, pay Temporary Disability Benefits in the first two years, and continues to refuse to pay estimated Permanent Disability, causing what the social security administration says is permanent and chronic injuries to my brain. Nobody believes I can return to work, but my current doctor instructed me to write the Pros and Cons of returning to Work at Wyndham, per the in place accommodation request.
While Human Resources has been unable to meet to engage in the interactive process (we did have a meet and greet last summer, but no progress was made). CNA did pay approximately $50,000 for 24 sessions of speech therapy, occupational therapy, physical therapy and an extensive auditory processing evaluation and driver safety evaluation in the Summer of 2014. That Interdisciplinary Treatment Program had been requested for 3-6 MONTHS, and 16 days were authorized, then extended 8 more days. Also included in the fees was assistance in the Interactive Process, where the SCRIPPS BRAIN INJURY DAY TREATMENT CENTER Occupational Therapist was to go to the job site with me, meet with HR, and explore necessary accommodations. Apparently, the Defense Firm, who seems to relish in lack of expertise of ADA/Return to Work/Employment Law, forbid HR to meet with me and qualified professionals. The early termination of the program by the Defense also muddled those return to work plans, as no doctor would release me to work without care.
Other professionals have indicated that had I received medically necessary treatment in the first year, it might have been possible to return to work in some capacity back in 2012. In a pattern of practice of omitting hundreds of pages of medical records with clear intent (and years of success now), the defense has implicated many doctors in their sham. Bear in mind, upon diagnosis of BRAIN INJURY, CNA immediately terminated Benefits and all treatment, and resorted to financial terrorism, bullying and worse. Nothing has changed, and now they include Judges in their chicanery.
After a very positive conversation with an agent of the FBI, it is clear to me that there is no agency that can help me personally in the horrors I have experienced at the hands of the Wyndham Worldwide WorkComp insurance carrier and their defense counsel. While California Labor Codes allegedly provide an Exclusive Remedy for injured workers that includes immediate, reasonable and appropriate medical care, with disability payments, all with an alleged aim to help injured workers recover and return to work as soon as possible, this was not and is not my experience. The evidence of my case may prove valuable in investigations of “similar” cases, and I have assured the FBI agent that my “arsenal of work comp records” is at their service. In the discussion, I mentioned that as an “OLDER WORKER” I fortunately had the fall back position last year to apply for “early retirement” so I did not join the increasing ranks of the homeless injured workers. It is my very strong belief that as an OLDER WORKER, I have an obligation to expose the crimes that I have been victimized by, and that millions of other Americans are being subjected to daily, in a Grand WorkComp Fraud.
While the Wyndham Worldwide Director of Risk Management, Michael Dougherty, has never once responded to my pleas for help since 2012, the congenial relationship between Wyndham’s Risk Management Department and Insurance Carrier Defense firm can be summed up in the public recommendation by the Defense firm below (It smacks of collusion to me, but they say since the brain injury and denials of medical care while doctors profit by writing false reports and attorneys profit by omitting medical evidence, that I am extremely “suspicious”…)
Shareholder/branch manager at Grancell, Lebovitz, stander Reubens & Thomas
I have worked with Michael for quite a while now. Since the time I have worked with him, he has successfully moved his program from its prior claims administrator to its present Third Party Administrator. In addition, Wyndham has continued to expand its business which includes aquiring other companies. This requires the integration of the new businesses into his existing program. This has been accomplished in an admirable fashion.
Not many states can boast the complexity, frequency and severity of Workers Compensation like California. I think Michael’s grasp on the California system through its many iterations as well as his knowledge of Workers’ Compensation in other states has truly benefited his employer in his ability to strategize, collaborate and manage the entire program.
Michael’s ability to work with all partners in his program and draw on their skills especially in complex cases is key in management and expeditious claim resolution.
January 20, 2015, Stewart was with another company when working with Michael at Wyndham Worldwide
As the records indicate, had I received more than chiropractic and a few visits with a clinical psychologist in 2012 (interdisciplinary treatments WERE requested, but were denied by non-medical personnel) the possibilities for return to work existed. In October 2012, the primary treating doctor attempted to facilitate return to work, but again Wyndham refused to engage in interactive process and simply extended leave without pay or benefits. In August 2014, through the expenses and efforts of an interdisciplinary brain injury day-treatment program, efforts were made to engage in interactive process repeatedly by hospital staff, and Wyndham was apparently mis-directed by the defense firm to refuse to engage in interactive process. SCRIPPS has recently offered to resume the effort to facilitate the interactive process, with a minimum of 2 more weeks of the interdisciplinary Speech/Occupation/Physical Therapy Program (and approximately another $25k?) to do what they were not allowed to do to facilitate return to work last year.
