Don’t Let Big Insurance Pull The Wool Over Your Eyes!
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By Sam Gold
Injured Workers Television Network
The insurance industry and specifically large self-insured companies are ramping up support in Sacramento for another, as they call it, Workers Compensation Reform – a very bad choice of words as the definition of the word reform means “the improvement or amendment of what is wrong, corrupt or unsatisfactory!” And corrupt and unsatisfactory it most certainly is, but not caused by employees, but the employers and their insurers. They have the vast financial resources to lobby our legislators who will gladly take their political contributions to make changes in existing law.
To put this issue into proper context, keep in mind that Workers’ Compensation was concocted over 100 years ago; not by injured workers or their advocates, but by employers and their insurers who had one sole objective in mind, to reduce their liability against civil litigation when their employees were injured in the line of work. And in over 100 years, that objective hasn’t changed one bit! And injured workers haven't had very much say in what happens to them!
The reality is this, the injured worker simply doesn’t have a chance in hell of ever becoming anywhere near whole again the way the system has been created here in California. And I’m sure that is just as bad in many other states around the country. Why, you ask? Well let’s see if you can stomach the realities of what every injured worker faces:
- The employer gets away scott free and has no civil liability even if his or her gross negligence caused the injury to their employee. They call it the “Exclusive Remedy”, and it’s exclusive alright; it provides them a shield from civil litigation and forces employees into a system that is simply weighted against workers!
- The insurers and their defense attorneys and doc-in-the-box doctors can pretty much say anything they want, literally lie thru their teeth, and make false statements without any fear of recrimination. They call it “Litigation Privilege.” Any mistakes that an employee might make are referred to the local District Attorney for fraud prosecutions.
- In many cases the DA’s are on the receiving end of fraud fighting funds that are handed out each year by the Department of Insurance and some of these DA’s have in the past crossed over the line of honesty and decency to obtain successful prosecutions so that their share of the Fraud Assessment Commission funds are as large as possible. And you thought they were there to protect you? Think Again!
If the employers and insurers want a real reform, I’m sure that injured workers, their advocates, treating doctors and others in this system that doesn’t consider the injured worker a “stakeholder” would welcome the opportunity to sit down and help create a system that really does what it’s name implies: adequately compensate workers for their occupational injuries, not throw some chump change at them and eventually dump them on the trash heap of society like they have been doing for so many years.
As a retired union sheet metal worker I am really embarrassed that the California Labor Federation has gotten behind this fiasco. Maybe it’s time for California workers to distance themselves.
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Sam Gold is a California injured worker and creator of the Injured Workers Television Network, a state-of-the-art, network quality, internet based television network.
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As I said before, when union members elect their union representatives, make sure that they are actually serving the labor interest. More often than not, those who we place in a position of power FORGET where that power came from. Union Members should remember this and stay vigilant. Power corrupts when no one is watching.
This hold true for our elected officials. Citizens should stay engage with what is going on in our government. If we can no longer rely on our elected officers to do government oversight, WE THE PEOPLE should take that proactive role as a responsible citizens.
XYZZX SJ02
I actually read the proposed 170 pages SB863.
There were some improvement but there are also takeaways.
One very important issue that the bill did not clarify is the most important question in the minds of those injured workers that has been impacted by the SB899 reform.
Arnold said that the reduction of PD indemnity and benefits is an unintended consequences. BUT THIS BILL does not address that issue to those INJURED WORKERS that has been AFFECTED by this "uninteded consequences". The increases in benefits appear to only affect those WORKERS injured on the Job prospectively commencing in January 1, 2013.
Can we have some clarity in this very important issue?
Injured workers got steam rolled once again by Corporate Business, Insurance, and special interest...the story never changes...those with the money influence, biggest lobby, and political horse trading clout; win.
None of players involved in this legislation has ever experienced this dysfunctional & dehumanizing system...they walk around wearing blinders; refusing to even look at what is actually happening; or will they ever investigate the real problems in this rigged & failed system...
It never has, and never will be about providing proper and humane services to injured workers....just a continued huge well financed propaganda machine demonizing honest workers with disingenuous campaigns of "we can't afford to take care of those who's hard labors made the fat cats their riches", and "everyone injured on the job is somehow a criminal fraud"....it's truly a sad situation with we have this ongoing symbiotic relationship between corporate business and our government have today...it surely is not getting any better looking forward...
I would personally like to Thank You for your steadfast efforts & voice of truth Sam Gold :)
This was a done deal even before it was introduced. Gov Brown wants support for his upcoming tax bill and guess what the price was?
