Remember the initial evaluation of this Brain Injury Survivor and #Wyndham Worldwide employee, by one of the early doctors:
APRIL 2012 –
Judgment and Insight: The patient’s judgment and insight seemed intact. Patient appeared to be aware of how the injury had affected cognitive functioning and discussed taking steps to remediate for areas of perceived deficit….
Test Behavior: The patient was also frequently tearful, becoming emotionally distraught when perceived unable to perform various tasks as well as perceived they would have been done prior to injury. Also becomes tearful when talking about various professionals who were perceived as not caring for medical needs appropriately.
COOPERATION: The patient was very cooperative. Completed all tests administered without complaint.
EFFORT: Patient appeared to put forth best effort on all tasks administered. Objective testing also gave no indication of purposeful exaggeration or distortion of symptoms….
Which deteriorated dramatically…..
….through 8,696 dangerous driven miles of muddling courageously to each and every appointment, hoping somebody would help find lost cognitive abilities, seeing just a few good doctors, who DO NO HARM, and being exposed to an army of incompetent, unscrupulous, criminal doctors, and/or doctors without expertise in traumatic brain injury, on the whole, and the outrageous denials of physician requested specialty medical evaluations and treatments form Traumatic Brain Injury, to the following $4,000 report insurance company doctor opinion:
April 2013 –
“IMPAIRMENT: RESIDUAL IMPAIRMENT DUE TO CHRONIC MALADAPTIVE COPING MECHANISMS, PREEXISTING PERSONALITY CONFLICTS, POOR ANGER MANAGEMENT SKILLS.”
and another that stated:
“Disability in Regards to the Head Region: The patient is status post trauma to the head region with development of post traumatic head syndrome, which is best described as slight. It is characterized by the presence of headaches, memory difficulty, dizziness, visual disturbance, and difficulty with the sense of smell.
Objective Factors For Consideration of Permanent Disability in Regards to the Head Region: None
FUTURE MEDICAL CARE: The patient should have access to plain over-the-counter analgesics for relief of her headache. However, she states she is not interested in taking any medication.
A Fraud Complaint is being filed with proper authorities for the above $4,000.00 AME / QME reports and ‘pack of lies’ and inaccuracies and negligence.
~~
Both doctors, in addition to their colleagues in the ‘small circle of worker comp providers’ made their reports based on incomplete medical records and both doctors refused to accept and consider omitted medical records in order to provide a supplementary report based on currently available facts. The insurance company denial of authorizations for evaluations and treatments, as requested by multiple physicians, further gives way to serious suspicions of extremely fraudulent activities, in collusion with highly-paid non-expert opinions.
~~~
Neither doctor has any known expertise or practice in diagnosis and treatment of traumatic brain injury, evidenced by the foregoing remarks, and cut ‘n paste thick reports of non-sense based on no facts or scientific evidence. Shame.
How long does it take to “break” even a brain-injured worker???
The Fourth Reich apparently has a fully subsidized army of nazi-type doctors maiming, drugging and killing American workers —– 21st Century SONDERKOMMANDOS, killing on behalf of Corporate Greed.
See the list below of ‘doctors’ who have profited by the Brain Injured Worker’s head trauma below. Some tried to help, some fought a little, others put the file in the ‘too hard’ pile. All made money….. while the Injured Worker loses hope and life.
See the specialties of each doctor…. all but a handful had any business treating an Injured Worker with Traumatic Brain Injury, as they are not in compliance with legal requirements to have doctors only treat what they are competent and trained to treat, rather than writing reports based on guesses and non-expertise, in order to make a mortgage or car payments or pay their dealers. Shame.
