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CA WORKERS COMP WC Resources & History The Realities Of Comp DWC Office Information Doctor Pre-Designation Glossary Of WC Terms 2006 WC Guidebook 2006 CHSWC Report 2007 CHSWC Report Utilization Review Dept. Of Workers Comp. CHSWC Fraud Commission Bus & Professions Code Civil Code Code Of Regulations Government Code Health & Safety Code Insurance Code Labor Code Penal Code California Physician California Psychologist California Chiropractor Calif. Accupuncturist California Attorney Cal. Private InvestigatorWHAT DO THEY DO? Neurologists Orthopaedists Physiatrists Psychiatrists Private Investigators PD Rating Schedule Prescription Drug Info Painkiller Addiction Mobile Video Studios WC Streaming Media Monthly WC Updates
Here is one California attorney who isn't afraid to take on big insurance. This book
isMUST READING! It's about insurance, fraud & the big business of bad faith! April 4 ,2011
Injured On The Job producer and NOIW director Sam Gold and Thurman Martin talk to Comcast's Mark Curtis about the Workers'
Compensation system.
Injured On The Job producer and NOIW director Sam Gold & guests drop in on the John Rothmann show on KGO Newstalk Radio 810AM to talk about the Workers' Compensation system.September 5, 2011 March 25, 2011 December 3, 2008 September 10, 2006 April 2, 2006 February 23, 2007
CONTINUOUS TRAUMA is a searing legal and psychological suspense drama that's also an
expose of corrupt worker's compensation and health care practices that endanger the health and welfare of thousands of
Americans every day. It's a story based on actual case histories and on events that could happen to any of us, at any
time.
Winning the Disability Challenge charts a course of action to personal security and
self-fulfillment and guides the disabled worker through both the emotional trauma of occupational disability and the
complex world of disability rights and resources.
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Just look at California. In 2004 our celebrity governor, who himself was an injured worker, rammed legislation down our throats that trashed the entire system. If things were screwed up then, just look at them now. You can't go to your own doctor, you have to go to your employer's doctor and he or she knows who butters their bread. And if the doctor does recommend a method of treatment that doesn't agree with the insurer, they lay down a gauntlet called Utilization Review which is nothing more than a Delay & Deny tactic disguised as a way to keep costs down. Now if that doesn't disgust you, what about vocational rehabilitation to help you return to meaningful employment. Hey that's gone too, now replaced by a ridiculous job displacement voucher that pays you more, the worse you are injured. In other words, here's some cash, go rehabilitate yourself! The system works well, that is if you are an insurance provider. Common sense says if you don't treat the occupationally injured and take care of their injuries, costs will go down. Duhhh! of course they will, but what about those who were injured in the line of service to their employers; they still need to be taken care of. As director of the National Organization of Injured Workers, I get letters and correspondence from injured workers around America from time to time, chronicling their plight to hopefully get some form of simple justice from a system that is supposed to weigh in their favor and make them whole again. Here's a letter from the wife of an injured worker which pretty much spells out what the occupationally injured of America are forced to deal with on a daily basis: "I am filling out this form on behalf of my husband, who has a Severe Upper/Lower Respiratory Disease & Immune System Damage from 2 workplace accidents. He was negligently sent into a new department at a Plant in Niagara Falls, New York, without prior training or being issued a chemical respirator which went against their own company policy. His secondary injury is a Severe Back Injury (13 herniated lumbar,thoracic & cervical discs and 5 compression fractures with nerve impingement/damage, he is in excruciating pain 24/7, and on 15+ different respiratory, pain & various other medications costing almost $500,000.00 a year. Having the injuries was not the worst though. The worst by far was being sucked into the evil vortex "The Black Hole" called Workers' Compensation, a cesspool of pure evil & corruption. An isolated little world, a "Groundhog Day" existence, where everyday is the same and the nightmare never seems to come to an end due to the fraud committed through phony appeals, re-trying already settled issues (likened to Double Jeopardy), IME medical whores, holdouts and serious game-playing and hemorrhaging of time by insurers, lawyers and judges who would never put themselves though what they put us through. It took 9 years for my husband to have one surgery and only because it turned into an emergency. It should be called "Comp Wars", because that's what it is, a War. An everyday battle for what you are supposed to be already entitled to, with the ultimate goal being cutting you off from your benefits no matter how sick you are. It starts right at the beginning of the Workers' Comp. case with false statements from the IME's (supposed Independent Medical Examiners). They focus on cutting off your medications and supplies, so you will cry uncle and take a low-ball settlement from the insurer, which in essence is a death sentence to most. Workers' Comp is a disgrace. It is past time for serious action to force changes. I have been yelling at every Politician I can. Secretary of State Clinton promised me 3 times she would help and then let me down. Senator Gillibrand also promised. No one really cares. Workers' Comp is a dirty little secret no one really wants to deal with, but we need to make them listen! I really want to work with someone to force changes, to stop the madness of the oppression that injured workers are dealing with. It is as good as attempted murder to hold out on a person who needs medical attention. Workers' Comp. was supposed to reduce litigation, yet it is nothing but one big phony litigation fest. Permanently and totally disabled workers need to be able to sue insurers who refuse to obey the mandates of the law. Lumping everyone together is ridiculous. Martin Luther King's letter from the Birmingham jail is a letter every injured worker needs to read. He explains what an unjust law is ("An unjust Law is no Law at all," St Augustine). An Unjust Law is a Law where a minority group of people make laws that they would not follow themselves. This is the essence of Workers' Comp and I resent this. It is what happened to the Blacks in the South, and the Jews in Germany. Every person needs to obey the law, not just an injured worker while the insurers and their