Perhaps we can now work together to organize a viable return to work plan with increasing work days as the Coastline Acquired Brain Injury program reaches completion and the Desert high season begins. I have approximately 3″ of communications of attempts to organize return to work, all failed attempts included spread sheets of if this then that. Let’s plan on a working meet to put something in writing this coming week so that my treatment team can determine if indeed a TRIAL RETURN TO WORK IS POSSIBLE.
I would further suggest you advise defense counsel to put the case and chicanery on hold until we get through developing a return to work plan, with aim toward July 27, 2015, and identify all the necessary accommodations, scheduling, locations, and paperwork. Again, you can let Mr. Norin Grancell know that the injured worker intends to return to work despite the atrocities commited by his firm, BY ANY MEANS NECESSARY. He will understand and explain it to Stewart, we’re sure.
I truly do not know if I am CAPABLE of returning to work; at Coastline I have heard that some people with most severe brain injuries are amongst those say most adamanatly that they can return to work…when they can hardly speak, have zero working memory, and other major issues. Nobody has told me they think I am ready to return to work, but as I have always said, I AM INJURED, NOT STUPID. One Work Comp doctor in 2012 said, when I asked, “When will I know I am ready to return to work” and he said, ‘You’ll know you’re ready when you’re back at work.”
OK, let’s get to it.
Please let me know about a meeting the afternoon of July 9th in Palm Springs or Indio, and advise who I will be meeting with and if Wyndham Leave Support Management can participate by phone to document. This, with prior requests, seems to give you what you need to propose what can work for a return to work. I know I still struggle with being concise, and untreated vision processing with working-memory issues makes editing a challenge, so perhaps the best next step is for Wyndham Leave Support Services to send a proposal for return to work, subject to medical release and we can either finalize or fine tune from there. The professional help that was paid and every effort was made to get Wyndham HR to participate with the SCRIPPS INTERDISCIPLINARY TREATMENT TEAM to facilitate return to work was refused repeatedly by both Wyndham HR and it’s legal counsel.
I cannot reasonably be expected to do the work of a team of professionals who are allegedly well versed in such matters as return to work. So, I await response this week, and as I have said to HR repeatedly, let’s do what we can to avoid a FEHA complaint and get me back to work and earning capacities, with an aim to have me fully integrated into the work force by December, starting July 27, 2015.
Thank you. I look forward to return to working and to magnificent outcomes that help not only me, but other injured workers at Wyndham Worldwide, and everywhere. PS The Ramada people are tops! They reallly exude COUNT ON ME behavior!
How Does an Injured Wyndham Worker Return to Work? BY ANY MEANS NECESSARY!
Let’s get down to business.
Linda Ayres, In Pro Per
PO Box 835
Yucca Valley CA 92286
760 368 7236
cc: “Supplemental People” and The Working World At Large via Social Media
PS As I try to edit this and check for typos, I just keep adding more text and I have to prepare to drive to Coastline. I will send it shortly and hope to receive the proposal from the Wyndham Leave Support offices this week, in time for my Thursday morning doctor’s appointment. I will print and take this blog with me to that appointment, as the doctor is just now reviewing my medical history. Thanks a bunch. Hope to see you all July 27, 2015. Please advise if the training class starts sooner or later, and assign a “table” to me at the Palm Springs Sales Office….. “I’ll be back!” If Bobo is there, I want to sit by him, or by Rodney!
#WorkCompChat? Fascinating that #CNA insurance might find my #LinkedIn profile of such interest? Classic #RockPaperScissors?
Let’s hope it is a good sign and that audits may be conducted to ensure that the horrors I experience by their failures and refusals to provide medically necessary treatments since date of injury, 1/9/12, must not and will not happen to other injured #Wyndham Worldwide Employees. This is an outrage to Shareholders and Injured Worker alike.
