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!
For Injured Workers, the need has never been greater for us to tell our stories. We need a #CommitteeOfBloggers. Tell your story to the good peeps at ProPublica…..they may not be able to get the whole truth out there, but they’re doing a damn good job creating some cognitive dissonance. Look ’em up under The Demolition of Workers Compensation and find the link to SHARE YOUR STORY aobut “What Happens When Americans are Hurt on the Job? Help ProPublica Investigate” because, afterall, WE ARE THE MEDIA NOW. #InjuredWorkersUniting #SilentNoMore.
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||WEEKS PAID|
|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 $49,49,422 from 2012-2013 because C N A refused to despite Court demand:|
|$ 31,400.00||=||24.17579||weeks||99/weeks effective payment?|
|Lump Sum Permanent Disability Advance|
|$5,000||1/30/2015||(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||$44,903.61|
|EDD paid approximately||$47,922.00||difference EDD gave to C N A, not IW|
|EDD discounted back to C N A, collecting:||$31,654.00||$16,268.00|
|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||13 weeks||8477.95|
|2-5-13 to 5-8-14 TTD at $649.41 per week||38 weeks||24677.58|
|Reimbursed EDD for period of 1/28/2012 – 3/4/2013 for a total of $31,400.||48 weeks||31171.68|
|Fred Sachs, C N A||64327.21|
|C N A alleged total paid $82,092.04 for 1/9/12 – 5/8/14||$82,092.04|
|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.
Here’s the revised Chapter 5, How it Works TEMPORARY DISABILITY BENEFITS
“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…”
When do TD payments end? TD payments end when:
• 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?]
“What are permanent disability benefits?”
“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!
WE ARE THE MEDIA NOW –> BE GEEKY!