As I said folks before you jump the gun, read the SB863 in its entirety. There are in fact some really sound reforms and an improvement from SB899. If I understand it correctly, medical decision should be made by medical professionals, not by Judges. And the decision will be based on sound medical opinion according to medical evidence. I think that is proper. If I sensed correctly in previous previous statments, DIR Director Carol Baker and DWC A.D Rosa Moran, actually understood the unintended consequences to the Benefit indemnity reduction arising from the flawed SB899 reform, and the impact that has on all the injured workers that has been the victim of that reform, then I think THEY will do the right thing and restore the PD pay that reflects a fair and reasonable level.
The right, fair, and equitable way to determine the allocation and adjustment that will meet this objective is using the imperical data. Impirical data and the history it offers is a much more scientific actuarially sound basis than off the "wim" number that former DWC AD (God bless her soul Carrie Nevans)came up with approved by Former Gov A.S. that has no actual background in this field of logic. Had he acted on the advices of professional accountants and actuary, rather that the lawyers and business people and insurance industry that concocted the SB899, He may have had a better legacy as a Governor. In the SB899, the LAWYERS (defense and plaintiff counsel alike) and the Insurance Industries came up the winner.
In my experience some lawyers are not upfront with the cost of their services and often vulnerable applicant clients are pressured by their Attorneys to accept whatever they "successfully negotiate for their them relying on TRUST. While not really and completely giving them "full-disclose". Any hidden cost were never specified in the Findings and Award what other "statutes" are there that actually takes-away from the clients final Findings & Award settlements or stipulation until injured workers are caught by surprise at the end of ther term (long after they have reap the benefits from their commutation of their legal fees). Such hidden or undisclosed takeaways from the final settlement will surface. Yet the imfamous "Its a done deal" means a client can not dispute.
They (Attorneys) charges a between 12% to 15% depending on the complexity of a case. And yes indeed the laws were created and engineered that way by the Attorneys at both ends of the deal. What may appear at the rate mentioned actually becomes more than what the rate actually is. Even though the WCJ decides the attorney fees, there are other cost that significantly reduces (yes a significant reduction) the ACTUAL benefits paid directly to the injured worker--thus, not only reduces the benefit but actually costing the injured worker MORE than the percent rates on the face of the settlement.
For example: I have been rated 69.5% PD. under that rate I received $101,832 in benefit for this rating. The WCJ approved a 15% attorney fees amounting to $15,275 and cost of $125. In addition, there was a lien in the amount of $21,756.
A claimant would think that the total reduction from my final award would be $37,156. Right? Leaving me a balance of $64,676. Right? WRONG!
I was caught by surprise when my biweekly pay of $400 had abruptly ended with $8400 balance NOT paid to me.
What happened here, after months of trying to get an explanation, I recently got one this week. There was NOTHING in the Stipulation & Award that indicated that my total settlement would be subject to ((subject to Section 10169) an "INTEREST" pay back to the Insurance compay as a result TO agreeing with the attorney's stipulation that legal fees and cost to and lien will be "commutated at far-end". THIS IS THE HIDDEN COST that they don't tell you when you sign the Settlement. So the $8,400 that was retained and given back to the insurance is the hidden cost. The statute says that it is " 3% Interest of the present value of Life pension ". I asked my Attorney to provide me information of statute section 101169 and said that I will read it carefully to see if it is actually applicable. As I noted above Life Pension IS NOT applicable for PD rating of 69.5%. Therefore the interest of 3% of the Present Value of pf Permanent Disability which came out to be $8,400 that I thought was shorted to me. THAT is because I agreed to a COMMUTATION. So ACTUALLY the total amount I actually paid for agreeing to this stipulation cost me more MONEY out of my settlement than the 15% attorney fees. In my particular case I "was" a high wage earner before becoming injured worker and permanently disabled. My Temporary Total disability was at the maximum because my earning before injured was more than $1,400 week earning. The SAWW top at $1062 at the time of my injury with that said the Temporary disability cap at $728/week. THAT replacement pay does not even come close to 2/3 of my actual weekly pay (approximately on the basis of the $1400 I disclosed above that would amount to $932/week. $932/wk less $728 = $204 (this is the amount per week that I was losing or $10,608 per year) So my loses amounted to $10,608+ 15,400 + $8,400=$34,408 for a settlemt of $101832.
To make it more clearer, the cost of my settlement amounted to $23,800 (or 23.35%) for a settlement of $101,832. NOT the 15% for the settlement that actually I was led to believe.
I knew nothing about the statute pertaining to Section 10169.
So, Ladies and gentlement and most importantly injured workers and their family should be aware of this statute before signing on this kind of agreement. Insist the "Statute" that will affect your final award before signing to the agreement.