lawyers and phony doctors get away with everything under the sun. There is so much to say. Enough is enough, we need expose the corruption and make things right! We can make something happen if we all work together. Please someone call me! Let's start the conversation and get to the next step of overturning this corruption. We need to force the hand of the politicians to change and amend the laws now. After being in it, I know what needs to be changed. All of us together could come up with a new plan. We need to rally the troops in unity for change." Next question is why do insurers and employers get away with crimes that would get them imprisoned if committed in any other arena? In the area of work related injuries, the right to bring civil action against an employer or their "Workers' Compensation insurance carrier" has been almost totally eliminated. It has been replaced with the infamous, "Exclusive Remedy", a drastically flawed concept of "fairness" given to the employer and worker alike. Insurers have found it less costly to pay up to $10,000 for immediate medical attention while they work on denying the claim without fear of retribution. The Exclusive Remedy is best described as a compromise, an agreement if you will, to provide the appropriate and immediate medical care/treatment necessary to "Cure or Relieve", even before the claim is processed. For this seemingly empty promise, injured workers have been stripped of their rights to bring suit within the civil court system. And, just who made this compromise; it certainly wasn't the workforce of this state. It was employers, insurers, and your state officials that have brought this system to the sorry state it is in today. The Exclusive Remedy has become exactly what insurers have wanted all along, a "post-injury" shield to protect them from prosecution for the widespread criminal acts, abuses and fraudulent practices employed to deny, delay, and/or terminate all claims, legitimate or not. Then there are the state agencies who commission studies costing hundreds of thousands of dollars that come up with the same results as we do. Next time you want to do another dog & pony show, give us a call. Ask any injured worker, save a bunch of money. And last but not least, the injured worker advocacy organizations who try to convince you that they have influence with our legislators. Come on, if they had any influence, the laws would have been changed a long time ago. The only thing that talks in the capitol is money. So in the absence of a warchest full of money, we offer something that is more valuable, the truth, and we disperse it on our own internet television network! If you want the most bang for your buck, and you really want to see the results that your money can bring, watch IWTN; the print, radio and television media are!
Contributions to the National Organization of Injured Workers and the Injured Workers Televison Network will be Tax Deductible once our tax exempt status is received from the Internal Revenue Service.
With an internet publishing point with the capability of 3000 concurrent high quality streams and utilizing state-of-the-art virtual set technology and template based graphics, this will certainly bring NOIW's media efforts into the 21st century!
New video production equipment was made possible by a private grant to NOIW (the National Organization of Injured Workers, Inc.), a charitable California educational non-profit corporation dedicated to informing, educating, empowering and helping America's injured workers so that they don't become victims of "Big Insurance"!
With the purchase of this new studio and High Definition field equipment, NOIW will be able to cover the most important
Workers' Compensation related stories in a more timely fashion and get that information out to the public faster than
ever before.
Sam Gold, volunteer director of NOIW and producer of Injured On The Job, said, "Up until now we have solely relied on
Bay Area public access television production facilities and equipment to produce the video productions that you see on
television and on our web sites. As such, we have had to conform our studio reservations according to their time schedules."
We plan to start broadcasting IWTN for 6 hours per day from 4:00PM till 10:00PM PDST on Mondays & Fridays.
"It's great to see that there are individuals and foundations out there, who are stepping up to the plate and making
funding available to organizations like ours that are trying to get the truth out to the American Public! People have to see the human carnage that this dysfunctional Workers' Compensation system of ours is wreaking upon the people that it was designed to serve."
"2012 is the year of the injured worker and his legal advocates. They now have control of their own media voice"!
"It's time for our legislators to stop and take notice of this terrible problem, rather than simply keep raking in all that insurance industry money that the lobbyists throw at them"!
Mainstream radio, television & print media have been totally bamboozled by the insurance industry and the Chambers of Commerce to the point that they simply cannot be relied upon to tell the truth about what is really happening. Essentially we have created our own media voice where 100% of the truth WILL get out!
IWTN will also be broadcasting disability oriented programming as well as some of the best programming from Public Access channels from across the United States.
If you want to participate and be part of the "IWTN" production team, give them a call, toll-free at 1 877 484-3990.
The word "reform" is defined in many ways; Here are some examples:
1. To improve by alteration, correction of error, or removal of defects; put into a better form or condition.
Can you honestly say that what occurred in the legislature in 2004 with Senate Bill 899 meets any of these definitions?
Didn't think you could.
He threatened to put an initiative on the ballot to change the system if the legislators didn't pass a bill that his buddy Sen. Chuck Poochigian was pushing on behalf of their insurance buddies.
There were 6 principled legislators who just simply refused to vote for this travesty of justice; On the Assembly side, Hannah Beth Jackson, Loni Hancock (now in the Senate) & Jackie Goldberg; On the Senate side, Richard Alarcon, Joe Dunn & Martha Escutia. We all know how that ended up; introduced in the middle of the night. Had it gone before the voters, it most certainly would have been turned down by a great majority.
He managed to bluff an entire state legislature, many Democrats reluctantly voting for it so that he wouldn’t go messing around in their districts! He conned big business CEO's like Jim Sinegal, the CEO of Costco Warehouse Stores to gather signatures for this abomination. I'll bet you that Costco's Workers Comp rates didn't go down very much afterwards!