While CNA, the work comp carrier for Wyndham Worldwide, continues to harm, harass, fail to provide reasonable and appropriate medical care for a traumatic brain injury January 9, 2012, it
…..appears to be a complete breach of fiduciary responsibilities and in what appears to be clear violations of California Labor Code exclusive remedy of workers compensation, a claim fraught with what appears to be egregious attorney and doctor and adjuster incompetence, malpractice ….and fraud, as defined by the Department of Industrial Relations…and California Civil and Labor Codes.
TREATMENTS PROVIDED BY CNA:
2012: a few chiropractic sessions in the first year with clinical psychology sessions in Feb, Mar, Apr with 4 more in Jul-Aug
2013: a few physical therapy sessions in the second year,
2014: a few chiropractic and acupuncture sessions in the third year with finally a few speech therapy, occupational therapy and more physical therapy, and neuro-psychology support in April,
(after injured worker found a neuro-psych willing to treat an injured worker; none available on alleged ‘mpn list’ since date of injury after treating Orthopedic Surgeon’s office staff shrugged at one of the last bizarre UR denials and suggested, ‘you’ll have to find your own brain doctor, obviously they are not going to get you any medical care…ever.’)
2015: more denials and more evaluations to prevent anticipated return to work.
Tens of thousands of dollars have been spent by carrier on evaluations upon evaluations, with supplemental reports due to objections of omissions of more than 300 pages of medical evidence, with suspected intent to deny medical care, with failures to provide even the simplest requests since date of injury.
CNA has submitted every request since February 2013 to UR, and Court intervention was required in 2013 to schedule authorized chiropractic and acupuncture sessions, which took many months. CNA has currently asserted that replacement of Orthopedic Surgeon PTP, who has reported MMI for Orthopedic Injuries as of December 2014, requires Utilization Review for a neurologist to become the primary treating physician.
CNA seems to only have a small collection of evaluating neurologists, not treating doctors, and none current with brain injury practices of the 21st century; neither do they have physiatrists, neuro-psychologists, or anybody on their ‘lists’ that actually treat brain injuries, but they pay the evaluating doctors who provide reports prepared by non-medical personnel handsomely for their signatures on such reports, regardless of how flawed they are. In fact, the greater the flaws, the greater the obfuscation, the longer the denials, the greater the billable hours.
SELF-PROCURED TREATMENTS OBTAINED BY INJURED WORKER, BASED ON MEDICAL EVIDENCE OF THE NUMEROUS MEDICAL EVALUATIONS
Most expert treatments have been abruptly and prematurely terminated due to threats to ‘cease and desist’ treatment by defense to providers and unlawful termination of disability benefits in what appears to be a pattern of continuous harm and financial terrorism by defense, as a pattern of practice, apparently approved of by WCAB and DIR and offices of the District Attorney. DOJ and EEOC investigations pending on multiple matters.
2014: Acupuncture, Chiropractic, Vision Therapy, Therapeutic Prism vision Lenses, Coastline Acquired Brain Injury Program for Compensatory Strategies
2015: Acupuncture, Chiropractic, Coastline Acquired Brain Injury Program for Compensatory Strategies (updated therapeutic vision lenses pending funds)
Evaluations obtained by injured worker, recommended by multiple doctors but carrier failed to provide, while subsequent evaluating doctors have deemed all evaluations appropriate, albeit very late in happening
The BRAIN INJURED worker, seeking compensatory strategies for the brain injury… because restorative medical treatment was denied for more than three years… is now witness to legitimate business building condos week after week after week, while obtaining self-procured compensatory strategies in a one-to-year program at Coastline Acquired Brain Injury Program, the #1 program in the USA, and a part of the California Community College system, with experts in brain injury with more than 25 years experience each, helping people doctor’s did not reach, or that doctor’s gave up on for a variety of reasons.
“Compensatory vs. Restorative” (Northeastern University)“Compensatory strategies focus on adaptive behaviors. A person with a TBI may no longer be able to perform a task the way (s)he used to because of the injury. A compensatory strategy is coming up with a new way to perform a task. For example, a college student who suffered from a TBI may no longer be able to write down notes for his lecture as fast as he used to. A compensatory strategy could be for him to now record the lectures and transcribe them into note form after class.”
“Restorative Strategies are designed to repair processes and restructure or rebuild damaged neural networks. Examples are tasks and drills to help a person with a TBI restore his/her memory.”