I had no problem with it but I do have a problem when Attorney do not disclose everything that injured people should know. It is especially important for a FAMILY to understand so they can may their financial planning and make adjustment and prepared before their benefits end.
This is where the Justice System need to improve if Legislature want seriously to protect injured Californian.
This a true story I wish to share with my fellow Americans that are injured. Know exactly the date of the week when your last payment will become FINAL (so that you are not caught by SURPRISE when it actually ends abruptly. You will not get a warning until it ends.
Know your Rights. You have the rights to question and get clarification. Don't assume that your Attorney will actually give you all the information you should know. I just assume my attorney gave me all the information I needed to know. I simply dismissed it--that they forgot and I didn't probe anymore when I should have. That is a hard lesson learned for me. And I don't want you (injured worker) and your family to end up in my shoe.
I will conclude my optimism that the current administration will do the right thing for the injured workers that lost so much due to the unintended consequences of the infamous SB899 reform.
XYZZXSJ02
I am not afraid to attach my name to my comments as apparently you are. I also the read the bill too. After talking to numerous legislators and getting the real skinny, I can justify saying that this whole thing was rigged from the get-go.
Notice that they took a bill that had been thrown into the inactive can and revived it at the beginning of this month with an amendment that took precedence over what the bill was for in it's earlier life. This is a common practice when they want to run a railroad train thru the center of town.
The current administration will do whatever is right for those who support them in more ways than one. They follow the feeding trough. That's what politics is all about. Follow the money train and see how much can fall off in your hands!
This bill only benefits those who have thrown a ton of money behind it. Everything else is shall we say "Smoke, lights & mirrors......
Thanks Sam for pointing out the ridiculousness of this bill and process... The injured worker loses virtually all appeals processes and the insurance company gets a win-win. I've been fighting just to get my QME for the last 6 years, and finally just caught a break -now this. More and more LEGITIMATELY injured workers will be looking to just get out (if they have private insurance) so they can get the treatment they need. I can't imagine what will happen to the more seriously injured who may not have other options... And again, guess who wins? Surprise surprise... The insurance companies...
Dear Sam,
I respect you and your comment, believe me. If you know my case, then you should also know why I use my alias name rather than my real name. I am beyond being "afraid". I am more angry than afraid. I am just being smart about my case, and I promise you that I will disclose my identity when the time is right. I am sure you will find the story of my case interesting when the case is completely resolved.
The Presiding WCAL Judge Oliver Boyer issued this alias name in a court-order The manager at OSH gave me the claim number to protect me. Needless to say, that protective court-order was not respected by the defendant in my case (Duncan SIF v WCAB, XYZZXSJ02, aka BAKER v WCAB). In this case my personal identifiable information was NOT redacted according to the Court-Order. This linked me to the super-confidential medical information that was disclosed to the media and in a document that was filed by BAKER and cousel in the California Supreme Court, which then was posted on-line in the California Judicial Branch world-wide-website. That BREACH of PRIVACY is a serious violation that precipitated from the 'Cost-of-living Adjustment case that was heard by the California Supreme Court.
I wrote you to see if you know of an attorney that you may refer me to that is willing to take my case to court. This is a pending CIVIL Rights issue. The defendant filed a Request for a Judicial notice which I did not get a copy of when it was initially filed. I assumed all the attorney had read it, when it was first presented in Court. I think this 'Request for Judicial Notice' document was initially filed in 2010. I discovered the BREACH (in May of 2011) of my REAL NAME, date of birth and other identifiable information with alias name (XYZZXSJ02) in a document that was filed as Exhibit 10 (The document is called Stipulation and Award issued by WC Judge Lauerman) in this Judicial Notice that was filed by DIR.
I immediately notified my Attorneys. Mr. Johnson then wrote a letter to the California Supreme Justices pertaining to this incident and requested that it be remove and replace it with another copy of the Stipulation and Award letter with my name "REDACTED". The letter was written in July 2011. The court made a final ruling in 8/11/2011 in favor of Baker (DIR), then removed the entire Judicial Notice document from the website. There were no other responses made known to me from either the Chief Justices that is responsible for the actions of the Judge that initially made the mistake in the Stipulation and Award letter or by the Ms Baker who was named in the case when it was heard for Oral Argument in May 23, 2012. Everyone involved was silent up to NOW. According to the LAW, the Chief Justice should have reprimanded those involved in the Breach.
Honorable Ronald Geroge was the Chief Justice in 2010 and John Duncan was the head of DIR. They both left the government before my case was heard at the California Supreme Court. In 2011, Chief Justice Sakauye and Christine Baker were the successors.