Ironically, Workers' Compensation does everything but, compensate the worker for his injuries which in many cases are caused by the gross negligence of his or her employer! But hey, this is a no fault system, right? Or so we are led to believe!
Treating doctors no longer have a say in the treatment of their patients, instead being forced to run their treatment recommendations by insurance company employed Utilization Review doctors who have never seen nor examined these patients. It is a primary reason why so many of these highly qualified physicians are refusing to treat occupationally injured patients anymore!
With the loss of the Vocational Rehabilitation benefit, just precisely how are seriously injured workers going to have any kind of a reasonable chance to rejoin the work force. A job displacement voucher you say? The worse you are injured, the more you get? Now that's total nonsense! But consider the source of those who dreamt that one up! It just plain doesn't work. As a matter of fact, none of the stuff that they dreamt up and have shoved down our throats works worth a damn! It never was supposed to!
California Workers' Compensation has morphed into "Mother May I" medical care.
Mother, may I have some physical therapy for my injuries?
Mother may I have the surgery that will make me a whole person once again?
Mother may I have a power chair so that I can get around my house?
If a legislator or anyone else in the upper levels of government are injured in the course of their employment, they are handled with kid gloves by the State Compensation Insurance Fund and pretty much given what they need to return to the work force. Why? Well when legislation comes up that makes it more profitable for the insurance companies, they want them on their side. You and I are treated in a whole different way.
Is it time to regulate this line of insurance, the only type that is unregulated in this state? Former Senator Richard Alarcon tried when he was chair of the Senate Labor & Industrial Relations committee, but to no avail. The insurance industry lobbying money did all the talking!
Look at Berkshire Hathaway's Warren Buffett who had Schwarzenegger's ear during the transition. He now has multiple insurance companies doing a land office business in California's unregulated Workers' Comp market. It kind of makes you ask yourself just where did he get all that money to buy the rest of the Burlington Northern Santa Fe railroad that he didn't already own!
It's time to take the system back! We have the opportunity to put someone in the Governor's office who will put their constituents first for a change! After all that's who he or she works for. Workers' Comp is supposed to be about people, or so they say.....
Yes, We Can Influence That Vote! In many states, including California, voters can propose and enact laws through the ballot measure process. Both federal tax law and California state campaign finance law permit 501(c)(3)s to proactively initiate ballot measures (including ballot initiatives, constitutional amendments, bond measures, and referenda) by circulating initiative petitions or to react to measures proposed by others, including efforts to support or oppose qualification of an initiative for the ballot, and to support or oppose the passage of a qualified initiative. Additionally, 501(c)(3)s can lobby either the state Legislature or a local legislative body to place a bond measure, ballot measure, or constitutional amendment on the ballot. 501(c)(3)s can support or oppose ballot measures and encourage the public to vote accordingly. Even though 501(c)(3)s cannot support or oppose candidates for public office, 501(c)(3)s can urge voters to support or oppose particular ballot measures because the IRS treats this work as lobbying. 501(c)(3)s must comply with both federal tax law and California state campaign finance laws. We discuss each of these laws separately below, but in general, federal tax law limits the amount of lobbying work the organization can do (including, work on ballot measures), while state campaign finance law requires disclosure of the organization's ballot measure activity. It is important to keep in mind that federal tax law is the body of law that governs the federal tax-exempt status of 501(c)(3) organizations. An activity, such as ballot measure advocacy, can be perfectly permissible under federal tax law, but may also require additional disclosure at the state level. Federal tax law considers ballot measure work to be a lobbying activity - not electoral activity - because members of the voting public act as legislators when they vote "yes" or "no" on the legislation proposed in ballot measures. Federal tax law allows 501(c)(3)s to engage in lobbying, but limits how much lobbying, including ballot measure activities, a 501(c)(3) can engage in annually. A 501(c)(3) organization may measure its lobbying under the "insubstantial part test" or the 501(h) expenditure test. Under the 501(h) expenditure test, ballot measure work is considered to be direct lobbying, not grassroots lobbying. Whichever test the 501(c)(3) uses, it should be tracking its lobbying activities and expenses. These lobbying expenses must be reported on the IRS form 990 that most 501(c)(3)s file each year. State campaign finance law considers ballot measure activity to be potentially reportable campaign activity. State law does not limit how much a 501(c)(3) (or any organization) can spend on ballot measure activities. However, if a 501(c)(3) engages in ballot measure work state law dictates that the organization disclose it's expenditures and, potentially, it's donors. The type of disclosure that the organization is subject to will depend on the kind of activity the organization is engaging in, and the source of funds it is using to fund the activities. So when they tell you that NOIW is just an educational organization, they're feeding you a line of BS! It simply isn't true. We work closely with our legislators to effect a real change to the system by stopping the fraud & corruption that have brought this system to it's knees and we also use our state-of-the-art media production facilities to do it! Thanks to the Alliance For Justice for clarifying these very important issues!
POLITICAL ORGANIZATIONS We want a system that actually helps those who it was designed for. Get rid of the fraud and corruption that brings this system to it's knees and maybe it will resemble what it was intended to be. We educate not only injured workers and their advocates, but also our legislators who create the public policy that can help make the right changes. And we do it with state-of-the-art 21st century media!
Legislators who condone it! An Insurance Comissioner who closes his eyes to it! Attorneys who look the other way while their clients are victimized by it! The type of fraud that destroys and ruins the lives of injured workers and their families!