DIAGNOSES: 854 Closed head injury, 784 Headaches, 310.2 Post concussive syndrome, 850.1 Concussion with brief loss of consciousness, 850.9 Head Concussion, 309.81 PTSD, 310.2 Post concussive syndrome, 780.93 Closed Head Injury with amnesia, 921.00 Contusion (left orbit), 750.90 Concussion, 959.01 Head Trauma, 959.01 Cognitive Changes following head trauma, 850.0 Concussion, 959.00 Head Trauma (Contusion x 2) with Impaired Memory, Speech, Balance and Vision, 850-854, 959.01 Somatic/cognitive dysfunction and emotional dysfunction, 310, 310.8, 438 Mild cognitive dysfunction, memory processing, 850 Mild TBI positive lapse of consciousness, 310.20 Post Concussive syndrome, 309.28 Mood Disorder secondary to Post Concussive Syndrome, 959.01 Head injury, Lobe Disorders: frontal, parietal, cerebellar dysfunction, motor dysfunction, segmental dysfunctions, Closed Head Injury with Ongoing Sequelae, Psychological sequelae, possibly secondary to industrial injury, 959.01 Closed head injury with cognitive dysfunction and speech dysfunction, 784.00 post traumatic headaches, brain based vision impairments, brain-based vestibular and balance disorders + secondary to head trauma, NECK, BACK, Shoulder PAIN and related ICD-9 codes
| APPLICANTS MEDICAL INDEX | ||||
| Author | Date | Type | Representation | |
| Other specialists, as required based on ability to find and afford. | LIFETIME | Expertise in brain based treatments for TBI etc. | IN PRO PER | |
| MD – Psysiatrist | 8/2/2013 | Visit, Follow Up Exam and Hopefully progress report based on authorized treatments for brain injuries and related issues | ||
| Neuro-Optometrist | 8/23/2013 | Neuro-Vision Follow up Evaluation (Brain Rehab Center) | IN PRO PER | |
| Occupational VISION Therapy | 7/11/2013 | Occupational Therapy – Vision + 7/18, 7/25, 8/1, 8/8, 8/23 | IN PRO PER | |
| MD – Orthopedic Surgeon | 7/10/2013 | Visit, Exam | IN PRO PER | |
| MD – Radiologist | 7/3/2013 | MRI-right shoulder | IN PRO PER | |
| MD – Phsysiatrist | 6/13/2013 | Visit, Exam, Evaluation | IN PRO PER | |
| Occupational VISION Therapy | 6/13/2013 | Occupational Therapy – Vision | IN PRO PER | |
| DC – Chiropractor | 6/6/2013 | Visit, Exam | IN PRO PER | |
| Occupational VISION Therapy | 6/5/2013 | Evaluation, Occupational Therapy – Vision | IN PRO PER | |
| MD – Orthopedic Surgeon | 5/29/2013 | Visit, Exam | IN PRO PER | |
| Neuro-Optometrist | 5/24/2013 | Neuro-Vision Evaluation | IN PRO PER | |
| MD – Orthopedic Surgeon – State | 5/16/2013 | Evaluation for Social Security office | IN PRO PER | |
| Clinical Psychologist – State | 5/10/2013 | Evaluation for Social Security office | IN PRO PER | |
| Physical Therapy | 5/8/2013 | Physical Therapy, Cervical | IN PRO PER | |
| Physical Therapy | 5/6/2013 | Physical Therapy, Cervical | IN PRO PER | |
| Physical Therapy | 5/1/2013 | Physical Therapy, Cervical | IN PRO PER | |
| Speech Therapist | 5/1/2013 | Speech Therapy Exam | IN PRO PER | |
| DC – Chiropractor | 4/26/2013 | Visit, Exam | IN PRO PER | |
| Physical Therapy | 4/25/2013 | Physical Therapy, Cervical | IN PRO PER | |
| MD – Orthopedic Surgeon | 4/24/2013 | Visit, Exam, Report | IN PRO PER | |
| Physical Therapy | 4/24/2013 | Physical Therapy, Cervical | Lawyer #3 | Lawyer #3 dismissed 4/24/13 |
| MD – Radiologist | 4/19/2013 | MRI- Cervical (did not include thoracic; injured worker became ill after noise of MRI and brain sensory overstimulation; felt nausea, cold sweat and clammy for approximately 4 hours) | Lawyer #3 | |
