Just submitted an update to the good peeps at ProPublica. FYI: I love what you folks are doing! Amp it up! People are dying in the WorkComp Ghettos and Gulags in the USA and elsewhere. Here’s an update: Do YOU want outcomes like this for your WorkPlace Injuries? Guaranteed by CNA? Works for Wyndham–You Too? https://lnkd.in/b9Ubefq Full story here: ASK ABOUT WORKERS COMP GRAVY TRAINS https://lnkd.in/btH3gtS
……As part of our ongoing investigation, we invite you—whether you are an injured worker, claims adjuster, an employer or lawyer—to tell us about your experience navigating the workers’ comp system. Have something we should look into? Fill out the form below and we may be in touch. If you have an idea to fix workers’ comp, lower costs or help injured workers return to work, we’d love to hear that, too.
Who are you? * Employee Claims Adjuster/Insurance Employer Lawyer State Regulator Doctor/Medical Staff
What’s your workers’ comp story? *
Tell us about your experience with workers’ compensation.
What was injured? * Head Neck, Including Throat Trunk (chest, internal organs, back, pelvic region) Upper Extremities (shoulders, arms, hands, fingers) Lower Extremities (toes, knees, legs) Body Systems (nervous, respiratory, circular, gastrointestinal) Multiple Body Parts (two or more of the regions above) Other Body Parts (prosthetic, orthopedic) Nonclassifiable
Check all that apply.
Approximate date of injury
In what industry did the injury take place? *
Natural resources and mining
Trade, transportation, and utilities
Professional and business services
Education and health services
Leisure and hospitality
Were you (or was the employee) disabled? * Not disabled Temporarily Permanently
Was a claim filed? * Yes No
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Name of employer
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My Dear Fellow Americans — aka “The Unsuspecting Public” — yes, we were warned about all of it. How few listened? Well, what is, is. In the meantime, ASK ABOUT YOUR #RADIATION THIS WEEK. Start with CNN’s version of the number of nuke reactors near you – https://lnkd.in/b97tkSv Then, ask about #Radiation and #WorkComp and #Timeshares, just for a well rounded opinion… https://lnkd.in/bMvk4n8 Then, if you’re still ok with doing nothing/saying nothing about things, and silencing those who do, well
ASK ABOUT WORKERS COMP CORRUPTION, MISTAKES, SONDERKOMMANDO, GRAVY TRAIN WRECKS AND MORE HERE….
After reviewing the list of doctors/providers, you may be ‘baffled, puzzled, confused and perplexed’ and asked, “WHAT TREATMENTS DID THIS INJURED WORKER RECEIVE, AND HOW MANY THOUSAND AND THOUSANDS AND THOUSANDS OF DOLLARS WERE SPENT ON EVALUATIONS THAT DID NOT RESULT IN AUTHORIZATION FOR HOW MUCH MEDICALLY APPROPRIATE CARE? FOLLOW THE MONEY. ALWAYS FOR THE MONEY.
If YOU make it to the “NAUGHTY LIST” all thanks go to CNA and defense firm, Grancell Stander et al, and of course, to Wyndham Worldwide for corporate irresponsibility and callous disregard for the life of an injured worker, in a serious breach of human right and ethics, extreme discrimination of injured workers with disabilities, not excluding age and gender discrimination issues. They could have made a difference. They chose not to. Bummer.
Will someone let DIR Director Christine Baker know what happens where there are only illegitimate practices and legal chicanery in brain injury cases? Everybody planning to watch #Concussion?
Find Physiatrists and Neuropsychologists and their inter-disciplinary teams for helping Injured Workers with brain injuries, and stop relying on Orthopedic Surgeons who admittedly know little to nothing about brain injuries, although along with chiropractors who are the first doctors often seen after a slip and fall or foot ball injury or car crash. Most experts will not play the killing games of Workers Compensation, as they took an OATH TO DO NO HARM. Did you?
Also, encourage investigations into who writes these regurgitations called reports, without benefit of legitimate medical evaluations, and how much money is wasted. Investigate why/how defense firms can have the pattern and practice omission of hundreds of pages of medical records with intent to deny medical care.
Governor Brown, could you kindly have the Attorney General Investigations of corruption at the highest levels of Workers Compensation, and encourage Governors across the USA to do like-wise, and dispatch the National Guard to protect injured workers from these WorkCompsters? The FBI stands ready to help and maybe even the District Attorneys. Thanks a bunch!
Dr. Jaime Whitlock – DC
Dr. Jay SanVictores – MD, GP – Urgent Care
Dr. Daniel DeGoede – Clinical Psychologist
Dr. Esmail Sebti – Neurologist
Dr. Gurvinder Sunny Uppal – MD, Orthopedic Surgeon
Dr. John Lambros – MD, ER
Dr. Christopher Hancock – MD, Radiology
Dr. Eileen Kang – NeuroPsychologist
Dr. Stephen Waldman, MD, Neurologist
Dr. Lynda Wells – PhD, EEG NeuroFeedback Practitioner
Diana Wallace, Acupuncturist
Dr. Marcel Ponton – Clinical Psychologist, Neuropsychologist
Dr. Gunn, Neuropsychologist
Dr. Khalid Ahmed – MD, Orthopedic Surgeon
Dr. Hoang – Optometrist
Dr. Nguyen – Optometrist
Dr. David Patterson – MD, Physiatrist
Dr. Tyson Chung – Clinical Psychologist
Dr. Gilbert Jaudy, DC – FACFN, FABVR, CCST, Functional Neurology
Dr. Jacob Rabinovich, MD – Orthopedic Surgeon
Dr. Bijan Zardouz, MD – Neurologist – QME
Dr. James O’Brien, MD – Forensic Psychiatrist, AME
Julie Simmons- MA, PSY.D
Dr. Darren Bergey – MD, Orthopedic Surgeon
James Lanier, PA
Crystal Crites, PT, MPT
Jennifer Diemart, MA, CCC-LSLP
Dr. Eric Ikeda – Neuro Optometrist
Debra Outlette, MS, OTR/L
Don Risser, Acupuncturist
Dr. Ronald Kent – MD, Neurologist, QME
Dr. Lynn Lowell, OD, FAAO, FCOVD
Dr. Seymour M. Young, MD – Neurologist
Dr. Hilda Chalgujian, Neuropsychologist
Dr. Michael Lobatz – MD, Neurologist
Jessica Martinez, OTR/L, HTC, PAM
Kelly Owen, MA, CCC-SLP
Margaret Fuller, MA, OTR/L
Rebecca Askew, MPT
Suzanne Carr, DPT
Catherine Fabian, AuD
Julie O. Johns, AuD, CCC-A
Dr. Jeffrey Holmes – MD, Orthopedic Surgeon
Dr. James Pasino – Neuropsychologist
Dr. Jay Jurkowitz – MD, Neurologist
Hoag Memorial – ER
Dr. Christian Reichart, DC
CORVEL TEAM SINCE 2013, 3D Practices — They even harm Cops, right Mayor Betsy? Did the Unions get to the bottom of the bad behavior by Corvel out in Ft. Worth yet? You should see how Injured Cops and Firefighters are treated in California. Shameful, indeed! Reams of Denials via CorVel for ADJ8181903! (Chronoloical Order, 2013 to present….notice a pattern of expertise of denying parties?) CorVel reports tend to be convoluted regurgitations of disorganized and incomplete medical records, violations of HIPPA rights, and inappropriate reviewers for types of injuries. Readers may opine that the submitting RNs wrote the reports, poorly and incoherently, for the most part.
