Injured Workers "Committing Suicide"

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 isn’t 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 didn’t 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? It’s 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 don’t 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 don’t 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 doesn’t 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. It’s 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 don’t 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 Enloe 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 PEOPLE," right?

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 Work.