| Physical Therapy | 4/19/2013 | Physical Therapy, Cervical | Lawyer #3 | |
| Physical Therapy | 4/17/2013 | Physical Therapy, Cervical | Lawyer #3 | |
| MD – Forensic Psychiatrist | 4/10/2013 | AME evaluator (based on incomplete records provided by defense, records omitted skew actual facts of findings, recommended treatments and denials of medical care, a similar ploy applied by defense in October/November 2012 in order to obtain a minimized report of collective findings and recommendations. First time it may have been an ‘oversight’….the multiple times it sounds like collusion to hide facts in order to favor defense clients.) The first time the ploy was applied a deposition was cancelled and attempt for a premature Settlement offer was made in order to have the injured worker accept an offer without a medical evaluation and to have injured worker forfeit any/all rights under the law. The attorney representing the injured worker was summarily dismissed with cause. TBI is clearly and evidently not an area of his practice experience or expertise. | Lawyer #3 | |
| MD – Orthopedic Surgeon | 3/20/2013 | Primary Treating Physician’s Orthopedic Spine Surgery Consultation with request for Authorization | Lawyer #3 | |
| MD – Neurologist, unknown speciality, non-US trained | 3/18/2013 | Secondary Treating Physician, Neurological Eval (based on incomplete records provided by Defense and TBI is not an area of his practice expertise) | Lawyer #3 | |
| MD – Orthopedic Surgeon | 2/22/2013 | Leave Accommodate Request report to Employer | Lawyer #3 | |
| MD – Orthopedic Surgeon | 2/15/2013 | Primary Treating Orthopedic Spine Surgery Consultation with request for authorizations | Lawyer #3 | |
| MD – Orthopedic Surgeon | 1/9/2013 | Orthopaedic Evaluation and request for treatment authorization | Lawyer #3 | |
| MD -Orthopedic Surgeon | 1/9/2013 | PTP Evaluation | IN PRO PER | |
| Functional Neurology: DC, FACFN, FABVR, CCST | 12/12/2012 | Visit, Treatment | IN PRO PER | |
| Functional Neurology: DC, FACFN, FABVR, CCST | 12/6/2012 | Visit, Treatment | IN PRO PER | |
| Functional Neurology: DC, FACFN, FABVR, CCST | 12/3/2012 | Visit, Treatment | IN PRO PER | |
| Functional Neurology: DC, FACFN, FABVR, CCST | 11/30/2012 | Visit, Treatment | IN PRO PER | |
| LAB Corp | 11/29/2012 | Self-procured Urinalysis work REPORT requested by functional neurology doctor,, only scientifically based treating doctor to-date | IN PRO PER | |
| Functional Neurology: DC, FACFN, FABVR, CCST | 11/27/2012 | Visit, Treatment | IN PRO PER | |
| Functional Neurology: DC, FACFN, FABVR, CCST | 11/21/2012 | Visit, Treatment | IN PRO PER | |
| Functional Neurology: DC, FACFN, FABVR, CCST | 11/19/2012 | Visit, Treatment | IN PRO PER | |
| Functional Neurology: DC, FACFN, FABVR, CCST | 11/16/2012 | Visit, Treatment | Lawyer #2 | Lawyer #2 dismissed 11/17/12 |
| Functional Neurology: DC, FACFN, FABVR, CCST | 11/15/2012 | Visit, Treatment | Lawyer #2 | |
| Functional Neurology: DC, FACFN, FABVR, CCST | 11/14/2012 | Visit, Treatment | Lawyer #2 | |
| Functional Neurology: DC, FACFN, FABVR, CCST | 11/12/2012 | Visit, Treatment | Lawyer #2 | |
| LAB | 11/12/2012 | Self-procured blood work REPORT requested by functional neurology doctor only scientifically based treating doctor to-date | Lawyer #2 | |
| Functional Neurology: DC, FACFN, FABVR, CCST | 11/8/2012 | Visit, Exam | Lawyer #2 | |
| Functional Neurology: DC, FACFN, FABVR, CCST | 11/7/2012 | Consultation | Lawyer #2 | |