Grace Napoles, RN – Utilization Management Department
Keith Louwenaar, MD – American Board of Orthopaedic Surgery, CorVel “Physician Advisor”
Joanne Palladino, RN, MSN, CNS – Utilization Management Department
Lailannie B. Matthews, RN, BSN – Utilization Management Department
H. Leon Brooks, MD, American Board of Orthopaedic Surgery
Sloane R. Blair, MD – American Board of Orthopaedic Surgery
Melinda Rubel, RN – Utilization Management Department
Maureen E. Mackey, MD – American Board of Physical Medicine and Rehabilitation
Lexi-Welanetz-Bursin, Psy.D., CA – Clinical Psychologist
Jean Caldwell, RN BS CCSM JC
Kenneth L. Nudleman, MD – American Board of Psychiatry and Neurology
Harish Porecha, MD
Jennifer Tayag-Castillo, RN, BSN – Utilization Management Department
Elena Vega, Supervisor, Utilization Management Department
Jeannie Romero, RN – Utilization Management Department
Lorne S. Label, MD – American Board of Psychiatry and Neurology
MAXIMUS FEDERAL SERVICES, INC.
Dr. Paul Manchester, MD, MPH – Medical Director, Specialty, Neurological Surgery
In the observed slip and fall backwards on ice by Wyndham Worldwide Vacation Ownership Sales Executive Linda Ayres on 1/9/12, the following people have been involved in the case, evaluations and determinations of care for a well diagnosed concussion/traumatic brain injury/closed head injury/ptsd and more. Summary statements in this blog: Surviving Work Comp — Just Do It!
Orders are face to face medical exams for the first set of chronological providers, separated by year by an underline….starting in 2012. (Blatant disregard of ACOEM/MTUS guidelines, but that’s for another blog.) Second set are CorVel and Maximus regurgitation reports, apparently written by RNs or others and signed by a variety of doctors, citing guidelines for necessary treatment, and somehow denying it anyway. Plenty of expensive bla bla bla. DO THE MATH. FOLLOW THE MONEY. ASK MORE QUESTIONS?
For now, let’s just make the list. Is your name on it? “Let’s get started.” Remember, all of these people have made money for seeing/knowing the Injured Worker. Did they all provide “care” or “medical treatment”?
In contrast, Injured Worker was denied benefits, denied medical care, forced to file for welfare with Social Services and rely on the charity of friends and the Salvation Army—-proving that with Wyndham Timeshare, there are “No Free Gifts” and there is blatant and callous disregard for lives of injured workers and customers. A friend shared this link with more news on how Wyndham Worldwide behaves in the global marketplace.
While WCAB seems to deem “evaluation after evaluation after evaluation” as evidence of InjuredWorkers receiving medical care, the Information and Assistance Officer, last resort for help for unrepresented Injured Workers, is not a doctor, nor a lawyer, and practice without those licenses is questionable indeed.
The dubiousness appears compounded when good doctors properly make legitimate and conservative recommendations for immediate and necessary care, only to have the recommendations denied by attorneys and adjusters in 2012, then, aided and abetted by Team CorVel. Advising an Injured Worker to “have better control” of counsel when represented is a joke—if CAAA can’t police their own members, how can a Worker with a Brain Injury be expected to know when representation proves to be totally incompetent, dangerous, and worse?
CAB Commissioners and DIR seem complicit in the Gravy Train, at least in this case, which so many Super Lawyers indicate is ‘just how it is’ — happens to everyone — very common case, or maybe they just don’t know. More on attorneys in another blog.
Follow this blog for more details that everybody knows but has kept the dirty secrets behind closed doors, while American workers and taxpayers pay and pay and pay—-with life, liberty and justice for none attacked by the Workers Compensation maiming killing brigades.
By the time you finish reading this blog, you will have a better idea of why Workers Compensation Survivors call it a GRAVY TRAIN WRECK. (Some of these doctors were paid by CNA, some were paid by CIGNA, some were paid by the Injured Worker (unreimbursed medical expenses and miles to date exceed $43,300 – failures to receive adequate treatment have caused permanent and irreparable damage to IW.
Without WorkersCompensation, legitimate insurance would have facilitated care that would have been immediate, expert, reasonable, beneficial and IW may have returned to work within months, back in 2012. Without care, Injured Worker has been advised to make plans for Assisted Living in light of risk of dementia, with a need for personal assistance now. Thanks WorkCompsters!
1. MMI and Future Medical Reports & Personal Assistant now; Independent/Assisted Living, Memory Care for future
2. Trial Return to Work since I don’t get to complete Coastline Acquired Brain Injury Program thanks to file churning, refusals to mediate in June/July/August and Court delays and income issues and more] Nobody has responded to my inquires about if you need any thing else from me. Tina kept asking for a doctor release. I think you have it…that MMI says this is as good as it gets. Well, let’s make some lemonaid. SSA preliminary staff says you don’t need brains to sell timeshare.
