Activists Demand Prosecution of Insurers, Too/Next Action In Oakland 6/29

http://www.workcompcentral.com/1/news/news_print.htm?id=t171d06s1751228ab6n25hj&token=l173p06a312905ef24f21l&state=CA

Activists Demand Prosecution of Insurers, Too
California -- Activists Demand Prosecution of Insurers, Too: Fraud [06/21/06]
SACRAMENTO -- Some of California's most vocal injured worker activists on Tuesday demanded that the Fraud Assessment Commission place as much emphasis on prosecuting fraud by insurers as it does on fraud by applicants.
The band of about two dozen injured workers brought rare public participation to the commission, which typically performs its function of doling out fraud-fighting grants to county district attorneys in obscurity. At one point Fraud Assessment Commission Chairman Bill Zachry demanded that an activist stop videotaping the meeting, only to relent after he was told by the commission's attorney that state statute probably protects the public's right to videotape the meetings of public bodies.
The loosely knit band was organized by Dina Padilla, president of the California chapter of VOICES, an injured worker advocacy group founded in Florida. Each had a different story to tell, but, in summary, the activists argued that Fraud Assessment Commission grants are used by prosecutors to harass and persecute legitimately injured workers, while insurance companies are allowed to delay and deny medical care despite court orders and hire physicians who lie about injured workers' medical conditions.
Zachry refused to comment on the complaints after the meeting, but he did offer that of all arrests for insurance fraud last year only 26% was for fraud by claimants. All the others were for allegations of fraud by providers, employers and insurers, he said.
"I think we have pushed for balanced case loads," said fraud Commissioner Donna Gallagher, who heads fraud-detection efforts for the State Compensation Insurance Fund.
The activists waited for the commission to conduct its business and then took to the podium during the public comment period to paint a picture of a system stacked against them.
A tearful Rachel Williams said she injured her spine when a 300-pound patient fell on her in a convalescent hospital. She said she became homeless after the insurance carrier cut off her temporary disability benefits and now the insurer refuses to pay for back surgery.
"I have been in pain every day of my life for five years while these insurance companies belittle, threaten and harass me," Williams shouted while pounding the podium. "I have a nine-year old son. He needs his mother."
One by one, the injured workers told vignettes about alleged abuses by the workers' compensation system in a room filled mostly with prosecutors who had gathered to await the commission's vote on $22 million in grants to county district attorneys offices. Most spoke longer than the three minutes allocated for each public comment, with Zachry occasionally prodding them to sum up.
Barbara Clark, who has state and federal lawsuits pending against her former employer, Seventh Day Adventist Health, brought with her a stack of nine restraining orders that the hospital chain had obtained barring her from contacting her claims adjusters and the organization's executives. The restraining orders alleged "workplace violence" by Clark, but she said she never threatened or attacked anyone.
Clark said the restraining orders are a part of Seventh Day Adventist's pattern of intimidation and blatant disregard of a court order to provide medical care, which has gone unpunished because insurance fraud investigators refuse to go after the industry.
Jeff L. Corzine, a Sacramento attorney who represented Adventist Health in obtaining the restraining orders, did not return a call requesting comment. The Placer County Superior Court has scheduled a July 10 hearing on the temporary restraining order against Clark.
--By Jim Sams, WCC Senior Editor
jim [at] workcompcentral.com



WORKER'S COMP- Hearing
Thu Jun 29, 2006
at 10 a.m.

State Building Auditorium
1515 Clay Street
Oakland

Regulations implementing penalties against employers and insurers for delays in complying with the laws governing authorization for medical treatment will, at long last, be considered for adoption by the Schwarzenegger administration. All injured workers are encouraged to attend. Those who have experienced delays in medical treatment because of utilization review dismissals or have had recommendations totally ignored should be especially interested.

<http://www.viaw.org/board.php?b_code=blog&c=list#345> Click here for more information from Voters Insured at Work (VIAW).

<http://www.worksafe.org/events/coalition/injuredworkerpage.cfm> Click here for more WORKSAFE! information for Injured Workers about Workers' Comp.


http://www.viaw.org/board.php?b_code=blog&c=list#345
<http://www.viaw.org/board.php?b_code=blog&c=list#345>
June 29 Hearings in Oakland! Join Us!
1515 Clay Street, Auditorium,
Oakland, California

Regulations implementing penalties against employers and insurers for
delays in complying with the laws governing authorization for medical
treatment will, at long last, be considered for adoption by the
Schwarzenegger administration. “Utilization Review” laws, enacted in
2003 by SB 228 and effective 1/1/04, have given employers and insurers
the ability to seek an outside medical review for every single treatment
recommendation given by the treating physician, allowing up to 14 days
to modify, delay or deny the physician’s request. The lack of oversight
and enforcement up until now has proven catastrophic for many workers
over the last 2 1⁄2 years, a situation that will continue until the
regulations are finalized sometime in the fall.


VotersInjuredatWork.org representatives will testify at the hearing and
provide written responses to the administration’s proposals on June 29,
2006. The hearings will be held at beginning at 10AM. All injured workers are
encouraged to attend. Those who have experienced delays in medical
treatment because of utilization review dismissals or have had
recommendations totally ignored should be especially interested.


These penalties, however, are not destined to compensate injured workers
for their trouble nor provide any relief to physicians who must go
toe-to-toe with UR physicians who never see the patient nor are they
required to be licensed in California. Under the laws, the penalties
assessed will go to the state.


The Division of Workers’ Compensation will also consider testimony on
proposed regulations implementing more severe penalties for unreasonable
delay of compensation where a judge has found such a delay under Labor
Code §5814 – a section that was dealt an almost fatal blow in SB 899.
This section, originally intended to urge careful compliance or face
severe monetary consequences, was changed to limit penalty awards to
injured workers to a maximum of $10,000. Concurrently, SB 899 allowed
the state to invoke additional penalties against employers or insurers
who were found to have violated Labor Code §5814 “knowingly” and “with a
frequency to indicate a general business practice” of up to $400,000.
Again, this money, when assessed, will go to the state to fund the
Return To Work program that was established in AB 749 in 2002. The
glacial speed with which the administration has allowed judicial
findings of unreasonable delay to flourish with relative impunity is
troubling. We saw how they rushed to implement a permanent disability
rating schedule that cut benefits to workers.


Hope to see you at the hearings. Let us know if you have questions or
want additional information.


Working for You,


Peggy Sugarman, Spokesperson for VIAW.org