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A Day in the Life: Riverside Electrician Can't Get Medical Care Three Years After His Injury on Job--Asks California Insurance Commissioner to Investigate
Denial of Needed Care Leaving Family Destitute--Unfortunately is Typical
By Frank D. Russo
Greg Parr was injured over three years ago while working as an electrician. He fell and injured his left arm and shoulder. After more than three years, he still can’t get authorization for needed care.
Outside the Workers Compensation Appeals Board in downtown Riverside, he told his story of how an insurance company has been able to get away with leaving him and his family I the lurch by overruling medical care recommended by his doctor that he needs to get back to work. He called for Insurance Commissioner Steve Poizner and Division of Workers Compensation Director Carrie Nevans to investigate insurance company abuse of "medical care review."
If this was just a single case, it would be a personal tragedy. Unfortunately it is all too common. As an attorney who represented injured workers for over a quarter of a century, I have seen this before, but what is accepted as commonplace today is far worse than it has been in the past.
This is how Parr described his injury: “I was walking on a pipe when I felt my feet slip out from under me. I fell down head first, and landed on my shoulder. The pain was unbearable. I went to work the next day and could barely move my left arm. I had pain shooting up and down my arm and shoulder. I found out later that I had a split elbow bone. The workers compensation insurer has delayed and denied treatment for my elbow since the claim was filed for my ‘left arm,’ but didn’t use the word ‘ulna.’”
What you have to understand is that workers' compensation was supposed to be a "no fault" system. When it was enacted in California in 1913 as one of the great reforms of Governor Hiram Johnson, it was supposed to provide speedy and "expeditious" medical care for those injured on the job along with adequate payments to substitute for temporary periods of disability and permanent injuries. Injured workers gave up their rights which they had at the time to sue employers for injuries on the job, and this is the bargain they were supposed to get. This tradeoff is in the California Constitution.
The system is supposed to work on it's own without the need for workers to jump through a bunch of hoops. The worker fills out a claim form when injured himself or herself, gets treated, and gets back to work. Whether a claim form says "left arm" or "ulna" is not supposed to matter, but sometimes it seems that any old excuse will do.
So keep this in mind as this once proud man tells us what the system has done to him and why he is reaching out for the help of those in charge of the system and insurance companies in the state.
Fighting back tears, he says, "I am a single father, have diabetes and have lost my job and my sight in one eye since this injury at work. If the insurance company had approved the needed treatment, I would probably be back at work today."
Greg Parr lost his health insurance as a result of his injury on the job. He says: “When the doctor removed me from work temporarily, I was fired! Because I was fired, I lost my health insurance. I can’t get better without treatment, and I am getting worse without the proper care. I still need surgery and I can’t get approval for needed care. My diabetes has been aggravated by the injury, the stress from getting poor medical care, and the financial disaster that has happened to my family since this injury. I have gone blind in my left eye, and my right eye is not far behind. I can’t wait any longer.
"I cannot return to work with the physical limitations I now have. I have been denied physical therapy and, due to constant pain, became addicted to vicodin. If it weren’t for my parents, my girls and I would be on the streets.
"My family and I are barely getting by on advance Permanent Disability payments. And those will run out soon. How am I to heal and return to work when I can’t get approval for treatment and care? I wonder if I will ever return to work. The workers compensation system is not working for injured employees like myself."
Sue Borg, President of California Applicants Attorney Association, speaking on behalf of attorneys who routinely need to go to court to get medical treatment for injured workers joined in the call for an investigation. She said:
“We call upon the Insurance Commissioner and the Administrative Director of the Division of Workers Compensation to investigate Greg’s case, and other cases of insurance company abuse of regulations allowing review of doctors’ recommended care. Thousands of people like Greg Parr, who have worked hard all their lives, are losing everything after being hurt on the job. The system today is serving insurance companies very well – they’re recording record profits. But those who are hurt serving California are being mistreated. Greg’s case shows just how badly they are being hurt after they are injured at work.”
Borg said that out-of-state medical review companies regularly deny and delay needed treatment. “Insurance adjustors regularly overrule medical care that physicians recommend. In Greg’s case, the delay and denial of care has led to complications that have worsened his condition and sent his family and finances into a downward spiral. We are calling upon Insurance Commissioner Steve Poizner and Division of Workers Compensation Director Carrie Nevans to investigate the outrageous abuse of utilization review in Greg’s case. We are also calling upon them to investigate a pattern of such abuse. It is time to take the veto power over medical care away from insurance companies. Doctors, not bean counters, should be making the decisions about medical treatment.”
“The system is not working for those injured on the job,” said Jesse Ceniceros, president of VotersInjuredatWork.org. “We need to restore fair treatment and compensation for injured workers. Injured workers are at the mercy of insurance companies. We are losing our health, our jobs and our homes as a result of work injuries. That breaks the promise made to California workers, of adequate compensation and prompt medical care to heal and return to work.”