It's an epidemic that is totally out of control, and you have your legislators to thank for it. After all, if they stopped pimping and pandering for the big insurance conglomerates in exchange for those big campaign contributions, we wouldn't be in this mess, and you would be getting the medical treatment and receiving the benefits that the law mandates. But big money has a very loud voice in our state capitals. Spread enough of it around and even the best of intentions will get skewed and turned into something totally unrecognizable. And it doesn't matter what you do for a living...fireman, lawyer, policeman, indian chief...everyone is the target of employers and insurers who just don't want to provide the benefits that they agreed to and are more interested in their financial bottom line! It is truly unbelievable, the extent that insurers will go to to deny you the benefits to which you are legally entitled. Their attorneys are "Master Manipulators" of the law and they will spend obscene amounts of money to make sure that a dangerous precedent is not set; that of an injured worker actually getting the proper treatment that he or she is entitled to under the law! Employers and insurers just hate adverse publicity, and it's time to bring these issues to the front burner of America's dinner table converstaion. Radio and television are very valuable media resources and we need take advantage of the impact of the aural and visual messages that these media channels offer. Very mysteriously you don't hear a word about this most serious of issues from the California Applicant's Attorneys Association or even their subsidiary injured worker group, Voters Injured At Work. And you have to ask yourself why. Why aren't they interested in stopping this unlawful behavior that so adversely affects their members? Before you can fix something, you first have to admit that the problem exists. We can't answer this question, only they can! Be part of the cure, not part of the problem! We own and control our own television media voice, "Injured On The Job", seen on Public Access television stations around the nation, and streamed over the internet! We also stream it on our own injured workers channel on "YouTube." We've been doing it for the past 5 years and it's been a very effective tool to get the truth out to America's injured workers.
We're not afraid to "Get In Their Faces!" If you aren't either, then join us! Click here to
join NOIW! and do your part to stop the fraud and corruption that simply goes unchecked. It's up to you. Put your
best foot forward and be counted..... and together we can try to fix this mess. The choice is yours....
Before the industrial revolution, Workers' Compensation coverage didn't exist or was considered unimportant.
In the shipping industry, you were entitled to wages, transportation, maintenance, and cure if you fell sick or were
injured in the service of a ship and could also bring an action against the ship itself under general maritime law if
the illness was caused by the unseaworthiness of the vessel.
Agriculture workers enjoyed little in the way of civil rights and injuries to these workers were not considered to be a
problem by the American public.
Injuries to trade workers were infrequent since virtually all of their work was performed slowly and meticulously by
hand.
With the advent of the Industrial Revolution, high-speed machinery and mass-production techniques, combined with poor
working conditions, led to a startling increase in work-related injury, disease and death.
At that time, an employee's only recourse was to sue the employer based on the employer's failure to meet one or more
of its common-law obligations to the employee.
According to common law, an employer had five obligations to its employees:
Those three defenses were commonly referred to and defined as the following:
If an employee were killed on the job, families of the deceased had no means for recourse.
For the sake of brevity, we fast forward to the time where Workers' Compensation is instituted in the United States and
the 'no-fault' law is enforced.
This law meant that if an employee were injured on the job, the employee was compensated by the employer, regardless of
whether the employer was negligent, and in exchange for this automatic, 'no-fault' compensation, the employee forfeited
the right to bring suit for compensatory damages against the employer.
As a note, to be covered under a Workers' Compensation statute, an injury or disease must arise out of and in the course
of employment.
In most instances, the Workers' Compensation law provides full and unlimited medical expense benefits for a covered
injury or disease.
Disability is paid after an assessment of the level of disability is determined: temporary partial, temporary total,
permanent partial or permanent total.
Disability income is typically paid as a percentage of the employee's currently reported wages, typically 66 2/3 percent,
and is subject to minimum or maximum dollar amounts.
Other benefits under the policy include rehabilitation and death benefits.
Most states require their employers to provide Workers' Compensation coverage for its employees.
Walmart had a carefully crafted and calculated plan to create a shopper's "feeding frenzy" between 5 and 11 a.m. during it's "blitz" "door-buster" sale. When it offered incredible deals on "hot toys" such as plasma TV's to hungry shoppers, it was really doing nothing more than throwing "blood into shark infested waters". Just look at the the language Walmart used to create the climate necessary to create this horrific event. For the non-football fans out there, both common usage and the Merriam Webster dictionary define the word "blitz" as a "sudden attack", which can easily describe the rush of shoppers Walmart anticipated and invited yesterday. The fact that such sales are known as "door-buster" sales clearly puts Walmart on notice of the imminent danger they were creating, not just for its own employees, but for shoppers alike. It was only divine intervention that stopped a shopper 8 months pregnant from losing her baby in the same stampede. Walmart is a smart highly successful consumer retailer - with a horrible record of mistreatment of employees. They fully understand the concept of "mob psychology" that caused this preventable death, but willfully chose to ignore the threat to fill it's cash registers. In our opinion, the police do not need to check the store security "video-tape" to find the party responsible for this homicide. Just check the sign outside the store. This is no different than when Ford willfully decided not to recall the defective Ford Pinto gas tank in favor of profits over safety. Despite Walmart employee requests to close the store after the tragedy, Walmart allowed all important "shopping" to continue. Shame on Walmart for being so callous. The profits from a single door on a single day would not even register on the Walmart (or Wall Street) radar screen. Of course, Walmart is protected from a direct lawsuit in this case by the New York State Workers' Compensation Law. Mr. Damour's family will receive a measly $6,000 burial allowance under the law. You can be sure that Walmart's public relations agency has been working overtime to do damage control and minimize any negative publicity due to the death. After all, this is the Christmas season - a time of charity and goodwill! The days of government "looking the other way" while worker safety is ignored must come to an end. New York Attorney General Andrew Cuomo should launch an immediate investigation into whether Walmart's actions (or failures to act) leading to the death of it's own worker are criminal. There is ample legal precedent for such prosecutions. Certainly, even if not criminal, they further highlight Walmart's corporate irresponsibility toward the safety of both workers and consumers. The costs associated with a small Workers' Compensation claim of a dead worker will be fully absorbed in no more than 1 minute of Walmart shopping at the Valley Stream store. What say you, Mr. Cuomo? What say you, Mr. Public?