3. Mediation or Settlement Offer (your turn, or pass again)
4. Actual vs. Reported TTD and PD benefits (and fines and 25% penalties per incident for failures to pay)
5.. SSA needs accurate benefits report from CNA Was it $87,422.04, $82,092.04, $49,899.12, $47,252.31, $49,393.52 or some other number? (see below)
6.. The reimbursement to EDD with the nearly $20K discount for refusing to pay TTD in 2012/2013 does not count as money given to me; apples and oranges; of that.. let’s look together, details below:
To Whom It May Concern: Just so you know, my outrage is not because I have a brain injury, my outrage is because so many people of the WorkCompsters ilk have profitted by FRAUD causing egregious harm to me, other injured workers like me, from doctors, lawyers, judges, politicians and agencies of the US government–by their total disregard for Civil Rights and all things American. The “Naughty & Nice Lists” are being collected by WorkCompCentralProPublicaNPR and me and my fellow Injured Workers. Expect Us. Join Us.https://lnkd.in/bMvk4n8 #WATMN
$ 77,821.38 [total paid by EDD $49,422 for 2012-2013, and in 2014,
after reimbursement of $31,400 from CNA, EDD paid IW approximately $21,000 of the $31,654
(did EDD get $31,400 or $31,654? who knows? and they still have a $1,500 lien?
with final payment 7/25/14] CNA reimbursed $31,400 of the 49,422 that EDD paid 2012/2013
(amounts are stated differently by all sources) Who’s on First? What’s on Second?
You received the MMI medical report from Dr. Hilda Chalgujian last Friday, August 28, 2015 and on Monday, September 1, 2015, you received a further report from Dr. Chalgujian regarding future medical needs. I have asked Wyndham Worldwide for the dates of the upcoming sales training and to commence the ADA required interactive process to explore trial return to work. I have also restated my desired accommodations and I have asked if any thing else is required of me. I have heard nothing.
Because of what appears to be inaccurate reporting by your client to and with EDD and WCAB regarding actual monies paid to me, there is extreme confusion regarding my Social Security Disability Benefits, causing further audits of amounts paid and due.
I did receive yet another print out from CNA (thanks, Fred) but the numbers are different from other numbers I have received, EDD has received, and apparently those reported to WCAB. (Copy attached; maybe respective numbers people can take a look and sort it out; the Advocator has not been able to, Matrix was also confused last year and I need to follow up with them since they demanded pay back due to information somebody gave them about income I was allegedly receivig but did not; this current CNA print out supports that.) (Did anybody ever figure out yet why SSA thinks I’ve been receiving an disability benefits since May 2014? Much less, they are alleging approximately $4k a month is being received? Yikes! Gotta find out where that money went don’t we? I did not come to me! I have some uncashed checks for evaluations that have not been attended, and those checks will have to be replaced if we ever to Court on seeing an Ear Nose and Throat doctor for my brain injuries!)
As another adverse consequence to me, upon the threat by SSA of termination of all income benefits in November, I was unable to continue to complete the Coastline Acquired Brain Injury Program. I did ask CNA to help with lodging and I would pay (as I have done thoughout) the meals and miles. I am, as you know, out of pocket more than $43,000 to date because of your client’s patterns of continuous harm and failures to provide either immediate or further discovered necessary medical care. If you recall, I was not provided transportation to as much as an urgent center, in fact, I worked my full shift and somehow drove 60 miles after work down an icy mountain to see the first doctor, per management instructions, who “would accept workers compensation insurance.” My confusion and disorientation and inability to speak as I used to be able to got worse. You know the rest of the story.
As it appears now: (text from blog: https://askaboutworkerscompgravytrains.com/2015/08/30/3-of-3-workcomp-magic-money-math-or-follow-the-money-on-the-workcomp-gravy-train/)
It is unclear to everybody how Social Security Administration came up with the numbers for their calculations, and what sources were used. As is apparent here, CNA is all over the place with how much they paid and when. CNA has not paid any penalties to date for delays in payment, which are apparently substantial consider refusal to pay TTD through most of 2012 (4/16/12 – 2/14/13, with last payment being 5/8/14 in the amount of $1,298.82, issued 5/7/14)
EDD PRINT OUT SAYS THEY PAID 938 DAYS AND THAT WC PAID 509 DAYS FOR A TOTAL OF 1,447 DAYS FOR A TOTAL OF 127,214.90 FOR A TOTAL BETWEEN EDD AND WC FOR 1013 DAYS. MAKES SENSE SO FAR? YEAH, TO ME EITHER.
EDD says here EDD paid
EDD SAYS WC PAID IW
WC SAYS HERE PAID IW
CNA adjuster alleges on 10/19/14 they “paid” 1/9/12-4/15-12 @ 652.15 per week and 2/15/13-5/8/14 @ 649.41 per week and reimbursed EDD for 1/28/12 to 3/4/13 for a total of $31,400.
CNA “Total WC Ind to Date””
C N A “Total WC Ind to Date”
CNA adjuster alleges on 10/19/14 they “paid” 1/9/12-4/15-12 @ 652.15 per week and 2/15/13-5/8/14 @ 649.41 per week and reimbursed EDD for 1/28/12 to 3/4/13 for a total of $31,400.
Total WC ind to date
Notice of termination of benefits; last check was 2/12/14, when “Total WC ind to date” was $42,899.12 — approximately 40 weeks
“Notice of TTD Resume for 2/14/14 – 4/24/14 @ 649.41 ” w/check for $6494 issued 4/18/14 and a check for 4/25/14 – 5/8/14 for $1298.82 on 5/7/14
C N A issues another ‘notice of payment termination, again alledging “104 weeks of payments paid 1/9/12 – 5/8/14 @ 652.15/week for a new total of $82,092.04
LAST PAYMENT ISSUED 5/7/14 for $1298.82
PD Disability status – repeated refusals to provide estimate PD benefits or advances
PD advance on estimated PD to help get TBI treatment, $5,000, subrogated to LTD carrier, new total paid stated as $87,422.04
So, please sort out what was actually paid to me by CNA, would you pretty please? Was it $87,422.04, $82,092.04, $49,899.12, $47,252.31, $49,393.52 or some other number? Please send proof of payments also, as it will be necessary to forward to SSA and WCAB Audit Unit.
