By Sam Gold
A California Injured Worker
The California insurance industry agreed to a social
plan known as Workers Compensation almost 100 years ago, and they have been
scheming to figure a way to keep every bit of the premium dollar collected ever
since. 30 cents of it just simply isnt good enough for them. They want
the entire premium dollar, period!
Since the California Workers Compensation industry was
deregulated at the end of the last century, numerous excuses have been given as
to why it went to hell in a hand basket! Why several insurers went
insolvent and eventually belly up. The cutthroat competition along with
insurers getting suckered into reinsurance scams by unscrupulous agents just
added fuel to the fire. It was about greed; plain and simple greed!
So how did they find a way out of the morass? Simple,
blame the injured worker, the primary stakeholder in this process, and those
who seek to help them thru their medical and legal nightmares.
2004 was the "Year Of The Terminator." Arnie was elected
by a state unsatisfied by the performance of Gray Davis. So what did we get? We
got a Senate Bill that literally intimidated every legislator in Sacramento! We
got a governor who didnt know the foggiest thing about Workers
Compensation except what his advisors told him, advisors like Warren Buffett,
who I might point out, are profiteering hand over fist in this new millennium
due to those changes.
So who is on the losing end here? Its the injured
worker, the very person that this system was created to assist in his or her
time of need. I can just hear Hiram Johnson rolling over in his grave!
But first let's get a couple of things straight.
Contrary to what Governor Schwarzenegger would have you believe, the attorneys
who represent injured workers thru the legal process are NOT trial attorneys
and they simply dont get paid like trial attorneys. They get paid a very
small percentage of permanent disability recovery, and only at the end of the
case, which in many cases can be anywhere from 2 10 years. So they
dont get anything until the case settles and are essentially fronting all
costs on the cuff. This area of law is so complex that unless one is a
specialist in this field, they are at a distinct disadvantage.
In stark contrast, defense attorneys who represent the
interests of the insurance companies get paid by the hour and essentially are
running an endless taxi meter. They get paid for their accumulated time during
the duration of the case, not just a lump sum payout at the end.
So who here really has the financial incentive to drag
these cases out for long drawn out legal fights? OK now do you get the picture?
This doesnt present a very level playing field, does it?
In 2004, the insurance industry put millions of dollars
behind a concerted effort to as they say "reform" Workers Compensation. But the
dictionary defines a "reform" as an improvement and Senate Bill 899 improved
only one thing, insurance industry profits, nothing else. It doesn't take a
rocket scientist to figure that one out. Money well spent!
Reality is that Workers Compensation is not about truth
and justice, nor is it about fairness and equity. It's simply about money and
power and what you can try to prove in front of a judge. Its about
medical-legal doctors who prostitute themselves and use more of their creative
writing skills than their medical skills for those big money payoffs from the
insurance carriers. A very sad anthem for the 21st century!
SB899 created the "Medical Provider Networks!" Now, when
an injured worker goes to the doctor, the foremost 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 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 cheaper to pay the penalties than
it is to comply with the law. And they dont even get a slap on the hand
for committing the most heinous of crimes.
Where else can the gross negligence of the employer and
insurer with reference to the incompetent delay or denial of medical treatment
that leads to the death of an injured worker allow get them to get off scott
free with no fear of recrimination or financial liability?
It's getting so bad that injured workers suffering in
excruciating pain and getting a blind ear from the insurance companies and
their defense counsel are simply committing suicide and that is a list that
keeps growing and growing as time goes on with no relief in sight.
A report just released states that the list of available
Qualified Medical Examiners is down by almost 25%. And many physicians are just
plain disgusted with this system and are not accepting occupational injury
cases anymore. A recent article about
Medical Center in Chico bears credence to that statement.
So where does that leave the injured worker? Simply,
with a steadily shrinking pool of available legal advocates, as many applicants
attorneys are no longer able to make a decent living since SB899 unfairly
manipulated the permanent disability rating schedules by requiring the use of
ACOEM guidelines, which ACOEM admits were never, ever meant for acute
occupational injuries. And they are leaving the field in large numbers! It
leaves the injured worker with fewer and fewer competent doctors who are
genuinely concerned about their welfare, making them whole again and getting
them back to work.
And now county District Attorneys are climbing on the
bandwagon too by prosecuting injured workers for Workers Compensation fraud,
with the most flimsiest of evidence, some that doesn't even meet the legal
requirement to prove fraud, and others using tainted evidence that is "the
fruit of the poison tree!" Their ulterior motive is to get a piece of that $43
million dollar Fraud Assessment Fund that the Department of Insurance hands out
for successful prosecutions. Your constitutional rights and protections simply
don't matter here!
When our 24 hour around-the-clock governor broke his leg
last December, he was admitted into the hospital for surgery so fast (less than
72 hours) that it would make your head spin. How many injured workers can
attest to that fact? Did he use his own personal medical insurance to pay for
the surgery? Did he commit fraud by using it instead of informing State
Compensation Insurance Fund of his injury?
It appears that their master plan is working, unless you
and I rise up and help put an end to it. After all we're "WE THE
Sam Gold is an injured worker who created the first
regularly scheduled television program on the California workers' compensation
system. Injured On The Job (www.injuredonthejob.tv) is produced at
state-of-the-art video production facilities in San Francisco and Sacramento,
and exposes that fraud and corruption in a manner that the television viewer
can easily understand. He also maintains the web site
Californians Injured at