The workers sued Illinois-based Cassens Transport Co., insurance claims adjuster Crawford & Co., and Warren physician Dr. Saul Margules, alleging mail fraud, wire fraud and violations of the federal Racketeer Influenced and Corrupt Organizations (RICO) Act. It is alleged that the defendants conspired to falsely deny Workers' Compensation claims. "They further pleaded that Cassens, Crawford, and Dr. Margules, as well as other 'medical whore' doctors, engaged in a pattern of racketeering activity that denied the plaintiff's Workers' Compensation claims," the court wrote. "Specifically, the plaintiffs alleged that Cassens and Crawford deliberately selected and paid unqualified doctors, including Margules, to give false medical opinions that would support the denial of Workers' Compensation benefits, and that defendants ignored other reasonable medical evidence in denying them benefits." Does this sound familiar? It is also alleged that the defendants communicated amongst themselves by mail and wire, bringing them under the umbrella of the federal RICO statutes. Thursday's ruling by the U.S. 6th Circuit Court of Appeals does not mean the workers have won their case. It just means the lawsuit can move forward and proceed into the discovery phase of the trial in U.S. District Court in Detroit. In the conclusion of its 13-page opinion, the appeals court said that it reversed "the dismissal of plaintiffs' RICO claims because their RICO claims are not preempted by state law and because plaintiffs have adequately pleaded a pattern of racketeering activity despite the lack of reliance on the defendants' fraudulent acts and remand to the district court for further proceedings consistent with this opinion." U.S. District Judge Paul D. Borman dismissed the lawsuit in 2005 and, in a split decision, the 6th Circuit upheld Borman's ruling in 2007. But the U.S. Supreme Court sent the case back to the 6th Circuit earlier this year in light of a ruling the Supreme Court made in a case involving similar legal issues in the area of alleged fraud. Marshall Lasser, the Southfield attorney representing current or former Cassens employees Paul Brown, William Fanaly and Charles Thomas, said he was stunned and pleased by Thursday's ruling. NOIW's acclaimed "Injured On The Job" television show held an exclusive telephone interview with Attorney Lasser than can be seen by Clicking Here! Make sure that you have the RealVideo plugin for your browser. It is quite an interesting in-depth interview conducted by attorney Sam Lasser, Marshall's son, who is a California criminal defense attorney. This interview is also available at YouTube as well.
Bad Faith deals with the fraud and corruption perpetrated by the disability insurance industry against those who purchased their policies and thought they would be covered in case of a long term disability. These same illegal tactics are used against injured workers in the Workers' Compensation industry as well, hence the reason for the screening as there are so many close parallels that affect us all!
Over 51.2 million people, nearly 1 out of 5 U.S. residents has some level of disability. Over half of our work force, 56% of the population, ages 21 to 64, has some type of disability. The insurance industry, and specifically the disability insurance industry, is an industry rife with unlawful and unethical practices. The crisis is rooted in the industry's gross overselling of disability policies to younger professionals in the 1970's and 80's. As that population aged and its claims increased dramatically, the insurance companies began casting about for ways-not always legitimate-to cut their losses. This is not about arguing with an insurance company over your standard coverage or their prompting you as the insured to seek mediocre care, this documentary is about insurance companies' deliberate "policy" of wrongfully black-balling policyholders, and using hardball tactics calculated to cheat them out of their rightful benefits.
intended to ruin someone's reputation.
Commonplace in the disability insurance industry, all of these actions are intended to ruin the insured's reputation and cast doubt on their character. Terms used by insurance companies are nebulous at best, and purposely vague. The actual insurance policies themselves are thick, contain small type and are virtually unintelligible. Their language and these clauses are purposefully impossible to understand and are designed to allow the insurance companies numerous ways to avoid paying their policyholders' claims.
of common sense. and
Cus.tom.ar.y (adj.): based on custom and tradition
They will ask the insured for documents or to perform tasks, such as taking medicines not prescribed by their own doctors or to engage in employment in a field other than their norm, none of which are required or listed in the actual policies themselves. They will require second medical opinions from doctor's who are already on "their" payrolls. They will presume, based on testimony from questionable and unethical witnesses, specifically interviewed to corroborate the insurance company's position or case.
between two or more parties for a fraudulent, illegal, or deceitful purpose.
as indisputable evidence or proof, especially of a crime.
responsible for investigating and settling a claim.
dishonesty, or failure to meet an obligation or duty.