There are also unpaid late fines and penalties due for failures to pay TTD, and failures to reimburse medical miles dated back to 2012, fully documented on the premature C&R proposed that included payback had I been willing to quit my job, forfeit any future medical, promise not to file for Social Security Benefits and worse. There are also fines and penalties for failures to pay medical expenses. That is not the spirit of the Workers Compensation laws and the Labor Codes. Actually, the 2012 attempt to coerce premature settlement once the brain injury was diagnosed and Kim Mall and Daniel Elliott obstructed every effort to get medical care and more complete diagnosis sounds pretty predatory and probably quite illegal.
Bottom line, as I told you all, due to the financial terrorism and refusals by CNA to pay TTD benefits, last year I was forced to apply for social services welfare, and the Salvation Army helped me keep my lights on. I’m not doing that again.
This is America, and we have laws. While I am not an attorney, attempting to represent myself despite my brain injuries due to the Ethics Violations of the prior attorneys that handled my case so poorly, I DO KNOW THE DIFFERENCE BETWEEN RIGHT AND WRONG, LAW AND ORDER
So, let me know how we proceed with return to work. I’m not going back to social services for welfare money because so many people profited by my injuries and now I am no longer a profit center for same. The District Attorney and FBI Corruption Task Fore has just shut down Palm Springs City Hall, and Wyndham has many properties in the area. Let’s hope the alleged Wyndham WorkComp collusion/corruption finally makes it to their radar also.
I will be in Palm Springs and Rancho Mirage this afternoon, doing some research into Independent and Assisted Living communities, that also have Memory Care services. As Dr. Chalgujian’s report indicated I could certainly benefit from 8-10 hours of personal assistance, if you could organize that now, it could help me expedite return to work tasks.
Many thanks. Let’s get going, we don’t want this file to churn several more years, or do we? As mentioned on voice mail to Fred, if you all want to make a settlement offer, I have someone who will review it with me whose opinion I respect. He doesn’t think you have any interest in settling, nor do I, so let’s get me back work. We won’t know if I can do it till we try, and I am most willing to try.
Thanks a bunch.
LINDA AYRES, IN PRO PER
From: Linda Ayres <email@example.com>Cc: Linda Ayres <firstname.lastname@example.org>
Sent: Sat, Aug 29, 2015 1:28 pm
Subject: Fw: PD & TTD Benefit Printouts – Linda Ayres
WorkCompCentral 4th Annual CompLaude Awards Gala is coming up…. Mark your calendar for Saturday, December 5, 2015.
BTW, August 31, 2015 is the deadline for submissions of YOUR nominees for the WorkCompCentral CompLaude Awards. After the recent news about Director Christine Baker, it seems that the need for your to dig deeply into your database to find good people doing good stuff in America’s work comp system has never been greater. Here’s the link again.
On the who’s been naughty and who’s been nice, WorkCompCentral has the ‘nice” list being covered, and looks like ProPublica and #InjuredWorkersUniting will simply have to continue cover the ‘naughty’ lists and enlist support, #TEO!
HAVE YOU BEEN ALSO BEEN CHEATED OUT OF DISABILITY BENEFITS AS WELL AS DENIED MEDICAL CARE FOR YEARS, CAUSING PERMANENT DISABILITIES TO YOU, TOO? WE’RE NOT ALONE.
BUT WAIT! THERE’S MORE! AM I MISSING SOME CALCULATIONS HERE??!!! NOBODY AT EDD/SSA/CNA/MATRIX/ADVOCATOR/WYNDHAM SEEMS TO BE ABLE TO HELP OUT EITHER. IT’S IN THE ‘TOO HARD’ PILE EVERYWHERE….
The skewed and repeatedly mis-stated numbers have Social Security Administration in a super quandry over retroactive Social Security Disability benefits. First, they sent $_____________ to a dead bank account, and the Treasury Department kindly intervened. Then they sent a letter saying, whoooops, miscalculated, send us back $______ (more than the original amount) within 30 days, or else we’ll terminate all your benefits, but you can appeal it.
Then it was discovered they generously overpaid the law firm by $1,500 which was reimbursed immediately in June back to SSA, but SSA had apparently just processed that repayment, so they sent a follow up letter acknowledging the reimbursement and reduction in the demand for funds from Injured Worker by same amount.
Weeks have passed and SSA has been unable to return calls to the Advocator handling the case. The time to appeal is fast approaching, hence, this outreach via the internet. ARE THERE ANY FORENSIC ACCOUNTANTS OUT THERE? OR CAN THE STATE CONTROLLER’S OFFICE HELP? (3 OF 3 WILL FILL IN THE BLANKS ON AMOUNTS FOR SSA/EDD/CNA FIASCO…IT’S A TOUGH SHELL GAME TO FIGURE OUT—–> PARTICULARLY WITH A BRAIN INJURY.
I JUST KNOW IT AIN’T RIGHT…. and it’s in the “too hard” pile on too many desks, another example of ‘obfuscation of facts’ with intent to deny benefits and further harm injured worker? Sure looks like it, huh? Not even experts can sort it out.
CNA aka American Casualty refused to pay TTD from 4/15/12 – 2/14/13 — and there are extenuating circumstances involving not only WCAB Courts, but Information and Assistance Officers and EDD parties. Adult Protective Services, State Senator and Assemblyman’s office helped to break the stranglehold that resulted in Injured Worker having to apply for Social Welfare, Public and Private Assistance, including help from the Salvation Army for utilities in early 2014 because of this practice which is apparently “done all the time” according to CNA Adjuster, Daniel Elliott.
Reimbursement discount was ‘negotiated’ by defense firm with EDD, apparently without any State oversight, and a Judge on appeal said it was ok. Apparently, some Judges think it’s ok for the State to give away taxpayer dollars to big insurance companies.
[Yikes, CNA has racked up some penalties, haven’t they? Is there anybody enforcing these rules?]
____ Weeks Late; 25% penalties +++
___ Weeks late; 25% penalties +++
C NA PAID TO IW
104 weeks per Labor Code, weekly rate questioned, but at $1,298.82 x 52 checks = $67,538.64
C N A Reimbursed $31,400 to EDD on 4/29/14 for paying IW $49,49,422 from 2012-2013 because C N A refused to despite Court demand:
99/weeks effective payment?