With that said, I want to use this alias name for now until this issue is resolved. According some article I read, an bill was passed by the Legislature in 2009 that may have immunized the Judges and Legislature of any wrongdoing retrospectively. That bill was SBX211 which was passed and signed by legislature and signed into law by former Governor Arnold Schwarzennegger. It was done without the public consent and maybe unconstitutional if former Attorney Richard I Fine was correct. Richard I Fine was was a prominent former U.S. Prosecutor and a Famous Attorney in Los Angeles for the ordeal that he went through when he discovered corruption activities and allege this in the L.A Superior Court that involved LA County officials and Sheriff Baca. He was placed in solidary confinement for 18 months without his rights to legal due process by retired Judge Yaffe of Superior Court of Los Angele County. He became a political prisoner in order to silent him.
I have nothing else to hide since the STATE's DIR and the Justice violated my rights. I just want to MITIGATE the damages that has been done to me and to stay consistent with the Court-Order until this serious Civil Right Violation is resolved.
As you know my case with regards to COLA issue has been politicized and rendering the INJURED WORKERS victim of this insidious ruling which is not only discriminatory as demonstrated by my attorney but defy the real meaning of COLA that was designed to protect the most seriously injured workers from the ravages of inflation. COLA rates will be determined prospectively according to the interpretation made to labor code 4659(c).
If the IW is determine 70% to 100% PD rating COLA does not take effect until P&S and when PD payment actually commence. That in effect can take 5, 10, 15 years from date of injury in which benefits are NOT protected. If a person is determined Total when all medical evidences are there to substantiate a 100% ruling at the date of injury, COLA will apply the following January. If the claims adjuster fail to provide the UR all the document relevant to this case such as the pre-existing medical condition that may warrant an injured worker a 100% PD rating, and later goes to court 10 year later and the QME determine a 100% PD rating, THAT injred worker does not get the same protection from COLA as the IW in the previous scenario. That was discriminatory.
THAT was the issue that compel the Supreme Court Justice to modify their previous ruling in 8/11/2011 that was amended in 10/19/2011. The modification furthermore did not address the gap of the dates when the TTD ended and PTD commence. According to the labor law IW workers that are HIV or Diabetic or with other seriously illness may be entitled up to 5 years of to recover from an injury as they usually take longer to heal from a serious injuries thus are entitled to up to 5 years of TD rather that the ordinary cap of 104 weeks TD payment. This may also be a constitutionality issue.
So there is a question whether these actions were in fact within the confine of our Constitution. So with this respect, I want to avoid myself from having to endure what Dr. Richard I. Fine has been through.
And I don't want you think in anyway that I was not "objective" in my assessment with regards to SB863. My comment above was only my best opinion after reading the SB863 and does not make my analysis of it as final or claim it to be completely correct. I do agree with you that the "manner" this was handled was not appropriate, neither did I minimize the objective analysis made by the other. I was merely noting the positive side of the bill. I am holding the responsible people how they assume to allocate the $120 million that was added. I will hold them to account when the result does come out damaging to the Injured Workers and does not result on the promises that this administration claim that it will be a WIN-WIN for all. The bill was passed and signed by Governor Brown. If I understand it correctly, the bill can be tweeked and amended later unlike Governor Schwarzennegger unwillingness to make the necessary changes when it fails to deliver the appropriate benefit changes that closely reflects the injured workers losses.
If you have an Attorney to refer to me, I would appreciate your help. If you have a referral please forward it to my WC Attorneys to deliver it to me. I have been having a difficult time finding one. Perhaps I have been blacklisted like Dr. Richard I Fine and many other individuals that stood up for their rights and the rights of those that concerns the Injured Worker who were treated unjustly. I am with you have been studying this system since my case began and I assure you, I have learned alot and can attest to the problems you addressed in you many blogs regarding our current workers compensation system in California. I know of the fraud, waste, and mismanagement you have addressed in the past and I have experienced some if not everything that you commented in your blog. So don't misunderstand me. I am evaluating all of the angles and have made note and gathered evidences that substantiates your claims that corrupted our system. I promise there are much more problem to this that extend beyond the the workers compensation insurance industry.
Yours Truly,
XYZZXSJ02
correction:
Dear Sam,
I respect you and your comment, believe me. If you know my case, then you should also know why I use my alias name rather than my real name. I am beyond being "afraid". I am more angry than afraid. I am just being smart about my case, and I promise you that I will disclose my identity when the time is right. I am sure you will find the story of my case interesting when the case is completely resolved.
The Presiding WCAL Judge Oliver Boyer issued this alias name in a court-order. ( I don't know how the following statement regarding "OSH" got pasted on my response to your comment).
Well, in this case, they must get an e discovery services for them to have proper process on legal terms. This is very crucial and only experts can do the job.