In the last decade, a wave of reductions in benefits spurred by the massive legislative efforts of an industry that is totally out of control, have brought workers and their families to the brink of financial, emotional and psychological collapse. Rather than talk about lowering and limiting workers benefits, we should be trying to raise injured workers' benefits to a living level so that these injured workers and their families can survive and at some point re-enter the workforce as productive workers once again. We have a crisis in America that threatens to destroy a hundred years of gains by labor to make America a safer workplace. The insurance industry and their mighty checkbook have drastically diluted laws in almost every state that were created to be a safety net for those who are unfortunate enough to be injured at work. Diluted them so that they are not even recognizable anymore! And their money has a very loud voice in state capitols all over the country, where legislators count on political contributions from these big business special interests for their respective campaigns. As a matter of principle, benefit levels for injured workers should not be subject to the crass commercial arguments of the employers, insurers and their lobbyists. A worker who becomes disabled suffers real serious losses, and should not be asked to subsidize the employer's gross negligence by taking reduced medical and monetary benefits. Employers are trying to place the concept of "fault" back into the Workers' Compensation process thereby eroding the fundamental principles upon which it was established. Contrary to what insurance industry lobbyists and the Chambers of Commerce want you to think, no one gets rich by receiving Workers' Compensation benefits. A worker always gets less than the wages he is losing from the injury, bearing at least 1/3 of the cost himself, and often more for higher wage earners. He is not compensated for the loss of health insurance, pension benefits or other fringe benefits that go with his job. Consequently, in real dollar value, a worker and his family bear 50% or more of the cost of injury or disease. The employer is protected from paying for the full economic losses and is relieved entirely from compensating the worker for pain and suffering and a loss of life's enjoyment. Take a look for example, at the fight in California over permanent disability. This is compensation for injured workers who are no longer able to compete in the workplace for their entire lifetime. A union worker who can no longer work at his job that brought home almost $125,000 a year to his family, and they want him to take a paltry $20,000 settlement if he's lucky. So how does he fend for his family now? With a voucher worth maybe 6 or 7 thousand dollars to secure some type of retraining that won't guarantee any type of meaningful employment and doesn't allow for any living allowance during the training. If he's lucky he might find a job that would pay maybe 25 or 30 thousand a year. Undocumented workers who cross over the border daily to do the jobs that Americans wouldn't even consider doing, and are threatened with deportation should they be injured while performing their jobs. These hard working folks are exploited by their employers on a daily basis. Take for example, the case of Edgar Velasquez who was horribly injured by a chain saw while working for a Rhode Island tree trimming firm, a firm that was not carrying Workers' Compensation insurance to cover it's employees in violation of their state law. His employer called immigration on his employee when faced with having to account for his actions before a Workers' Compensation court. Workers who are falsely accused of fraud and are retaliated against, have their lives turned upside down after they catch the insurance companies violating their lawful rights, and have the nerve to report it to the proper authorities. But then they get a rude awakening when the District Attorney who they think is going to protect them against some very ruthless and vicious employers and insurers, turns against them on the basis of flawed private investigator reports supplied by the Special Investigation Units of these very same insurers. Little do they know that these District Attorneys are receiving money for fraud investigation from funds supplied by these same insurers in the form of mandatory surcharges on the sale of each insurance policy sold. A conflict of interests you say, you betcha! There needs to be a common level of accountability to the law that simply does not exist in Workers' Compensation. If an injured worker makes a false statement, even if it's by accident, it's called perjury, a felony. If an insurer and/or their doctors knowingly and willfully make a false statement, it's simply referred to as an opinion and nothing is done about it, despite the horrendous damage that it may cause the injured worker and his family. And if one is lucky enough to force the issue in a court, the employer and his insurer will try to hide behind the doctrine of the "Exclusive Remedy" or in the case of public entities, school districts and joint power authorities, "Governmental Immunity" regardless of whether these crimes are due to gross negligence, malicious intent and in many cases without any probable cause at all. The combination of high risk of injury and wealth-producing functions means that these workers are compensated at rates which to a degree but not completely reflect the risks they take and benefits that they generate for the national economy. Workers who become disabled still must bear a share of the loss, and shoulder completely the costs for loss of heath insurance for themselves and their families, and their pension benefits. Often even with the meager state benefits, their families can no long afford health insurance. As has been stated, the present system is not perfect. For example, employers frequently and unreasonably contest claims, many times in bad faith. Court hearings often delay the legal process while the worker's claim languishes. Some employers use this to their advantage. Employers can unilaterally terminate compensation for no justifiable reason, and without making a prima facie case of reasonableness to the court. Understand the realities of this system. You're dealing with corporate entities that have billion dollar bankbooks and they won't think twice about using those resources against you to save themselves a few bucks. If they do it often enough to enough injured workers, then it really begins to add up. They employ legions of defense attorneys, master manipulators of the law who play it like a finely tuned fiddle. If we can't bring fairness and equity back to this system, maybe it's time for the Justice Department and the United States Attorney to become involved in the process. Smells like racketeering and enterprise corruption to me. If you're sick and tired of watching these guys get away with this kind of behavior, then you're just the kind of person we're looking for. No kind of legislation will fix anything until the insurance industry gets the message that they WILL be held accountable for their actions! Stop the fraud and end the legislative corruption that has this system in a stranglehold! Help us help others. You get alot of bang for your buck and there is absolutely nothing wasted on administrative costs. It all goes to helping and assisting the occupationally injured deal with the best Workers' Compensation system that insurance industry money can buy.
Contributions to the National Organization of Injured Workers and the Injured Workers Televison Network will be Tax Deductible once our tax exempt status is received from the Internal Revenue Service.