Lump Sum Permanent Disability Advance
(subrogated by private LTD carrier?!!)
52 additional weeks of disability benefits to have been provided by the State, when the WorkComp system fails after the first 104 weeks, would have meant an additional benefit of 52 weeks x $961/week or $49,972.
So, if CNA had paid 104 weeks at $649.41 (eow check $1298.82) that would have been: $67,538.64
And if EDD has paid 52 weeks at $961/week that would have been: $49,972
Not counting the extreme hardships caused by months of non-payments by anybody, the total TTD benefits that were due between 1/9/12 and 1/9/15 seem to be around about $117,510.64 Injured Worker was actually paid 49,393.52 from CNA and $49,422, for a total of $98,815.52 for the 3 years (approximately $33K, that came in sporadic payments, causing extreme stress and hardship).
This appears to be a shortage of $18,695.12 (yikes, how close is that to the reward CNA received from EDD for refusing to pay TTD and for refusing to provide medical care? Is that a mere coincidence? These numbers alll jumble all over my brain. Social Security Disability was awarded in May 2015, with retroactive pay back to date of injury, 1/9/12, with the 6 month waiting period to 7/2012.
This is where it gets real real fuzzy…. that will be documented, with PDFs of all of ths in 3 of 3 – WorkComp MAGIC Money Math…
This seems to happen all the time, to many injured workers…..nobody seems to know how the sad tales end.
You’ll know how this one ends, count on it! Maybe you will even read about it in a ProPublica Report! ;D
Back pay caper of May 2014 RE
WC from SSA print out
C N A paid me
EDD paid approximately
difference EDD gave to C N A, not IW
EDD discounted back to C N A, collecting:
of the $31,654 EDD sent me approximately ($21,000.00)
C N A 5/8/2014 Notice states they paid a total of $82,092.04 – they did not. See above and figure in discounted payback to EDD
See also 9/23/14 statement from C N A
Weeks * $
1-9-2012 to 4-15-2012 TTD at $652.15 per week
2-5-13 to 5-8-14 TTD at $649.41 per week
Reimbursed EDD for period of 1/28/2012 – 3/4/2013 for a total of $31,400.
Fred Sachs, C N A
C N A alleged total paid $82,092.04 for 1/9/12 – 5/8/14
C NA alleges “We have paid the 104 weeks of benefits”
(law says 104 weeks + additional 52 by EDD afterwards as required)
THE MATH DOESN’T ADD UP
The question arises, how many unclean hands did that “negotiated discount” pass through before making it’s way back to EDD? If this is done all the time, how many times must that discounted $18,000 be multiplied to determine how much money leaves the State in favor of Insurance Profits??
If every State provides such “negotiated discounts” (aka “kickbacks”??!!)…. how much money is lost by such cost shifting by the State?
Further cost shifting involves shifting to Social Security Administration, also implicated in this convoluted mess, and they are spending weeks and weeks and weeks of labor hours trying to sort out the calculations. See below for more on that. Treasury Department has even had to become involved in May, and will likely need to jump in again before all is said and done?
According to the State of California Department of Industrial Relations, here’s the ideal regarding Temporary Disability benefits:
But wait! Is CNA aka American Casualty, THE ONLY INSURANCE CARRIER WITH SPECIAL PRIVILEGES AND DISCOUNTS afforded by DIR no matter what harm is caused to California Injured Workers? Have any politicians approved these little … what do we call it…. incentives???
Here’s what they say about attorneys: http://www.dir.ca.gov/InjuredWorkerGuidebook/FAQsAttorney.pdf (The warnings are quite inadequate–InjuredWorkers will create some new information for those new to the system. If you make a mistake retaining an attorney who freely violated the ABA Code of Ethics, you’re in for an awful ordeal, and they hang on like leaches to a file, preventing legitimate/competent attorneys from taking over their messes.
The In-Pro-Per community is a market overlooked by most WorkCompsters…. #InjuredWorkersUniting — perhaps with teams of Paralegals, the WarOnWorkers can be won, SunTzu style, with a Rag-Tag Army of Injured and Disabled Patriots and Others. Just sayin…THINK OUTSIDE OF THE WORKCOMP GHETTOS.
See the gaps in which CNA failed to pay a Wyndham Worldwide Injured Worker? Does that mean 25% of each late payment, up to $10,000 is now due and payable, with sanctions? Who absorbs that extra cost?
That looks like 45 weeks and 4 days? So would that would be 25% of…. ($1298.82 divided by…. times 45… no, times 22.5 which equals $29,200) so 25% of $29,200, or $7,300. Is that correct? So, if you multiply a practice of cheating injured workers like that times how many million injured workers are there, the plot thickens, huh?
There’s a rule about penalties for failures to reimburse medical miles which CNA also scoffs at. Complaints have been filed repeatedly with the Audit Unit; hopeful that Wyndham/CNA’s turn is coming up soon on auditors. Out of pocket medical expenses for this injured worker have exceeded $43,000. It seems to be a standard that injured workers who are able to, will often spend more than $50,000 in personal funds to survive the WorkComp system. Some grand bargain, huh? Wish for WorkComp only on your most despised enemies, huh?
“TD payments begin when your doctor says you can’t do your usual work for more than three days or you get hospitalized overnight. Payments must be made every two weeks. Generally, TD stops when you return to work, or when the doctor releases you for work, or says your injury has improved as much as it’s going to.”
APPARENTLY NOT IN CALIFORNIA! Does the State Controller know how EDD assumes risks for insurance companies then deeply discounts payback, which also deprives Injured Worker of the additional 52 weeks of State Disability, assuming that the first 104 weeks without medical care failed to result in employee death?
“ If you were receiving temporary disability (TD) benefits, the first PD payment is due within 14 days after the final TD payment” Ooooops, last TD payment was when? Shown as 5/8/14? Does that mean that some sort of estimated PD vs. receiving nothing for months and months and months was due?
Is the claims administrator required to pay a penalty for delays in PD payments? Yes. If the claims administrator sends a payment late, he or she must pay you an additional 10 percent of the payment.