| Phd – Clinical Psychologist | 10/1/2012 | Visit, Progress Report | Lawyer #2 | |
| PhD – Clinical Psychologist | 10/1/2012 | (Report) | Lawyer #2 | |
| Phd – Clinical Psychologist /Associate – ? | 8/7/2012 | Visit, Progress Report | Lawyer #2 | |
| Phd – Clinical Psychologist / associate – ? | 7/17/2012 | Visit, Progress Report | Lawyer #2 | |
| Phd – Clinical Psychologist / associate – ? | 7/3/2012 | Visit, Progress Report | Lawyer #2 | |
| PhD – Clinical Psychologist | 5/7/2012 | PTP Referral Form | Lawyer #2 | |
| MD – Psysiatrist | 4/30/2012 | Evaluation at Brain Injury Rehab center to dispute neuro-nazi unfounded neuro demands for epilepsy meds and his demand for DMV revocation of driver’s license hearing | Lawyer #2 | |
| Optometrist | 4/30/2012 | Self-procured by demand of DMV hearing. Reimbursements requested but denied. | Lawyer #2 | |
| Phd – Clinical Psychologist | 4/23/2012 | Neuropsychological Evaluation | Lawyer #2 | |
| MD – Orthopedic Surgeon | 4/20/2012 | Orthopedic Consultation (initial) | Lawyer #2 | |
| Phd – Clinical Psychologist | 4/19/2012 | PTP Referral Form | Lawyer #2 | |
| PhD – Clinical Psychologist / | 4/10/2012 | visit | Lawyer #2 | |
| PhD – Clinical Psychologist /associate (neuro-psych?) | 4/9/2012 | visit | Lawyer #2 | |
| PhD – EEG Neurofeedback Practioner | 4/3/2012 | EEG Neurofeedback Analysis | Lawyer #2 | |
| DC – Chiropractor | 4/2/2012 | Visit | Lawyer #2 | |
| PhD – Psychologist | 3/31/2012 | visit | Lawyer #2 | Lawyer #2 retained 3/30/12 |
| DC – Chiropractor | 3/29/2012 | Visit | IN PRO PER | |
| PhD – Psychologist | 3/21/2012 | visit | IN PRO PER | |
| PhD – Neuropsychologist | 3/21/2012 | Addendum to Neuro-psych Assessment | IN PRO PER | |
| DC – Chiropractor | 3/21/2012 | Visit | IN PRO PER | |
| PhD – Neuropsychologist | 3/19/2012 | visit | IN PRO PER | |
| DC – Chiropractor | 3/15/2012 | Visit | IN PRO PER | |
| PhD – Clinical Psychologist | 3/14/2012 | visit | IN PRO PER | |
| DC – Chiropractor | 3/12/2012 | Visit | IN PRO PER | |
| PhD – Clinical Psychologist | 3/7/2012 | visit | IN PRO PER | |
| DC – Chiropractor | 3/7/2012 | Visit | IN PRO PER | |
| PhD – Neuropsychologist | 3/6/2012 | visit | IN PRO PER | |
| MD, PhD – neurololgist, epilepsy/fibromyalgia specialty | 3/6/2012 | Visit | IN PRO PER | |
| PhD – Clinical Psychologist | 3/1/2012 | PR-2 | IN PRO PER | |
| DC -Chiropractor | 3/1/2012 | Visit | IN PRO PER | |
| PhD – Clinical Psychologist | 2/25/2012 | Physician Progress Report | IN PRO PER | |
| PhD – Neuropsychologist | 2/25/2012 | Neuropsychological Assessment | IN PRO PER | |
| DC -Chiropractor | 2/23/2012 | Visit | IN PRO PER | |
| PhD – Neuropsychologist | 2/22/2012 | visit | IN PRO PER | |
| PhD – Clinical Psychologist | 2/16/2012 | Visit | IN PRO PER | |
| PhD – Psychologist | 2/11/2012 | visit | IN PRO PER | |
| DC -Chiropractor | 2/8/2012 | Visit | IN PRO PER | Lawyer #1 dismissed 2/8/13 |
| MD – Radiologist | 2/6/2012 | MRI-Brain | Lawyer #1 | |
| MD – ER | 2/6/2012 | Clinical Report | Lawyer #1 | |
| MD – ER | 2/4/2012 | x-ray of the chest | Lawyer #1 | |
| PhD – Clinical Psychologist | 2/2/2012 | visit | Lawyer #1 | |
| PhD – Psychologist | 1/28/2012 | visit | Lawyer #1 | |
| MD Neurology (MPN) | 1/23/2012 | Referred to by PhD Clinical Psychologist 1/9/12; , later discovered was MPN provider, REFUSED TO SEE Injured worker when appeared for appointment. Said they do not see WC patients. | Lawyer #1 | |
| PhD – Clinical Psychologist | 1/21/2012 | visit | Lawyer #1 | |
