National Organization of Injured Workers

Fraud, the Legislature & Gubernatorial Temper Tantrums!

Arnold What happens to those medical-legal doctors whose medical reports would make the fiction best seller list of the New York Times?

Nothing... But wait a minute, they're just opinions right? Opinions that insurance company defense attorneys swear is the gospel truth!

What happens to defense attorneys who verify their pleadings and motions when they know that the contents are intentionally false and misleading, thinking it will carry more weight with the judge?

Nothing... The State Department of Insurance and the State Bar won't touch them!

What happens to those District Attorneys who venture down the road of fraud to get money to supposedly fight fraud?

Nothing... They are protected by Governmental immunity in most states, even if those accusations are of a negligent and malicious nature!

What happens to those who are victimized by these false prosecutions?

Their lives are destroyed and they are financially ruined!

What happens to an injured worker who has the audacity to file a complaint with the local District Attorney against an insurance carrier or one of their agents?

The DA's investigator looks at them like they are nut cases and dispatches it to the round file!

So goes Workers' Compensation in California and many other states. The insurance company gets the Gold Mine, the injured worker gets the Shaft!

Although Workers' Compensation systems vary from state to state, the insurance companies would like nothing better than to have a national system so that they don't have to deal with 50 different state systems. Likewise, criminal prosecution for fraud should be uniform as well, since this type of fraud is prevalent in all 50 states. And it's the same type of fraud:

Claimant Fraud (Less than 1% by the insurance industry's own admissions.)

Insurer Fraud.

Employer Fraud.

So why is claimant fraud the only type we hear so much about and see on television, although law enforcement is now under immense pressure to chase after employers who intentionally mis-classify their employees. Simply put. It's easy to demonize the injured worker because he has very little resources to draw on when he gets hurt, and he literally relies on the benefits delivery system for his survival and the survival of his family.

Governor Arnold Schwarzenegger spitefully vetoed three bills late Tuesday amongst hundreds of others - just before his deadline, and the California office of the American Insurance Association (AIA) was there patting him on the back for his vetoes of important, meaningful legislation that deals with basic rights for California's injured workers.

The bills were:

SB 1115 by Sen. Carole Migden, D-San Francisco. The bill would have outlawed using race, religion, color, gender or other factors in apportioning permanent disability. AIA argued, and the governor agreed, that current law already prohibits discrimination which doesn't mean a whole hill of beans if the state refuses to enforce its laws.
SB 1717 by Sen. Don Perata, D-Oakland. The bill would have doubled permanent disability benefits for injured workers over a three year period. Schwarzenegger said in his veto message the bill was too expensive.
SB 2929 by Assemblywoman Sally Lieber, D-Mountain View. The bill would have required all utilization reviews be done by doctors licensed in California. The governor said in his veto message this bill was "inconsistent with how utilization review is conducted in other areas of medicine and not in line with best practices nationwide."

Question is, are the state legislators going to reconvene and take up these matters that primarily affect those citizens who gave them their most precious of possessions, "Their Vote," and send a message to the governor that they have the conscience to "Do The Right Thing?"

Our legislators and our governor seem to lose track of the fact that Workers' Compensation is about Workers and People, not insurance company profits. It's about people who regretfully are injured in the course of their employment and who want nothing better than to get back to work.

Two of these bills would have made a significant impact in reducing fraud perpetrated on the injured worker by the insurers and the employers, but then the injured worker lacks the financial resources to sweeten the campaign coffers of our legislators and Governor Moneybags whose cash register keeps clanging away as the cash keeps pouring in.

Maybe Governor Arnold needs to go back to school and find out what the real meaning of the word "reform" is as he obviously doesn't understand how he has destroyed the lives of good working Californians who built this state into what it is. What he has reformed is simply the profits of the insurers by making it near impossible for the occupationally injured to get the treatment that the constitution that he likes to mess with so frequently supposedly guarantees them.

We all don't have the resources like he does to run down to St. Johns Medical Center in Santa Monica and get our injuries taken care of whenever we get hurt! We rely on a system that is fair and functional, and California's hasn't been since he came into office.

Hope it was worth it Guv'nor.....

S. Martin
A California injured worker.