“Is the claims administrator required to pay a penalty for delays in TD payments? It depends. The claims administrator must pay you an additional 10 percent of the payment, if: • The claims administrator sends a payment late; and • You filed a claim form for your injury more than 14 days before the payment was due. This is true even if there was a reasonable excuse for the delay. However, there’s no penalty if the claims administrator can’t determine, in the first 14 days after your employer learned about your injury, whether TD benefits must be paid and sends you a delay letter as explained above. You could be awarded a total of 25 percent of each late payment, up to $10,000, if there was no reasonable excuse for the delay…”
• Your treating doctor says you can return to your usual job (whether or not you actually return to work); or
• You return to your usual job or to modified or alternate work at your regular wages (or at wages associated with a maximum limit on TTD payments); or • You have reached a point where your condition is not improving and not getting worse. (When this happens, your condition is called “permanent and stationary.”); or
• You were injured on or after January 1, 2008, and received up to 104 weeks of TD benefits within five years from the date of injury, or you were injured sometime on or after April 19, 2004, through December 31, 2007, and received up to 104 weeks of TD benefits within two years from the start of payments. (Workers whose injuries involve acute and chronic hepatitis B, acute and chronic hepatitis C, amputations, severe burns, human immunodeficiency virus, high-velocity eye injuries, chemical burns to the eyes, pulmonary fibrosis, or chronic lung disease may receive up to 240 weeks of TD benefits within five years from the date of injury.)
When TD payments end, the claims administrator must send you a letter explaining why the payments are ending. The letter must list all TD payments sent to you. This letter must be sent within 14 days after your final TD payment. If your treating doctor says that you will never recover completely, you may be eligible to receive permanent disability benefits or a supplemental job displacement benefit. See Chapter 7. Permanent Disability Benefits, and Chapter 8. Supplemental Job Displacement Benefit [Ooooops, CNA didn’t do that either…. ]
[Yikes, CNA has racked up some penalties, haven’t they? Is there anybody enforcing these rules?]
“Most workers recover from their job injuries. But some continue to have problems. If your treating doctor says you will never recover completely or will always be limited in the work you can do, you may have a permanent disability. This means that you may be eligible for permanent disability (PD) benefits. You don’t have to lose your job to be eligible for PD benefits. On the other hand, if you lose income because of a permanent disability, PD benefits may not cover all the income lost.”
“Other Benefits Besides PD If you have a permanent disability, you may also be eligible to receive: • Medical care for your injury, described later in this chapter. • A supplemental job displacement benefit. To learn about this benefit, see Chapter 8. • Other financial help, such as Social Security disability benefits and benefits offered by some employers and unions. To find out about these benefits, use the resources in Chapter 9”
When do I receive PD payments? If you have a permanent partial disability, you are eligible to receive the total amount of your PD benefits spread over a fixed number of weeks. If you have a permanent total disability, you are eligible to receive PD payments for the rest of your life. PD payments are due as listed below, except as follows: If your employer offers you work that pays at least 85 percent of the wages and benefits that you were paid at the time of injury or you are working in a job that pays at least 100 percent of the wages and benefits that you were paid at the time of injury, you will not receive PD payments until after a workers’ compensation judge approves a settlement of your case or decides on the PD benefits you will receive. If neither of the above is true:
• If you were receiving temporary disability (TD) benefits, the first PD payment is due within 14 days after the final TD payment.
• If you weren’t receiving TD benefits, you should receive the first PD payment within 14 days after the claims administrator learns that you have a permanent disability caused by your injury. After the first payment, PD benefits must be paid every 14 days. PD payments end when you reach the maximum amount allowed by law or when you settle your case and receive a lump sum. Note: This lump sum is reduced by the PD benefits that you already received, including any lump sum advances.
Is the claims administrator required to pay a penalty for delays in PD payments? Yes. If the claims administrator sends a payment late, he or she must pay you an additional 10 percent of the payment. This is true even if there was a reasonable excuse for the delay and even if the claims administrator sends a letter explaining the delay. (Note, however, that this penalty is not required if you did not file a claim form for your injury.) You could be awarded a total of 25 percent of each late payment, up to $10,000, if there was no reasonable excuse for the delay.
EDD PICKED UP THE COSTS FOR TEMPORARY DISABILITY BENEFITS FOR THIS INJURE WORKER BECAUSE CNA REFUSED TO PAY TTD, ALTHOUGH AGREED UPON IN A COURT HEARING. THE ADJUSTER INDICATED THAT THEY DO IT ALL THE TIME. REALLLY?? THE INFORMATION AND ASSISTANCE OFFICER COULD ONLY SAY, ‘Look, the order says they would resume paying “if necessary” so apparently your Dr. Ponton didn’t think it was necessary.” Really, he continued to call me temporarily totally disabled in every reported, omitted and not, to the Carrier and to WCAB and to EDD, so what part of that could be misunderstood as being “not necessary”????!!!
For the records, EDD paid over an intermittent period, ending in mid 2014 for final reconciliation, after numerous appeals, a total of approximately $49,400 ….negotiated a discount of Injured Workers Benefits or Your Tax Dollars, providing the WorkComp carrier what appears to be an award for approximately $18,000 for REFUSING TO PAY TEMPORARY TOTAL DISABILITY PAYMENTS IN ACCORDANCE WITH LABOR CODE, AND FOR CAUSING PERMANENT TOTAL DISABILITIES BY FAILING TO PROVIDE MEDICALLY NECESSARY TREATMENTS WHILE RACKING UP WHAT APPEARS TO BE A DRAMATIC MONEY LAUNDERING EFFORT WITH MORE THAN APPROXIMATELY 40 FACE TO FACE MEDICAL EVALUATIONS.
NUMEROUS CorVel medical evaluations with supportive chicanery continuing the pattern of egregious harm with callous disregard for life and WITH TOTAL DISREGARD FOR RECOMMENDATIONS FOR TREATMENT.
This is the American Workers Compensation System? Everybody knows. What’s wrong you people putting up with these most vile practices that are mere profiteering by the maiming and experiments and exterminations of your fellow Americans? Is it really worth your soul to sell out humanity?
Well, we know that psychopaths have no remorse, compassion or soul—-is that what we have here, WorkComp is operated by a SWATH OF PSYCHOPATHS? SOS, MY FELLOW AMERICANS! SOS!