| MD – Orthopedic Surgeon | 1/21/2012 | PR-2 | Lawyer #1 | |
| MD – Orthopedic Surgeon | 1/21/2012 | PTP Initial Report | Lawyer #1 | |
| MD – Orthopedic Surgeon | 1/21/2012 | Work Status Report | Lawyer #1 | |
| Labs | 1/21/2012 | Toxicology Report | Lawyer #1 | Lawyer #1 hired 1/20/13 |
| DC – Chiropractor | 1/19/2012 | Visit | IN PRO PER | |
| DC – Chiropractor | 1/18/2012 | Visit | IN PRO PER | |
| DC – Chiropractor | 1/16/2012 | Visit | IN PRO PER | |
| PhD – Clinical Psychologist | 1/14/2012 | visit | IN PRO PER | |
| PhD – Clinical Psychologist | 1/13/2012 | Handwritten Status Report | IN PRO PER | |
| MD – Family Medicine | 1/13/2012 | PR-2 | IN PRO PER | |
| DC – Chiropractor | 1/12/2012 | Visit | IN PRO PER | |
| DC – Chiropractor | 1/11/2012 | Work Status Report | IN PRO PER | |
| DC – Chiropractor | 1/11/2012 | Visit | IN PRO PER | |
| MD – Family Medicine | 1/11/2012 | Doctor’s First Report | IN PRO PER | |
| MD – Family Medicine | 1/11/2012 | IC Office Visit | IN PRO PER | |
| MD – Family Medicine | 1/11/2012 | Work Status Note | IN PRO PER | |
| MD – Family Medicine | 1/11/2012 | Prescription Slip – MRI | IN PRO PER | |
| MD – Radiology | 1/11/2012 | x-ray report (right ankle) | IN PRO PER | |
| MD – Radiology | 1/11/2012 | x-ray report (C/S) | IN PRO PER | |
| MD – Radiology | 1/11/2012 | x-ray report (T/S) | IN PRO PER | |
| MD – Family Medicine | 1/11/2012 | Visit | IN PRO PER | |
| MD – Family Medicine | 1/11/2012 | IC Office Visit | IN PRO PER | |
| DC – Chiropractor | 1/9/2012 | Visit, Evaluation, Treatment, off-work note | IN PRO PER | |
| DATE OF 1ST INJURY, 2nd injury “2nd impact” head trauma, neck, back, ribs shoulder again after abruptly terminated medical care at demand of employer | 1/9/2012, 2/4/2012 | 1st – Approximately 8 am, Mountain Resort, Snowy Morning, in front of co-workers and manager; 2nd – Early morning of 2/4/12 | ||
| LEGEND | TYPE | |||
| BOLD, times new roman is from Defense firm 12/12 “Medical Index” provided to IW at WC Hearing of 12/18/12 wherein missing documents were again discussed. | Corrections to Urgent Care MD entries…defense shows 01/09/12…the first doctor on day of injury was Chiropractor, 01/11/12; non-bold entries indicate omitted records…. SEE earlier dated indexes showing adding in of some reports by defense, but not all | |||
| Adjuster indicated neither he nor defense counsel would dig through the files to find missing records, there’s ‘just too much paper’ in June phone call. |
SUMMARY OF DOCTORS SEEN FOR TRAUMATIC BRAIN INJURIES: Draw your own conclusions. Hint. The brain oriented doctors have all been ‘self-procured’ as seeing orthopedic surgeons for traumatic brain injury just ‘doesn’t make sense’ to any thinking person.
2 chiropractors (one declined to treat due to paperwork confusion), 1 neuropsychologist, 3 clinical psychologists, 9 MDS (3 family practice, 5 orthopedic surgeons [for brain injury, d’oh!] 2 neurologists (1 with speciality in epilepsy/fybromyalgia and another with specialty practice in Electromyography and Electrodiagnosis), and others: 1 DC with specialty in functional neurology, 1 accupuncturist, 1 EEG neuro-feedback phD (who provided the only EEG, self-procured, unreimbursed), 1 physiatrist, 1 speech therapist (MA, CCC-LS LSP), 1 physical therapist, 1 optometrist, 1 neuro-optometrist, 1 vocational rehabilitation vision specialist, 1 doctor of unknown credentials who repeated tests taken within 30 days, causing ‘practice effect’ in results, and 1 forensic psychiatrist.