The following are examples of interprofessionals who work together with TBI survivors and their families:
Ear, Nose and Throat Doctors (ENT)
Primary Care Physicians
Vocational Rehabilitation Counselors
Best outcomes of interdisciplinary treatment systems are when utilized immediately and NOT the ‘3+ years or never’ post-injury as practiced by CNA and other major carriers; CNA provides and encourages only an Orthopedic Surgeon to allegedly manage an interdisciplinary team, then disrespects and disregards all recommendations and requests for specialty treatment and further evaluations because, as defense indicated repeatedly, ‘an orthopedic surgeon has no knowledge of brain injury’.
At a court hearing in December 2012 a physiastrist or a neuro-psychologist or a neurologist was requested for treating doctor; denied and more recently, since previous PTP, Ortho Surgeon has determined MMI Orthopedically in December 2014, and has deferred to secondary doctor, a neuro-psychologist, a primary doctor has been requested in the field of neurology.
Adjuster and defense advise that change of PTP requires UR. Designation of neuro-psychologist as secondary treating doctor required Court hearing as well. Churn churn churn. (In 2013, an industry leased neurologist was designated as ‘secondary treating doctor’ but alas, his office mis-read the authorization and deemed it to be a one time consult, determined nothing more than over the counter analgesics was required to treat the brain injury and related complaints and reports of vision and other issues; dates of injury were mis-stated by the doctor, along with other gross inacuracies.
Then-counsel suggested injured worker take the concerns directly back to the doctor for corrections, and said doctor refused omitted records properly served, refused to answer questions his office required be put in writing, and actually threatened injured worker with a lawsuit for harassment for attempts to see this appointed ‘secondary treating physician’ and to correct gross misstatements in his reports and his supplemental reports, for which he billed handsomely.
Similar story with the appointed AME Forensic psychiatrist, although he assertions in his supplemental report were more outrageous than what might have been called simple mistakes in his initial report. That scenario was repeated again by yet another evaluating/non-treating neurologists, complete with fabricated dates and deceptions. Goodness, what a trio lead by then-defense counsel misleading correspondence with apparent intent to deny medical care, quite successfully for years.
Defense feels no obligation to pay estimated Permanent Disability, even on the orthopedic portions of the claim, nor do they anticipate the increased risk exposure due to their negligence and callous refusals to provide medically necessary treatments, as even recommended by their own leased doctors and evaluating firms.
ACOEM, MTUS, NIH and generally cognizant neurologists keeping pace with the neurosciences generally recommend such treatments as speech therapy with cognitive rehabilitation, occupational therapy, physical therapies as required, vision therapies, acupuncture, chiropractic and specialty examinations by brain injury experts.
Only a charlatan or worse would likely dare to recommend simply ‘over the counter analgesics’ for a well diagnosed closed head injury, called by more than 30 doctors by a variety of ICD-9 codes. While the Orthopedic Surgeon crowds are often designated as the Primary Treating Doctor for a head injury, their ilk are sadly ill-informed about diagnosing head injuries, and the urgency of getting patients to experts.
Until the Orthopedic crowd rises to their responsibilities in the life-threatening lapse in education of their peers, head injuries will continue to bring them small revenues as WorkComp ‘Primary Doctors’ and will ultimately bring them medical malpractices and charges for collusion to perpetrate fraud upon the disabled communities, for profit. Ask a Football Player. Ask a Retired Football Player. Ask a Veteran. Ask your kids.
Only a complete fraud would review medical evidence of more than 30 doctors, disputing all and further concluding that ‘if there was any evidence of a concussion, of course treatment would be necessary, but there is no such evidence by the finder of facts and the patient probably just has epilepsy, with a severe pre-existing personality disorder evidenced by records and learned helplessness….’
[Physician was referring to medical records from early evaluators, and substantiated the false allegations by simply moving the date of injury forward one year in reports, then back, without adjusting the false conclusions. Multiple industry leased/owned doctors seem to follow this pattern of practices in creating false AME/QME/Consult reports, upon which egregious harm continues, and renders UR and IMR practices complicit in the fraudulent mis-use of law.]
Semper fidelis is a Latin phrase that means “always faithful” or “always loyal”
The GrandWorkCompFraud inhibits and prevents return to work for years by failures to provide medically necessary treatments. In this case, in April of 2012, upon confirmation of brain injury of unknown severity, the adjuster, not a medical person, terminated disability benefits and any hope of medical care in that month. A Court hearing in June of 2012 authorized a neuropsychologist to be the new designated primary doctor, although said doctor’s office was more than 3 hours from the injured worker’s home.
