Arnoldwatch & Workers Comp.

The good guys at the Consumer Watchdog have started a new little site, ArnoldWatch, that is going to keep tabs on the new governor of California.

I think the man will need to be watched. For example, this article contains the following passage:

"Schwarzenegger said legislation passed this year doesn't do enough to lower the cost of workers' compensation. The governor-elect said he will take steps to close loopholes and eliminate incentives that encourage fraudulent claims."

So, it appears that the California Workers' Compensation System will be under attack by Arnold. This doesn't bode well for injured workers. I live in Texas right now, which is another state that had its workers' compensation system overhauled to prevent "fraudulent claims" and to "lower costs."

Here's an example of how the workers' compensation system "works" in Texas:

Are you injured on the job? Good luck finding an attorney to handle your case; very few lawyers in Texas will represent injured workers in a workers' compensation claim, because it's nearly impossible to get paid. Let me tell you about a client I will call "Mr. K" who was represented by an attorney I know.

Mr. K was working in a medical facility when a wall-mount broke and a television fell on his head. This was witnessed by a couple of other employees and never disputed by the employer. He was seriously injured, and filed a workers' compensation claim, which was denied entirely by the insurance carrier.

After his claim is denied, Mr. K searches for an attorney, and finds the attorney friend of mine. The attorney appeals the denial of the claim, and the game begins. One of the requirements for a Texas workers' compensation claim (and almost everywhere, I believe) is that of the Independent Medical Exam, or IME. An IME is a medical exam performed by a supposedly independent doctor, although the doctor is actually paid by the insurance carrier. During the IME, the doctor examines the patient to check for the existence of and extent of the disputed injuries.

Mr. K has to undergo several IME's. A couple of the doctors claim they don't think a TV even fell on him - remember, the employer never tried to dispute this, only the insurance carrier. One of the other doctors agrees a TV probably fell on him but repeatedly points out how Mr. K is a former alcoholic and claims that he reaked of alcohol during the exam.

After dozens of hours of work, the attorney won the first hearing with the Texas Workers Compensation Commission (TWCC). This entitled Mr. K to workers comp. medical benefits and lost wages, and entitled the attorney to 25% of those benefits.

However, the carrier appealed the decision to the next administrative level. This appeal held off the benefits and the pay for the attorney. The insurance carrier again tried some defenses that lacked merit, and again, Mr. K wins and is entitled to his benefits... Until the carrier appeals again.

By this time, Mr. K has been unable to work for months, and has lost his car because he couldn't make the payments. The attorney wins the third appeal, and the carrier doesn't choose to appeal from the TWCC to an actual court of law. This means Mr. K and his attorney can finally get paid.

The attorney got his first check for all his hard work last week, for $36.00. Why? Well, in many states, injured workers (and their attorneys) receive a "lump sum" payment for their injuries, but not in Texas. So, Mr. K will get $144 a week for the next 20 months, and the attorney will get 25% of that, which is $36 per week.

Few Texas attorneys handle workers' compensation claims anymore because not only will it take 6+ months to get paid a dime, but instead of getting a "lump sum" payment, the attorneys will get 25% of the worker's weekly benefits.

All of these "reforms" were put in place to lower the insurance premiums for workers' compensation insurance. So, are low premiums worth a system that is stacked against the injured? Texans can't answer that question, as we still have some of the highest premiums in the nation.

I have a sneaking suspicion that Arnold will look towards the Texas model for some guides on how to "reform" the California system.

Comments

[Craig Michie]

I live in Nevada and was injured on 10/29/99. The same issues exist here in Nevada. I have been in litigation for over 5 years, Have won at least two big decisions that place the entire liability on the employer.

The employer has failed to act, and or failed to act in a reasonable time period on these decisions. I have followed the law and filed complaints but the decisions from the enforcement department are faulty, poorly done and investigated and the only way to correct them is via more litigation. Attorneys in Nevada do not accept Work/Comp claims that do not contain the posibility for big paydays. The further fail to file complaints as they see the practice as a waste of time and paper.

Any injury that would lead to less than full disibility is not taken or considered by private attorneys here in Nevada very often. This leaves representation by the State Attorney for Injured Workers. A state funded group that is understaffed and underfunded. As a result of this funding condition they do not provide full and complete representation. A first time injured worker has no idea that they are receiving less that a complete representation. When their underpaid lawyers are fully trained they go and work for the employers and insurance companies. This is a HUGE racket here in Nevada and results in injured workers suffering far beyond the level that any human should ever have to face. And in the end, the BARGIN is not and violates basic rights, dogs and cats get better care for free!

When they do send you to a doctor, you soon find that these medical professional are "WHORE DOCTORS" who write reports and histories that tend to favor a no liability position for the employers, or are insulting because they claim that there are no injuries and they write full duty releases to again assist the employer and or insurer. When you are able to provide medical opinions that overrule the misrepresentation of the "Whore Doctors" they just slow down the whole entire process with appeals that lack merit or simply do not act on the Decisions and Orders of the judicial system.

I can see a point in time in the future where this type of conduct within the Work/Comp system will lead to pure outright fraud by injured workers, simply because when injured workers find out about this game being played with their health , wages and welfare, they will simply not accept this abusive treatment.