Greg Parr could be anyone--yourself, a member of your family, someone you know. What happened to him is below what a civilized society is supposed to tolerate. The Insurance Commissioner was elected by the people of California to investigate abuses such as this and what Carrie Nevins has been appointed to take care of as Administrative Director of the Division of Workers' Compensation--in her case subject to Senate confirmation in hearings yet to be scheduled!
Comments
What has happened to Greg and those like Greg is an outrage. Something needs to be done to rectify the curent situation he is in and to make sure that those that are injured in the future are not treated in the same manner. What is so sad, is that even if the State works on getting him the care he has needed all this time, the damage is done. Damage to him and his family that was unnecesary if the system had worked the way it is suppose to. Good Luck to you, Greg......My prayers will be with you and your family.
Posted by: Jennifer Vulyak at October 19, 2007 08:56 AM
What has happened to Greg and those like Greg is an outrage. Something needs to be done to rectify the curent situation he is in and to make sure that those that are injured in the future are not treated in the same manner. What is so sad, is that even if the State works on getting him the care he has needed all this time, the damage is done. Damage to him and his family that was unnecesary if the system had worked the way it is suppose to. Good Luck to you, Greg......My prayers will be with you and your family.
Posted by: Jennifer at October 19, 2007 08:57 AM
What has happened to Greg and those like Greg is an outrage. Something needs to be done to rectify the curent situation he is in and to make sure that those that are injured in the future are not treated in the same manner. What is so sad, is that even if the State works on getting him the care he has needed all this time, the damage is done. Damage to him and his family that was unnecesary if the system had worked the way it is suppose to. Good Luck to you, Greg......My prayers will be with you and your family.
Posted by: Jennifer at October 19, 2007 08:57 AM
What has happened to Greg and those like Greg is an outrage. Something needs to be done to rectify the curent situation he is in and to make sure that those that are injured in the future are not treated in the same manner. What is so sad, is that even if the State works on getting him the care he has needed all this time, the damage is done. Damage to him and his family that was unnecesary if the system had worked the way it is suppose to. Good Luck to you, Greg......My prayers will be with you and your family.
Posted by: Jennifer at October 19, 2007 09:10 AM
Injured workers like Greg Parr should never suffer without needed medical treatment for three years. That's why the state Division of Workers' Compensation has a process to bring these kinds of cases before workers' comp judges on an expedited basis. Any worker who has been denied medical treatment in their workers' comp claim has the right to see a judge within 30 days. The DWC has a guide and form that explain this process posted on line at http://www.dir.ca.gov/dwc/iwguides/IWGuide06.pdf. The DWC is also working to ensure that reviews of medical treatment done by claims administrators--known as utilization review--are done correctly. Earlier this year the DWC finalized penalites that apply to those who abuse the system, which was put in place to ensure workers get proper treatment. The DWC posted a complaint form on its Web site at http://www.dir.ca.gov/dwc/UR_Main.htm so that injured workers, their representatives, doctors or others encountering utilization review problems can file a complaint with the state. The DWC also posted an extensive set of answers to frequently asked questions so claims administrators understand their role and responsibilities in this process. The state provides free services through its Information and Assistance Unit for injured workers who are not represented by attorneys. More information on those services, along with a schedule of workshops for injured workers and a set of fact sheets and guides, can be found at http://www.dir.ca.gov/dwc/IandA.html or by calling 1-800-736-7401.
Posted by: Susan Gard at October 19, 2007 12:19 PM
HI, I am in the very same situation as Greg Parr. I wish you the Best Greg. ( My Prayer go out to you and your children ) Greg, I am * even approved * for my major lower back surgery. Approved about july of 2006. I still haven't gotten it.( today is Oct 20th 2007 ) Similar to Greg I developed (many complications) waiting even for approval for over two years. Their nightmare balance and check system. Two Neurosurgeons have both stated i will most likely have to have a fushion surgery after i finally get the first approved surgery on my lower back. Like Greg how do we even eat awaiting this.
Like Greg Parr our money for temporary disability just runs out after two years. My loan like Greg is receiving now, ran out May 14, 2007. I have had no income since. Over 5 months now. I am approaching homelessness very fast. Workmans Comp knows this. ( injury date may of 2004 ) Per Workmans comp , they have now paid us, even a loan against our finaly settlement for wage loss adjustments. We use this money to live on as we await more of their denials. We can expect to receive not another penny.
Susan Gard mentions alot for fighting them/appealing. If you fought them on everything you would be doing nothing but having hearings. They deny and argue so much. delay, Its a total Joke..I have had to have hearings and they just drag everything out even longer. Dr shortage means we wait sometimes over 5 months to see a DR. They send us to Their DRs over 100 miles away claiming no one qualified is in our local area.. We wait 5 plus months to see their DR's.
Like Greg how do i even live and eat if i was lucky enough to have my approved surgery tomorrow. Then if i need the fushion they are denying. Again. where do I live and how do I eat awaiting this whole approval process again.