The Court required the insurance carrier to resume payments of temporary total disability payments, which CNA defied and WCAB supported, in order to cost shift to EDD. The information and assistance officer, when help was sought from that office, asked the injured worker if she was stupid for not wanting larger amount, and when the hearing minutes were shown, she explained that the minutes indicated they were to resume “…if necessary…” and since they did not resume, her medical/legal opinion was that “Dr. Ponton clearly must not have felt it was necessary.”
[Ultimately, in 2014 CNA had to reimburse the State of California for the EDD monies advanced in the first 104 weeks for TTD, and CNA received a discount on the monies of approximately $16,000 from the State of California, which, as admitted by the adjuster, had the negotiation with the State not gone so well, that money would have indeed been paid/owed to the injured worker.
A Judge in the Appeals process determined the money did not belong to the injured, so apparently, the State of California is in the business of providing hefty profits to out of State Insurance companies who break the law, fail to pay TTD, maim and torture injured workers, all outside of the eyes of corporate media, and with apparently approval of the office of the attorney general et al. WCAB seems to operate like a secret police or military police action, reporting to no one but themselves and their benefactors. The injured worker has been without work comp disability benefits since approximately May 2014; aint’ that nuthin.]
The “TTD” [Temporarily Totally Disabled] condition was reiterated in every subsequent 45 day report in 2012 until the doctor (also with a QME designation) was also threatened by the defense, at which time, based on no medical evidence, nor treatment other than 4-delegated chat sessions with a psychologist of unknown credentials, at which time (October 2012) it was stated that return to work could be considered, with caveats, warnings, and accommodations, with allegations of continued authorized treatments, of which all his requested had been denied except the chat-sessions, discussed in more depth in earlier blogs.
Wyndham refused repeatedly to engage in interactive process and simply extended leave and continued to refuse to investigate why injured worker was continuously denied medically necessary treatments, thereby complicit in the compounding harm to the injured worker. Wyndham continues to refuse to engage in interactive process, and refuses to intervene in more than 3 years of failures to provide medical care and disability benefits by that work comp carrier.
ARE THESE ACTIONS OF BUILDERS OR DESTROYERS? Friends or Enemies of Humanity?
This photo shows the progress of a condo development being observed and enjoyed by the injured worker, a real broker who lost all professional credentials, including CA real estate broker license, CA Notary license, Hawaii real estate sales license, and was threatened with loss of CA Driver’s license.
During her weekly pursuits at regaining her life while attending the Coastline acquired brain injury program, since October 2014, with no thanks to CNA, and with thanks to Wyndham for an employee discount at a local hotel, watching the construction of this and other signs of economic good stuff has been smile evoking. Down the hill and to the north, Huntington Beach also has multi-unit ocean view properties under construction.
What an ‘Exclusive Remedy’…Employee insurance with CIGNA, without interference by CNA and Grancell, could have had the injured back at work, possibly, within months of the injury, similar to building a condo from a hole in the ground.
WorkComp is certainly the #GrandWorkCompFraud perpetuated on the Unsuspecting Public! What a shame! Contractors can build multi-unit residential buildings faster than a WorkComp carrier like CNA can authorize medically necessary treatment for a witnessed slip and fall backwards on ice.
How can that be?
Why would a corporation like Wyndham Worldwide pay a corporation like CNA to maim and injure it’s labor force, without batting an eye, or lifting a finger to ask more questions. Are Board Members really involved with conflicts of interest in the insurance industry? Does the Wyndham Risk Management division have unclean hands?
In any event, Wyndham Workers are violated obscenely by the fictitious promise of a Workers Compensation ‘Exclusive Remedy’…. It sure seems to be simply terrorism and death threats…. inexcusable in America….or anywhere else in a civilized world. Perhaps Kim Motley, Esq. can come to the aid of the USA? www.motleylegal.com/about.html
True defenders of Justness and Justice seem real hard to find in America….
Isn’t it amazing to be able to witness not only the good in America… But having the courage to expose the evil, the corrupt and the dangerous… Workers compensation is not an employee benefit.Sadly, the silence of the employer appears to be criminal complicity in the egregious wrongs done to this and other Wyndham employees. What say you America?Isn’t it time to hold the criminals accountable for the continuous patterns and practice of harm to injured workers across the nation?