Requested but denied medical evaluations and treatments, since January 2012:
EEG, EEG Neurofeedback treatment, MRI – brain, cervical, upper back, right shoulder (brain self-procured, cervical authorized Apr 2013, Shoulder authorized July 2013), Continuing chiropractic (6 sessions authorized late Jun 2013, no providers willing to accept WC paperwork risks for failures to pay; requested seeing initial chiropractor and first doctor seen on date of injury); neurology evaluation with expertise in brain injury, physiatrist, functional neurology treatments, Neuro-Optometry evaluation and Vision Occupational Therapy, Occupational Therapy, Physiotherapy (6 sessions – cervical only- authorized 2013) – no extensions;
Labor Code 4610 seems to be clear that “only a physician competent to evaluate the specific clinical issues that were within the scope o the physician’s practice can modify, delay or deny treatment plans. The insurance company actions to deny specific clinical evaluations are then used as ‘evidence’ of lack of evidence to support demand for medical care. Talk about a shell-game and Worker Comp Fraud! Furthermore, the defense counsel has a pattern of omitting medical records to further skew the ‘medical evidence’ and to further deny reasonable and appropriate medical care.
SELF-PROCURED REASONABLE, NECESSARY AND APPROPRIATE MEDICAL CARE, UNREIMBURSED TO DATE:
Jan 2012 $30
Feb 2012 $371 + 75
Mar 2012 $300 + 40
Apr 2012 $174.46 +40
May
Jun
July
Aug
Sep 2012 $40
Oct 2012 $40
Nov 2012 – $7,961.47
Dec 2012 – $2,030.16
Jan 2013
Feb 2013
Mar 2013
Apr 2013
May 2013 – $868.45
Jun 2013 – $30 + 160 + 160 + 184 + 322
TOTAL MEDICAL REIMBURSEMENT DUE
AND WAY PAST DUE:
$12,826.54 + penalties to be imposed by Court, at maximum;
For Brain MRI, Urgent Care Co-Pay, Lumosity Brain games thru April 2012, EEG, 2012 Eye Exam (DMV required after neuro-nazi attempted license revocation when non-indicated drugs were declined, Speech Therapy evaluation , Neuro-Optometrist Evaluation, VISION OCCUPATIONAL THERAPY, Physiatrist Evaluation, Chiropractic from 2012-February, March, April, September, October and June 2013, Functional Neurology Brain Based Treatments, Lab work. Vocational VISION rehab ongoing, and self-procured treatments with brain injury specialists, as protected by LABOR LAW.
~~~
June 2013 – Long term Goals of VISION OCCUPATIONAL THERAPY (self-procured as it has been denied by insurance company since April 2012)
1. Pt will be able to negotiate at noisy, crowded novel, dynamic environment without difficulty showing improved visual spatial skills and decreased sensory overload.
2. Pt will be able to visual scan across busy environment such as street crossing with cars passing without dizziness reported or blurred vision.
3. Pt will be able to tolrate 4 minutes endurance run on the Dynavision completing minimum of 245 lights showing increased visual attention and awareness.
4. Pt will be able to organize reading material in a normal pattern and complete reading task without difficulty.
5. Pt will incorporate home program to assist with integration of learned skills for improved functional skills in home and community.
6. Pt will be able to scan and visually search in a non-random pattern being able to locate 10/10 items in the environment.
Knight v. United Parcel Service and Liberty Mutual Insurance Company, 71 CCC 1423 In this case, the Board held that an employer or insurer’s failure to provide required notice to an employee of rights under the medical provider network (MPN) that results in A NEGLECT OR REFUSAL TO PROVIDE REASONABLE MEDICAL TREATMENT RENDERS THE EMPLOYER OR INSURER LIABLE FOR REASONABLE MEDICAL TREATMENT SELF-PROCURED by the employee.
Krueger v. Republic Indemnity Company of America, 28CWCR44 says I have the right to change treating doctors at any time pursuant to Labor Code S4060. It also rules that AD Rule 9785 is invalid. The case says AD Rule 9785 is invalid because it is inconsistent with the right of an injured worker to the “free choice of physician” guaranteed by Labor Code S4600. Therefore, under this case I do not need to request a QME evaluation in order to obtain medical care. Under the laws as set forth in the court case Emporium-Capwell Co. v. WCAB (Tidwell) 48CCC801 (1983), I have the right to change treating doctors at any time after waiting the appropriate time from the date of injury.
Rhiner v. WCAB (1993), 4 Cal.4th 1213, 18 Cal.Rptr.2nd 129, 58 CCC 172 (California Supreme Court Case). This very important case establishes that when an insurance company is guilty of unreasonable delays in paying benefits, the applicant is entitled to a 10% penalty based on the dollar amount of the entire benefit (“the entire species of benefit”) and not just on the improperly delayed portion of the benefit….past, present and future.