How It All Started Insurance companies and their corporate attorneys are in business to make a profit. As such, they are also in the business of making business profitable. Look around and you will find many examples of corporate fraud in the news, not only across all lines of insurance, but in many other consumer driven businesses as well. While not every businessman is a crook, some are. There are those who will "fudge" a little, and there are quite a few who will say nothing about it ["Job Security"]; however, there are a select few that will just break the law with impunity in order to improve their financial bottom line. The news is filled with million dollar "Insurance Fraud" cases within the Workers' Compensation system of California and other states as well, but it is generally employers, providers, vendors, and "insurance related" businesses you will hear about. Not until this past decade or so have some select "politicians" and "adjudicators" actually called them what they really are. Federal and State Courts, as well as representatives of several State Governments have accurately described the insurance industry as totally corrupted by greedy top-level executives. As with "privately" purchased insurance policies, individuals have civil Tort Law to compensate them when an "Insurer" has committed fraud [or an "act of bad faith"] against the applicant, claimant, and injured, or disabled person. However, in the area of work related injuries, the right to bring civil action against an employer or their "Workers' Compensation insurance carrier" has been eliminated. It has been replaced with the infamous, "Exclusive Remedy", a drastically flawed concept of "fairness" given to the employer and worker alike. But, more importantly it is just another part of the 20-year plan; insurers have found it less costly to pay up to $10,000 for immediate medical attention while they work on denying the claim without fear of retribution. The Exclusive Remedy is best described as a compromise, an agreement if you will, to provide the appropriate and immediate medical care/treatment necessary to "Cure or Relieve", even before the claim is processed. For this empty promise, injured workers have been stripped of their rights to bring suit within the civil court system. And, just who made this compromise; it certainly wasn't the workforce of this State. It was employers, insurers, and your State officials that have brought this system to the sorry state it is in today. The Exclusive Remedy has become exactly what insurers have wanted all along, a "post-injury" shield to protect them from prosecution for the widespread criminal acts, abuses and fraudulent practices employed to deny, delay, and/or terminate all claims, legitimate or not.
The 20-Year Plan The 20-year plan is a euphemism for "How To Keep All The Money". Insurance companies, over two plus decades, have been using a business plan designed to strip injury related cases from the jurisdiction of State and Federal Courts. Many years ago insurance companies started a process whereby they would invest millions in politicians, legislators, and the mainstream media, through political contributions and erroneous, misleading advertising. Attorneys and Lobbyists for the insurance industry have been very effective and, over time, have managed to make many subtle but significant changes to insurance laws and/or regulations, ultimately allowing insurers to write policies that afford them sole discretionary powers to investigate, interpret, and decide the validity of an injured workers claim. Simply put, to practice medicine without a license or fear of retribution. Each phase of this 20-year plan has brought with it additional resources the insurer would employ to deny, delay, and eliminate claims, i.e. unscrupulous claim handlers, unethical insurance company doctors, and outside vendors that provide the industry with a wide array of services geared toward reducing or completely terminating all claims made by injured workers. They've already started test-driving it right here in California. It started with "big insurance" flexing their legislative muscle and forcing the passage of Senate Bill 899 in 2004. If we don't put a stop to it now, it's going to spread like wildfire all over the other 49 states. SB899 created the "Medical Provider Networks!" Now, when an injured worker goes to the doctor, the primary goal of the doctor is to get repeat business from the employer, not take care of the injuries of the injured worker in an expeditious and humane manner. SB899 created "Utilization Review," which is nothing but a ploy to delay and deny treatment on a wholesale scale. Claims examiners requesting UR send case after case to these independent physicians with little or no documentation, so the review is doomed to failure from the start! SB899 removed any meaningful penalties that kept insurers in compliance with the law. Now it's simply cheaper to pay the penalties than it is to comply with the law. And they don't even get a slap on the hand for committing the most heinous of crimes. Where else can the gross negligence and wanton disregard of an insurer relating to the incompetent delay or denial of necessary life-saving medical treatment that leads to the death of an injured worker allow them to get off scott free with no fear of recrimination, financial liability or responsibility? Now do you get the picture? As with all business plans, the insurers have continued to fine-tune theirs. They have spent years figuring out how to bring together like-minded individuals with an ability to operate in unity; a blending of individuals from many "related" businesses. At the same time, this plan has had a drastic effect on legal representation for the injured worker. They found the easiest step of all was taking advantage of greedy corporate executives and government leaders, believing [and proving] that with a lack of integrity comes a powerful negotiating tool MONEY. The more money spent, the more influence bought, yielding a net result of more POWER afforded to the insurance industry. Insurance companies have been ever diligent in their efforts to bring this plan to fruition. They, step-by-step, have spent the last 20 years and billions of dollars bringing together like-minded individuals from the corporate world, select attorneys, and elected officials. Insurance companies have their attorneys in waiting and pay them well to defend their bad faith activities. All the while applicants' [injured worker] attorneys are being forced to reconsider taking on Workers' Compensation cases because, through legislation, the insurance industry has managed to drastically reduce Permanent Disability Awards; the single source considered in paying applicant attorneys their pittance of a fee for representing their injured worker clients. The insurance industry won't be happy until injured workers have totally lost their right to legal representation in a very legally complex system! This group of corporate criminals was formed [and continues to grow] with a common philosophy, "above all else, focus on profit retention". However, they knew to accomplish this they would have to exploit the American People, starting at the top.