Why America is NOT the greatest country in the world …
IF AMERICA CLEANS UP IT’S CORRUPT WORK COMP SYSTEM, PERHAPS WE CAN THEN BE OF ASSISTANCE TO CANADA, THE UK, JAPAN AND ELSEWHERE.
Remember remember, Thomas Motamed, CEO of CNA ‘made’ $10.7 million in ‘earnings’ in 2014…. and they can’t even pay simple TTD to an injured California worker in compliance with the law, and they terminate benefits on diagnosis of a brain injury, and even call to ask injured worker, “……so tell me, Linda, when ARE you going to die?….” Defense counsel suggests a court appointed conservator as he trolls for someone/something to blame from medical records of more than a quarter century ago looking for pre-existing conditions, apparently to support grossly inaccurate reports of three of their industry leased own reporters. Isn’t it funny how few QME/AME actual doctors write those reports? One such doctor openly admitted that his non-medical staff was ‘well trained’ to write such reports that he freely signs, and is paid handsomely for initial reports and supplemental reports, regardless of acurracy of apparently fraudulent intent. Hmph.
CITIZENS TRIBUNALS MAY REQUIRED….WITH A LITTLE HELP FROM OUR FRIENDS. Check with your international law friends…
#WorkComp legal chicanery comparable to ‘a strip search in a fascist gulag?’ Hint: Totalitarianism
#GrandWorkCompFraud! No Exclusive Remedies! No Remedies at All. Pure Chicanery.
MARCH IS #BRAIN INJURY AWARENESS MONTH…. What did YOU learn this month, so far?
If it’s a work injury, prepare for the fight for your life, and hope somebody will help you. Upon diagnosis of brain injury, it seems to be an insurance industry trend to immediately terminate benefits and begin a covert theme of terrorism—medical, mental, financial…. and they reap thousands of dollars in profits for their crime gangs. Can the DOJ really just continue to look the other way? America! America! We are witnessing the collapse of an Empire…. couldn’t be more timely, huh?
MARCH IS ALSO #FUKUSHIMA ELE AWARENESS MONTH…. What you don’t know, will indeed kill you. Start with the Science, 1,946 known lethal isotopes. Wishing all the #WorkCompsters very interesting outdoor living.
DEFENSE ATTORNEY JUST DOING HIS JOB/JUST FOLLOWING ORDERS?
“The more I think about this legal chicanery… and the defense’s new demand for access to 25 years of medical Records, when they have ignored medical evaluations, recommendations and requests for treatment for the past 3 plus years, it sort of feels like a quote strip search unquote in a fascist gulag.”
Remember when the Insurance Carrier’s rep called from Chicago and the phone conversation about denied medical care concluded abruptly with his question, “….so, tell me, Linda, when ARE you going to die?” Bullying? Harrassment? Threat?
Totalitarianism is a political system in which the state holds total authority over the society and seeks to control all aspects of public and private life wherever possible.
IS PRIVACY DEAD? Did she reallly compare #WorkComp legal chicanery to ‘a strip search in a facist gulag?’
Remember remember….. All Nuclear Reactors Leak all of the Time…. and #Fukushima is NOT a Leak either….
All this for an untreated observed slip and fall backwards on ice at Wyndham Worldwide WorldMark Resort in Big Bear, California at approximately 8 am on January 9, 2012. Wyndham had absolutely no WorkComp policies and procedures in place, did not call 911, did not offer a ride to a hospital, in fact, insisted that work shift be completed, and then was told to “see any doctor that takes work comp insurance” and proceed to drive down a snowy icy mountain road.
CAN YOU SAY CORPORATE IRRESPONSIBLITY? AND THE CASE IS RIDDLED WITH MIS-STATEMENTS WITH INTENT TO DENY MEDICAL CARE, FROM FALSE ALLEGATIONS THAT NOTICE OF AN ALLEGED MPN WAS PROPERLY SERVED, TO EGREGIOUS AND TERRORISTIC FAILURES TO PAY DISABLITY BENFITS, DESPITES ORDERS FROM THE COURT. NOW THEY WANT TO LOOK BACK 25 YEARS AND SEE IF I CONKED MY HEAD? A JURY SAID THERE WERE NO INJURIES IN THAT DISCLOSED ACCIDENT…. HARD TO FIND COMPETENT ATTORNEYS IN CALIFORNIA, HUH? CHURN, BABY, CHURN.