They said I will need quite a bit of therapy too after my surgery. The Voucher Bill for retraining Governor Arnold just veto'd . How do I afford to go to any kind of retraining . I will get my Voucher for retraining after im living under a bridge after surgery.
( PASS THE BUCK TO MAKE INS COMPANIES BILLIONS ) Truth seems to be they are shoving us truely hurt toward State Disibilty. ( which you must show income two years prior to applying >> like unemployment ) And shoving people to local welfare food stamps, Applying for Social Security Disability. they know time is completely on thier side. Look at Greg Parr and myself.
I have applied for Social Security Disability. Like a huge majority, same as workmans comp. DENIED. You have to appeal. Go through now SSDI's balance and check system. People are dieing now awaiting SSDI approval. I am now 1 year and 3 months into the SSDI approval system. I am awaiting a hearing that in California will be a MINUMUM of a 13 month wait now. I may have close to 28 months ( 2 years and 4 months ) wait in SSDI's balance and check system. As more now are forced to apply unfixed like Greg and I. Expect way longer waits for each process of SSDI.
Since SSDI denied me in the first go around. YOU DO NOT EVEN QUALIFY THEN FOR ANY KIND OF COUNTY AIDE TO HELP YOU. SSDI and the county and Medi-cal and all are tied together. Since I do not even have 1 dependant i do not even qualify for food stamps.
Why is the American tax payer going to be burdened by CA injured workers.( on SSDI ) Why ISNT Arnold taking care of us truely hurt like he promised.
They did not fix the machine at all. Greg and I are proof ! Even all the new bills they tried getting through do not help Greg parr and I. From what I seen they just tried to change some for people hurt after 2008. Means simply. Greg and his children could very well be homeless and unfix like I am very soon.
Good Luck Greg and My Prayers go out to you and your children. Please someone wake up and pay attention before there are thousands and thousands like Greg , His children, and I. Homeless and unfixed. Governor Arnolds new laws are just now starting to effect LOTS OF US. I see more weekly on Forums and Message boards seeking help, Scared like we are :(
Posted by: Terry T at October 20, 2007 12:03 PM
I too am a "victim" of the workers comp fiasco. I was injured in 3/04 with a back injury. Since that time, I have had to deal with denial after denial for treatment, medications, specialist, therapy etc... I even have had to deal with the WCAB (it took 6 months to get a status conference even though we asked for an expedited hearing.) and that was a complete nightmare. I have gone threw 2 insurance companies, 4 adjusters, 3 different defense councils and numerous doctors. It took 3 tries with the WCAB before, I was finally given the ability to maintain treatment with my pain specialist (who was an agreed medical provider, but not on the MPN) and see a psych doc that had been recommended by the defense QME 2 years ago. Even after getting a signed agreement with my attorney, defense council and the judge, there was still a fight with the adjuster who felt that she didn't have to follow the order. In the meantime, here I sit, in pain, no recourse, unable to return to work and out of money. I want to get the hell out of California, but I can't even pretend to try and move. The governor needs to get a clue injured workers CANNOT survive like this. We need to have access to proper medical treatment in an expedited manner, we need to have proper therapy and not just the "24" visit bit. We need to be able to obtain medications that are recommended without having to get prior authorizations. We need to have a better wage to survive off of. The ttd and pd rates need to be increased. I could go on and on... I am so tired of this fight and want it to be over, but NOT until I have the proper treatment. I am a US Citizen, I pay my taxes, I obey the laws, and yet... I have seen illegal people (people that come here illegally, just to clarify that statement)receive more treatment than I do. Where is the justice in that. I hope that one day this will all be done with and just a really bad nightmare. I wish you all luck and keep fighting, we can't let "them" win.
Posted by: Cathy at October 22, 2007 03:48 PM
Hi
I have been looking for any follow up on Greg Parr. Does anyone know if his press conference in Riverside made a difference and helped him ? Thanks , Terry
Posted by: Terry T at November 16, 2007 01:55 AM
If california is a no fault state then why does the the employee carry the burden of proving that the injury is industrial based. And when that is established. The employee is then fired.
Posted by: m at December 2, 2007 12:12 AM
I have gone through the same lies and denial as others when after a twisted knee I was treated by the clinic the contractor sent me to, and after being laid off two weeks later was denied benefits by Zürich due to there contention that I never mentioned the injury until I was laid off.This was a direct lie by the safety man for the contractor.I also found out they never filed a workmans comp case but used a private clinic.
After trying to fight the system and not finding an attorney that would represent me I gave up and paid for medical care out of my own pocket.If I did not have money I would be broke and would have lost everything. I was even told by Zurich that it was illegal for me to get private care from my private insurance Co. I had nothing left but use my own money and send them a letter after I recovered to kiss my butt. I never wanted money just medical care for my knee.
Posted by: Nick Edgecomb at March 31, 2008 05:12 PM
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