Knight v. United Parcel Service and Liberty Mutual Insurance Company, 71 CCC 1423 In this case, the Board held that an employer or insurer’s failure to provide required notice to an employee of rights under the medical provider network (MPN) that results in A NEGLECT OR REFUSAL TO PROVIDE REASONABLE MEDICAL TREATMENT RENDERS THE EMPLOYER OR INSURER LIABLE FOR REASONABLE MEDICAL TREATMENT SELF-PROCURED by the employee.
Krueger v. Republic Indemnity Company of America, 28CWCR44 says injured workers have the right to change treating doctors at any time pursuant to Labor Code S4060. It also rules that AD Rule 9785 is invalid. The case says AD Rule 9785 is invalid because it is inconsistent with the right of an injured worker to the “free choice of physician” guaranteed by Labor Code S4600. Therefore, under this case the injured worker not need request a QME evaluation in order to obtain medical care. Under the laws as set forth in the court case Emporium-Capwell Co. v. WCAB (Tidwell) 48CCC801 (1983), the injured worker have the right to change treating doctors at any time after waiting the appropriate time from the date of injury.
Under LC S5814, applicant may be entitled to a sum equal to 25% of the value of the treatment or service denied, if the doctor requires authorization for a medical procedures or treatment and the insurance company unreasonably delays or refuses to authorize it.
How can the lawyers involved claim a right to any compensation for their unconscionable ignorance and failures to adequately represent an American with Diagnosed AND TREATABLE Disabilities…… ??
They failed to perform legally contracted for representation, and must be subjected to disciplines and sanctions, not rewarded for their parts in the horrors the injured worker has been subjected to. Is there no policing or continuing education required in the legal gutters?? Minimally, they must be prevented from ever representing another brain-injured worker until and unless they are educated to competently do so. To lose their license to practice law in California would be too light a sentence, from the perspective of the injured worker, whose injuries were not alleviated, nor was reasonable and appropriate medical care facilitated by any of the three lawyers.
Lawyer #1 –— wasn’t really a lawyer—the lawyer did a 3 second-meet-and-greet and the firm’s office administrator does the intake, provides legal opinion, determines the type of doctor for primary treating physician (in this case, it was determined that an ORTHOPEDIC SURGEON was required for the brain injury.) That orthopedic surgeon wrote down brain injury complaints as ‘headache’ and stressed, by way of word and action example, to expressed and tearful concerns about the brain injury, “Look, if I kicked you in the leg, it would hurt, but it wouldn’t mean you were injured”. 0.o Then he proceeded to recommend a chiropractor in his office, twice a week. When that was met with a “That’s a hundred miles round trip, twice a week. I have a brain injury. I need to see a doctor for my brain, and I can’t drive that much.” He then asked, “You’re not working are you?” “Then, you can drive.” 0.o That issue escalated quickly and an attorney friend (who had sadly referred to this firm) and a retired judge encouraged immediate dismissal and deal with the Bar later.
Lawyer #2 — wasn’t really a brain injury expert, and his workers comp skill level was minimal. He dismantled the first ‘treatment team’ the injured worker had painstakingly organized, with the adjuster, to include a clinicial psychologist, a neuro-psychologist, a brain-MRI, and one neurologist (who sadly specialized in epilepsy and fibromyalgia, not traumatic brain injury) and was a total nightmare on his own. Lawyer #2 has ‘his own’ doctor, who was a 3 -hour drive from the injured workers home, had a lesser credential than the first testing neuro-psychologist, only saw the injured twice in 8 months, and had ‘chat therapy’ sessions provided by one of his associates, of unknown credentials. He did write with a Mont Blanc pen and had a very fancy office with great view of Pasadena, through the smog. He had a plan for further neurology evaluations, EEG neuro-feedback treatments, neuro-optometry and vision therapy….. NONE OF WHICH HAPPENED.
PTP, upon receipt of a threatening letter from defense attorney about his alleged failure to ‘write a report’ on time (which defense attorney had been sent, with proof of service, multiple times….patterns). After that, he determined injured worker was close to healed and could go be a greet or clerk. Clearly sexist-discrimination in his consult, suggesting that a cognitively impaired woman could be a clerk or administrative support person. He was clearly looking to keep his QME license clear, and to not overly-annoy the defense counsel.