Additionally, in light of the recent National Medical Malpractice Scam being created across the country, the doctors who participate in this type of conduct, like Dr. Mark Reed MD of Nevada, will soon find the low limit of $250,000.00, will incourage injured workers to consider the benefits of PHYSICIAN ELINIMATION over the pain of LENGTHY LITIGATION. The real benefit from this approach will be that it will be much more effective, much less costly, will save other injured workers from the same type of abuse and torture, and best of all, it's perminate!! Now that is an effective Plan!

This type of treatment is not at all what I expected when I was growing up as an American. If the high and mighty elected officials feel that this is what the people, the human working familys they represent want, then they are not really listening and are far away from understanding. Even low wage workers would not wager against their own health care interest.

This type of abuse and torture, supported by the LAW, GOVERNMENTS, EMPLOYERS, INSURERS, and ELECTED OFFICIALS is a sure way to bring TERRORISM straight to the U.S. HOMELAND. The public will soon learn the economics of this game and realise that bullets are cheaper than protracted litigation, and it's a lot more effective!!

[Geraldine Trice]

I have complained to the NV Medical Board re:Dr. Mark Reed. What else can be done? They stated that I had a reasonable complaint and nothing so far can be done. I will not stop complaining to elective officials until something is done to stop Dr. Reed from destroying lives. He had ruined my career because I am unable to work due to his malpractice. Please contact me.

[5 herniated discs in my neck]

FAIR WARNING TO ANYONE INJURED ON THE JOB, IN TEXAS, IF YOUR INJURY IS OF A SEVERE OR CAREER ENDING NATURE, DO NOT UNDER ANY CURCUMSTANCES USE OR IMPLY THE NEED FOR WORKERS COMPENSATION OR IT'S BENEFITS. USE YOUR PERSONAL INSURANCE AND LIE ABOUT THE SOURCE OF YOUR INJURIES. YOU WILL COME OUT BETTER IN THE LONG RUN EVEN IF IT COSTS YOU MONEY OUT OF POCKET... THERE ARE SPECIFIC GUIDELINES THAT YOU MUST FOLLOW TO BE ELGIBLE FOR CONTINUING BENEFITS THE DOCTORS THAT ACCEPT W-C INJURY CASES ARE ON A LIST THAT MUST BE APPROVED BY THE STATE AND THERE ARE VERY FEW DOCTORS THAT WANT ANY PART OF DEALING WITH WORKERS COMP INJURIES BECAUSE OF THE NEW LAWS AND THE INSURANCE COMPANIES THAT YOUR EMPLOYER USES FOR COVERAGE HAVE THEIR OWN LIST (IE.THE HARTFORD) OF "PREFERED"
DOCTORS THAT OFFER AN ADDITIONAL DISCOUNT (KICKBACKS) TO THE INSURANCE COMPANY IN EXCHANGE FOR RECOMMENDATIONS AND ASSISTING THE INSURANCE COMPANY BY REFERING OTHER SPECIALISTS IN THE SAME "PREFERED GROUP" I HAVE PERSONALLY ENDURED ABOUT 1 YEAR OF A COMPLETE NIGHTMARE IN DELAYS,INCOMPETENCE, MISDIAGNOSISES, TOTAL DISREGUARD FOR HUMAN DECENCY, EXTREME NEGLECT ON THE PART OF MY SO CALLED CASE WORKER (OF WHICH SHE HAS CONTACTED ME TWICE IN THE LAST 160 DAYS) WHO CONSTANTLY BADGERS ME INTO A FEELING OF COMPLETE SCHOOLYARD BULLYISM AND THEN TELLS ME "I NEED TO WORK ON MY PSYCHIE" AND ONE OF THE TWO TIMES SHE HAS MADE CONTACT WITH ME THIS YEAR (TODAY'S DATE IS 6-26-7) TOLD ME THAT I NEED TO CONSIDER WRAPPING THIS THING UP BECAUSE THERE IS A LIMIT OF TWO YEARS FOR PAYROLL COMPENSATION AND AT THE END THAT TWO YEARS I WILL BE CUT OFF... BACK TO TORT REFORM AND ONE OF THE THINGS TO WATCH OUT FOR IF YOU NEED MEDICAL CARE IN THE STATE OF TEXAS THERE ARE A RECORD NUMBER OF PHYSICIANS FLOCKING TO THE STATE OF TEXAS BECAUSE OF THESE MEDICAL MALPRACTICE LAWS AND MOST OF THESE ARE OLDER SEASONED INDIVIDUALS FROM OTHER STATES WHO ARE COMING HERE BECAUSE THE MALPRACTICE INSURANCE RATES ARE LOWER... DO YOUR HOMEWORK BEFORE YOU TAKE ADVICE FROM A MEDICAL PERSON THAT RAN AWAY FROM HIS OR HER ORIGINAL STATE OF CHOICE BECAUSE THEY COULD NO LONGER AFFORD THE FEES ASSOCIATED WITH DOING BUSINESS. MOST MALPRACTICE POLICIES ONLY INCREASE IF THERE IS A CLAIM AGAINST THAT PHYCICIAN.