“If not you, then who? If not now, then when?” YOU COULD BE NEXT!
Date of Injury: 1/9/2012 — Brain Injury Survivor still on the rest and wait and wait and wait for benefits and medical care program. WorkComp Carrier has successfully shifted risks and burdens to the State and SSA, IS THERE A FORENSIC ACCOUNTANT READING THIS? OR DO YOU KNOW ONE TO SEND IT TO?
‘C N A Reimbursed $31,400 to EDD on 4/29/14 for paying IW $49,422 from 2012-2013 because C N A refused to despite Court demands and Injured Worker Objections”
” Not counting the extreme hardships caused by months of non-payments by anybody, the total TTD benefits that were due between 1/9/12 and 1/9/15 seem to be around about $117,510.64 Injured Worker was actually paid 49,393.52 from CNA and $49,422, for a total of $98,815.52 for the 3 years (approximately $33K, that came in sporadic payments, causing extreme stress and hardship).
This appears to be a shortage of $18,695.12 (yikes, how close is that to the reward CNA received from EDD for refusing to pay TTD and for refusing to provide medical care? Is that a mere coincidence? These numbers alll jumble all over my brain.
Social Security Disability was awarded in May 2015, with retroactive pay back to date of injury, 1/9/12, with the 6 month waiting period to 7/2012. This is where it gets real real fuzzy…. that will be documented, with PDFs of all of this in 3 of 3 – WorkComp MAGIC Money Math… This seems to happen all the time…..nobody seems to know how the sad tales end.
You’ll know how this one ends, count on it! Maybe you will even read about it in a ProPublica Report! ;D “
How many unclean hands do how many such ‘negotiated discounts’ pass through for the ultimate profit and bottom line of insurance carriers across America doing nothing but maiming and permanently disabling injured workers, cheating remaining legitimate WorkComp providers out of their fees, while supporting operations of sonderkommando type doctors willing to write fraudulent reports on behalf of their benefactors?
There is no mechanism in America’s workers comp system for Injured Workers to report Doctor, Attorney, Provider and Employer Fraud. DA only goes after groups like “Hell’s Angels” …..for what, cutting into the WorkCompster Drug Trafficking?
D’oh! At least the HAs are honest about their motives and practices of PROFITS BEFORE LIVES. Very few peeps in WorkComp can claim such honesty.
Why would a doctor prescribe a stomach drug for a brain injury survivor and why would a doctor prescribe an expensive creme for brain injury survivor, or why would a doctor prescribe (and mail without knowledge) a hand held ultra-sound device, without instructions for which brain lobe to use it on? That’s WorkersCompensation.
My Fellow Americans. Boomers! Heads up! The younger people do not have a chance in hell to survive American’s WorkComp rackets! Mamas! Don’t let your babies be doctors and lawyers and thugs! #SOS! #CommitteesOfBloggers needed ASAP! #WATMN
Why would a doctor prescribe an ‘epilepsy medication with mood elevators as a precaution for a few years’ for a slip and fall head injury, after a 5 minute meet and greet?
The more conservative, well-paid industry leased/owned WorkCompsters will prescribe ‘over the counter analgesics’ for brain injury, and some that, in the 60’s would have been categorized as “MCPs,” shrug and indicate that a woman over the age of 35 is not entitled to medical care for a brain injury, particularly after medical has been denied by the carrier for more than 2 years.
WORKERS COMPENSATION APPEALS BOARD – State of California
3737 N. Main Street, 3rd floor
Riverside, CA 92501
RE: ADDENDUM TO DOR AND OBJECTION TO PETITION TO COMPEL ATTENDANCE (sent yesterday)
Dear Judge Hill:
I pray the Court will finally intervene on my behalf, and on behalf of all American Injured Workers subjected to such abuses by the insurance industries and their goon squads.
Senator Fuller suggested that I take my concerns to the DIR, and the FBI suggested I take my concerns to the DOI. Been there, done that. There will be a special blog soon on how and which State Officials and Agencies and Legal Communities also fail injured American Workers, in this case and in others.
As I am preparing for your Court and re-filing all the medical/legal papers in my possession, in reviewing the Medical Index in use by the Defense, I noticed yet another omitted report dated February 6, 2015 from Dr. Hilda Chalgujian regarding these very subjects. It is a 2 page summary after a series of “discouraging” CorVel communications. DR HILDA CHALGUJIAN 2 6 2015 FAX_20150217_1424143081_1 (1)
I ask that you include this in your reconsideration of your order to compel me to see an Ear Nose and Throat doctor as well as yet another set of neuro-psych tests for a very well documented brain injury of 1/9/12, treated by defense primarily with a few chiropractic sessions, a few clinical psychologists in 2012, 2013 had some physical therapy, 2014 finally saw to some speech therapy, occupational therapy and more physical therapy and sessions with neuro-psychologist and a few acupuncture sessions. That’s hardly compliance with ACOEM, MTUS or even common sense.
Dr. Chalgujian’s initial report is approximately 40 pages, which includes her testing results and her comprehensive review of all medical records up to April 2014, when she agreed to begin to treat me. Defense had no neuro-psychologists and I had to make many calls to find a local brain injury expert, and Dr. Chalgujian’s name was constantly recommended. As a result, she agreed to treat me, then defense wanted her to do another evaluation, which she agreed to and provided.
Please note that the difference between Dr. Chalgujian’s reports and those of QME/AME doctors — Dr. Chalgujian does the testing herself, and writes the reports herself, and reviews all the medical records herself. I know of no doctor in the WorkComp system that does so — in fact, a few have admitted that their “well trained” (non-medical staff) write the expensive reports that that doctors just sign. I suspect most don’t even even review them, or if they do, I would have to further suspect how they made it through medical school.
I don’t know if Dr. Chalgujian has been paid for her reports or all therapy visits; I know that Defense has refused to reimburse me for even those medical miles (90 miles, round trip; weekly for a while; gas at approximately $4.00/gallon. I hope to meet with Dr. Hilda to discuss resuming treatment with her, either via my alleged Workers Compensation Insurance coverage, or via my Medicare policy, awarded through recent total disability designation by the Social Security Administration.