~~
Then lawyer #2 alleged to prepare for a deposition, when all along he had apparently been seeking a premature settlement, which he secured an offer for $100,000 in November 2012—AND ATTEMPTED TO COERCE INJURED WORKER TO ACCEPT IT, as there was ‘no evidence’ of injury …………. except for the diagnosis and requests for treatment and denied evaluations. Injured worker had a enough remaining marbles and advised that a settlement offer could not be considered without a valid diagnosis and prognosis. He got paid for the aborted deposition, he made sure of that. Injured worker has yet to receive mileage reimbursement for even that.
~~
Injured worker then without any delay immediately sought a brain injury evaluation and commence self-procured treatment, then dismissed the attorney, who clearly had no clue of diagnosing or treating and representing a brain injured worker. The initial consultation was free, and it was such a relief to speak with an intelligent doctor who was very familiar with brain injury, and better yet, he has training in rehabilition and functional neurology, scientifically evidenced and measurable medical treatments.
Lawyer #3 was hired in January 2013, at the onset of more threats of more legal-mumbo-jumbo and deceptions and continued denial of medical care by the defense attorney, a non-physician, from a family of ‘bone doctors’. (Skulls and Bones??!!) #3 was a ‘cantankerous old goat’ resting on laurels of yesteryear, and had a staff that couldn’t even read a simple list of ‘omitted records’ and failed to keep any agreement with injured worker, and against wishes of injured, agreed to an AME not with a neuro-psychologist, but with a forensic psychiatrist of very questionable behavior and judgement. Lawyer #3’s office failed to ensure all medical records were provided to AME doctors, as had been adamantly requested by IW at the time of hire. This lawyer was arrogant in his response to the omitted records by stating ‘there is no conspiracy to omit records. You have major psychological issues and I suggest you get help immediately.’
~~
The injured worker responded in writing that psychological support was one of the often denied requested medical authorizations, and was he suggesting self-procured treatment, even though his office had no clue on how to deal with self-procured medical treatment, medical and miles reimbursements, or finding other than an ORTHOPEDIC SURGEON for a brain injury as a primary, and looked for a ‘pain specialist’ for the brain component….. CLUELESS AND VICIOUS. The only ‘butt kicked’ was that of the injured worker.
~~~~~~~~~
12 Frequently Asked Questions
about
California Workers’ Compensation Law
1. Now that I got hurt on the job, can I make that down payment on the Mercedes?
5. For how long can I get medical treatment, Answer Man?
6. What if I can’t go back to my job? Is that when I make the call to Dr. Kevorkian?
9. Wait a second… Color me CONFUSED! I can’t do this alone!! I need help! How?
http://workinjury.com/12-faq.htm#12
The above is dated information, but the principles are sounds and sassy. The California Workers Comp laws changed dramatically in January 2013, so do your own research, draw your own conclusions, and remember, it’s hard to find a competent workers comp applicant attorney, and if you want a smart one, with cognitive abilities and knowledge of brain injuries, good luck if you don’t hire them on the first shot. Nevermind that brain injury causes poor judgement and slow processing….. Lawyers seem superstitious (or stupid and greedy) and seem to have a monopoly on ‘first hire’ is it, as few others will take on a botched up legal mess, not even when a life depends on it.
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How do lawyers look away when someone pleads for life-saving help?? Pitiful, evil and pitiful.
Sonderkommandos, on the whole…. and they seem to think they’ll get out of this alive.
ASK ABOUT PSYCHOPATHS NOW.
HERE ARE SOME RESOURCES, SHARE YOUR RESOURCES; SUBMIT YOUR STORIES AS A GUEST BLOGGER!
WE ARE THE MEDIA NOW AND FOR THAT WE ARE RESPONSIBLE.
ASK ABOUT WORKERS COMP GRAVY TRAINS: FB PAGE: https://www.facebook.com/AskAboutWorkersCompGravyTrains
BRAIN INJURY ADVOCATES: An Activist’s Go-To Handbook…. the book: http://braininjuryadvocates.com/ by Susan Hultberg http://braininjuryadvocates.com/book-back-cover
CALIFORNIA WORKERS’ COMP – How to Take Charge When You’re Injured on the Job – Christopher A. Ball – http://www.nolo.com/products/california-workers-comp-work.html
