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.
2012: Chiropractic, Acupuncture, Functional Neurology
2013: Chiropractic, Vision Therapy, Therapeutic Prism Vision Lenses
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
2012: Brain MRI, EEG, Functional Neurology, Clinical psychology, Urgent Care, Xrays
2013: Neuro-Optometry, Speech Therapy
2014: Neuro-Optometry, Acupuncture, Chiropractic, Neuro-psychology strengths assessments, MRI with TBI Protocol
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.
The program is targeted to restore injured individuals to the communities in some capacity, either as volunteers or return to work, depending on nature and extent of injuries. See the link, and put it in your contact list: http://www.coastline.edu/students/students-with-disabilities/acquired-brain-injury/
- “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.”
SEE MORE; LEARN MORE: http://www.northeastern.edu/nutraumaticbraininjury/rehabilitation/professionals-help/
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.]
TO ENHANCE YOUR LEARNING ABOUT BRAINS?
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.
MEDICAL CARE PROVIDED TO DATE BY CNA FOR HEAD INJURIES OF 1/9/12…..A WITNESSED SLIP AND FALL BACKWARDS ON ICE?
Through mid-2013 https://askaboutworkerscompgravytrains.com/2015/02/13/workcomp-evaluations-are-not-treatments/
- 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?
- Ask more questions! If not you then who? If not now then when?
Interrupt the war on injured workers. Do it now. You could be next!
Follow one of more of these links, thanks, and tell your friends and neighbors about the GrandWorkCompFraud; your governments already know…
BRING THE CORRUPTION OF THE EXISTING EXCLUSIVE REMEDY/GRAND WORK COMP FRAUD TO LIGHT;
LET IT IMPLODE; BUILD SOMETHING ELSE. THE INSIDIOUS SYSTEMIC FRAUD OF THE CURRENT SYSTEM IS NOT SALVAGEABLE.
BRING IN THE WRECKING BALLS!
TIDY UP SOME DEATH ROW JAIL CELLS IN SOME OF THOSE PRIVATIZED PRISONS FOR THOSE FOUND GUILTY OF CRIMES AGAINST HUMANITY.
May 14, 2013 – Uploaded by EducateInspireChangeTV
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…
WE ARE THE MEDIA NOW