The Reality Sets In! Insurers educate subordinates ways to ignore the person and the injuries they suffer from and to focus solely on the industries profit driven directives, teaching them to make subtle [some not so subtle] influences within the claim process. We all know and talk about the fraud committed by insurers on a regular basis; however, what represents fraud to us is merely "business as usual" to the insurance industry. Did you ever notice that except for the accusations from the insurance industry there is very little in the news about "Worker Fraud"? Why, simply because there is very little actual "insurance fraud" committed by injured workers. Another aspect of this 20-year plan is the amount of money insurers spend each year in advertising campaigns. These ad campaigns are not sales oriented or directed not only to the public they are designed and used as propaganda to create the illusion of rampant worker fraud; with the sole purpose of misdirecting the attention of the our government leaders as well. As the old adage goes, "if you repeat a lie often enough, people will begin to believe it's true," and, for all intents and purposes it is insulting to the American people. A prime example of the influences that the insurance industry has on our leaders is evident in the attempts by State Senate Pro Tem Don Perata's efforts to pass his Permanent Disability increase bill, which has already been vetoed by Governor Schwarzenegger on two occasions. The governor has followed the line presented by an Insurer/Employer Coalition; as any "businessman to another" would do and has [twice] failed the workforce and the people of California. This Insurer/Employer Coalition, led by the California Chamber of Commerce keeps mixing their words up and calls any effort to help the injured workers of California a "job killer." It's not killing any jobs! What they really mean is that it is a "profit killer"!
The Final Step What has transpired over the past 20 years, the chipping away at our laws, the buying off of our elected politicians, and the networking with unscrupulous corporate executives has been what was necessary to finally take on the last and most important obstacle of all; an across the board, wholesale elimination of legal representation for the injured workers of California and the United States. Applicants' attorneys, are the last line of defense for the injured worker and the last obstacle for the insurance industry to overcome. The insurance industry has completed the prerequisites to get to this step and are now poised to attack. Once this occurs there will be no further obstacles to overcome and the insurance industry will finally have succeeded to destroy this much needed system. It's time to be part of the cure, not the problem. A legislative fix just simply is not the solution, as long as the insurance industry has the ability to grease the right palms in our legislature. We're the only ones that have the kahones to tell you the truth. Help us put a stop to this fraud & corruption! There is a WePay button in the next article below. Use it and help us get the word out to all concerned Californians. It's entirely up to you. Our 501(c3)tax exempt status is pending.
His so-called reforms have re-capitalized an industry that took some very serious hits in their investment portfolios in
the latter part of the 1990's due to bad investments and the reinsurance scams, to the tune of hundreds of billions of
dollars. The money had to come from somewhere. So why not get it off of the backs of California's injured workers and
make the public believe there is a serious crisis? And so they did. Now at least you know why you aren't getting the
benefits that the state constitution and that social contract of 1913 mandates.
Are you tired of the Fraud & Corruption that have taken over this state? Do you wonder why no one will enforce
the laws that are there supposedly to protect you and I when your employer and his insurer violate them with impunity?
It's all about Money & Power. Are you ready to do something about it? The National Organization of Injured Workers
is one of the oldest and largest injured worker advocacy organizations in the California and we're dedicated to stopping
this rampant fraud and corruption. We don't chase around kissing legislative asses! They are part of the problem, not
the cure!
Do you want to tell your story of horror on television, we'll give you that chance. That is precisely why we created the
"Injured On The Job" television program well over 4 years ago. Contact us for further information, meanwhile
check out the Injured Workers channel on www.YouTube.com or our streaming video page to watch and hear of the difficulties of others trying to deal with this dysfunctional and broken system.
If you need information about this broken Workers Compensation system, you've come to the right place. We have a built-in
internal search engine to find what information you might need, not some flash
enabled site that is all looks and no substance.
If you're tired of people and organizations who claim to help you, but don't, then join us and together we'll stop this
nonsense.
Join us and help us to help others. It's up to you!
To Join the National Organization of Injured Workers,
To Help Support the National Organization of Injured Workers, CLICK HERE!
The misfits. The rebels. The troublemakers. The round pegs in the square holes. The ones who see things differently. They're not fond of rules... And they have no respect for the status quo. You can quote them, disagree with them, glorify or vilify them. About the only thing that you can't do is ignore them. Because they change things. They push the human race, forward. While some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think that they can change the world, are the ones who do. Think Different! Watch the "Think Different" Video.......
I guess we're the crazy ones, the ones who aren't afraid of the insurance companies.....or the state bureaucrats who pimp and pander for the governor's interests.
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is the voice of injured workers around America. For more information on how you can help support our programming ![]() A Fraud Investigator Spills The Beans & Opens Up & Tells His Story! David DePaolo, President and CEO of Workcompcentral.com, speaks out about white collar Workers Compensation Fraud!
Author Lisa Cullen writes that legalities, politics and money have overridden the human rights issue of worker health and safety. Worker health and safety is becoming nothing more than a business line item.
What has happened to our nation that has allowed corporations and insurers to throw away the lives, the health of so many without caring, without fear of exposure, without being held accountable? It's called Workers' Compensation: the system we thought was there to protect us if we were injured on the job.
This book is a complete, how to do it manual, step-by-step chapter by chapter, learn how to implement an effective return to work program. Simply follow the practical instructions and smart tactics in this outstanding resource guide.
Take Charge of Your Workers' Compensation Claim: An A to Z Guide for Injured Employees in California. This book has so much virtually important information for the employee going through a worker's comp situation. It covers all from the begining to the end. |
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