If CNA continues to refuse to provide estimated Permanent Disability funds (they have breached the Law repeatedly on refusals to pay TTD as well, so there is no reason for me to expect right action or legal compliance at this stage either) , with penalties, and if WCAB allows them to continue all these atrocities, then I will be unable to continue at the Coastline Acquired Brain Injury program in Newport Beach — the lodging, travel and meals out are too expensive and I don’t know how I am to survive on the SSA award income.
Without completing the Coastline program, and dealing with the vision and auditory processing issues, speech and vestibular issues and other yet unknown issues (EEG scheduled for next month, self-procured, because CNA doesn’t apparently think they are valid for brain injury diagnosis, nor have they provided MRI’s) I don’t know how I will ever be ready for a trial return to work.
If I am unable to return to Coastline 8/24/15, my entire support system will break down, leaving me somewhat defenseless and could cause a loss of all the progress I have made in learning compensatory strategies.
Neuro-vision evaluations and vision therapy, acupuncture, Brain MRI’s (2012, 2014) as well as scientifically based functional neurology treatments have been self-procured since carrier’s callous disregard for law and life is indisputable; in October 2014, a State run program, the Coastline Acquired Brain Injury Program at Coastline Community College, best in the nation for people with disabilities and more, has also been self-procured.
How is this and EXCLUSIVE REMEDY when doctors are simply paid to write reports with recommendations for treatments that are ignored, then the select few doctors write clearly false reports at the beckoning of the defense, and the defense churns the file for billable hours, shifting cost burdens to injured workers, State & Federal Tax payers?
With the thousands and thousands and thousands of dollars the defense has paid for reports – false and otherwise – a fraction of those monies spent on medically necessary care might have helped me heal, and perhaps returned to work at any point along the way. I have SPENT more than $43,000 to-date to survive these atrocities.
How many thousands of dollars has the defense laundered through how many unclean hands to cause such harm to me, and Injured Workers like me? “Follow the money. Always follow the money.”
“Compel” the defense to identify what TREATMENTS they have provided; I CAN PROVIDE A LIST OF ALL RECOMMENDED TREATMENTS THAT THEY FAILED & REFUSED TO PROVIDE SINCE DATE OF INJURY.
COMPEL THIS! WorkComp Defense to provide medically necessary treatments as part of Exclusive Remedy
Is it time for more serious discussion about THE DEMOLITION OF WORKERS’ COMP? ProPublica peeps have just discussed the tip of the iceberg….Write on Michael Grabell and Howard Berkes! Keep involving the industry experts…..shatter their delusions.
Let’s do something good for America, your Honor.
Hold these insurance companies and their defense firms accountable for their actions, and do what you can for some house cleaning at 3737 North Main Street.
Thank you for your consideration and an expedited hearing. Mediation might be a good idea to save the Court some bother, wouldn’t you agree? It would be great if a representative from the Corporate Fraud Unit of the Office of the District Attorney could be invited to observe and review.
Not saying all doctors in WorkComp are horrible creatures; many have left the industry for private practice. It is said that some have ‘retired into’ WorkComp evaluations.
Better guidelines for QME/AME designations, along with ethics requirements and recordings of evaluations of all injured workers for at least the next ten years must be considered in order to save lives and indict criminals. Let’s have fresh trials, and stop history from repeating itself in America.
When doctors are not held accountable for false reports that cause harm and death, written for profit and with intention to deny medical care and worse, something’s rotten in the system. When doctors can willfully change dates of injuries in order to use earlier medical reports to falsely substantiate ‘pre-existing’ conditions, something’s rotten in the system. When the System itself allows for ‘secret reports’ and hefty payments to doctors who can’t even get a date of injury straight, something is rotten in the system.
Does anybody have hard stats on WorkComp in America? At the recent #WorkCompCentral #CompLaude Gala, it was mentioned, if memory serves sufficiently, that approximately 15% of injured workers in America are unrepresented..
If that math is correct, that’s about 8 million — UNREPRESENTED INJURED WORKERS.
It does not count the ‘poorly represented’ injured workers! WHAT ARE YOU DOING FOR THAT MARKET SEGMENT?
Tell us; we’ll tell the InjuredWorker populations, too; afterall, WE ARE THE MEDIA NOW.
Could ‘On-Time Records’ help America’s Injured Workers? What can YOU do?
Wow, that’s the direct opposite of USA treatment of disabled and injured workers, huh?
Insurance companies here are paid big bonuses for refusing to pay disability benefits, provide medically necessary treatments, and they seem to use any means necessary to shift cost burdens to State and Federal Agencies, before people enter the ranks of homelessness and incarceration. Same insurance companies are on a 3-D plan, DELAY, DENY, DECEIVE, approved by volumes of useless laws? Employers can willfully refuse to engage in interactive process for return to work discussions…FOR YEARS!!! d’OH! Without consequences? Hmph.
Apparently, there are ‘Tea Parties’ and ‘Tea Parties’ and “Tempests in Teapots?”
Often, #InjuredWorkers make poor choices in retaining legal counsel, and many have retained 2 or more, leaving them defenseless, since incompetence in the legal fields allows dismissed counsel to place a lien on the WorkComp claim, rendering it useless (i.e. unprofitable) to further counsel.
If 15% of the InjuredWorkers in America are currently unrepresented, 15% of 54 million is 8,100,000 at any given time. Many of those InjuredWorkers are too sick or medicated to fight the good fight, and many will simply join the ranks of the homeless and prison population and cemetaries.
WHAT SERVICES DOES YOUR WORK COMP FIRM OFFER TO UNREPRESENTED WORKERS, IN PRO PER?
Does YOUR STAFF understand the rights of flag-waving InjuredWorkers, In Pro Per, or is your staff increasing risk of malpractice complaints against your teams?
This case has several instances of WorkComp provider staff telling this injured worker that they can only take directions, requests, medical records, complaints and correction directly from the Defense Counsel, or adjuster, if unrepresented. The perjured Proof of Services and responses to proofs of services are another issue that causes egregious harm.
Really? How interesting. Does the ACLU agree with that interpretation of Civil Rights and Labor Codes? Does the DOJ agree?
CA Workers’ Compensation — Treatment Denial / Independent Medical Review (IMR)