A workcovervictimsdiary.com is wishing all its readers a healthy or healthier, prosperous or more viable New Year!
╭━━━╮╭━━━╮┈┏┓╭━━━╮ ┗━━╮┃┃╭━╮┃┏╯┃┗━━╮┃happy ╭━━╯┃┃┃┈┃┃┗┓┃╭━━╯┃ new ┃╭━━╯┃┃┈┃┃┈┃┃┃╭━━╯year ┃┗━━┓┃╰━╯┃┈┃┃┃┗━━┓ ┗━━━┛╰━━━╯┈┗┛┗━━ to all injured workers!
The year 2011 was a fairly decent year for me – relatively speaking, that is. Let us count the ways:
I did not hear of any new law(s) that took away more rights of injured workers;
I only had to write 6 or 7 complaint letters
I only had to attend the ACCS for concilliation on two matters
My requested surgery was only delayed by two months
My 3d Medical Panel assessment for permanent impairment rating was only suspended
I only had to increase my anti-depressive medication
I only had to increase my pain medication
I received help from a very good pain specialist
I only have severe end stage osteoarthritis and complete rotator cuff failure and only need a total reverse shoulder prosthesis, it’s not like I am dying or anything
I only had a heart attack and serious cardiac failure during my last, recent surgery but am recovering well
I finally started this blog (on 19 August 2011) and it’s going very well!
and I adopted Bobby, my boy eclectus parrot
Still, I hope that 2012 will be a better year for me, and – undoubtedly- for all of you (injured workers) too!
Goolgle Analytics for a workcovervictimsdiary.com
Analytics for the past month (30 November-30 December 2011)
The blog continues to increase its popularity, with 672 visitors, 6050 page views and 32% new visits this month alone! The Twitter followers have also dramatically increased and we have now over 500 followers! Not bad, considering that the blog was started on 19 August of this year!
TONAWANDA, N.Y. — The sprawling DuPont plant along the Niagara River here can be a grim place, but less so on the days when the company hands out coupons to reward workers for a few weeks without injury.Called “safety bucks,” the coupons look like real money and can be redeemed at Red Lobster, Home Depot and several other businesses in the area.
In Workplace Injury System, Ill Will on All Sides
For some workers who risk their fingers and bones to make Corian, the stonelike countertop material that is the plant’s major product, the coupons have become a modest blessing and benefit. But other workers regard them as a curse, as a way to mobilize peer pressure against workers who might consider reporting an injury.
“You know that if you report an injury, everybody says, ‘You son of a bitch,’ ” said Dan Austin, who worked at the plant for 30 years. “I’ve heard people say, ‘So-and-so reported an injury and it’s going to cost us our safety bucks this month.’ ”
Companies across the state have recently introduced reward programs to curtail injuries, in part to keep their workers safe, in part to cut down on workers’ compensation claims, which managers cite as a huge factor in the high cost of doing business in New York.
“There are an awful lot of situations where people aren’t truly injured on the job,” said Gregory Harden, the president of Harden Furniture, a 380-employee company based in McConnellsville. “I tend to be a little cynical. Monday is always the day with the highest injury rate for us. Someone comes in on Monday, and their back is really sore for whatever reason, and they end up missing a few weeks of work.”
The state’s multibillion-dollar workers’ compensation system is plagued by many shortcomings: endless delays, suspect doctors, and a rudimentary form of justice that prevails as employees and employers seek to survive.
But perhaps the most powerful way to appreciate how the system has failed is to see what it has done to New York’s workplaces. A century ago, when the state created its workers’ compensation system, the goal was a no-fault insurance program that would foster workplace harmony by resolving disputes over injuries without litigation or recrimination.
Today, however, employers and employees are still at war over workplace injuries, a war marked by mistrust and fear. Each side is angry; each side has its own powerful evidence to justify that anger.
Workers say companies are going to extraordinary lengths to cut back on claims: contesting injuries, checking on workers at home, even firing those who file for benefits.
Employers say that the compensation system is so expensive, so riddled with fraudulent claims, that they need to take aggressive steps to curb their costs. A single injury can easily cost $10,000, and sometimes several hundred thousand dollars when a badly maimed worker draws benefits for life.
Though no independent study has established that claimant fraud is rampant, many executives say the system is skewed against them by judges who favor claimants and by malingerers who collect benefits when they are well enough to work.
The state is putting reforms in place to reduce costs for companies and ease tensions in the workplace, but it remains unclear how much they will help. And the economic downturn has only added to the pressure to control costs.
So to cut back on claims, some factories are using scoreboards to record days passed without an injury. Some companies reward workers who report no injuries with a banquet featuring a lottery with a cash prize. Other plants play safety bingo: if there are enough consecutive injury-free days, one worker gets bingo and wins a cash jackpot.
“It keeps everybody’s mind on safety because every day when they come in, that bingo board is right next to the time clock,” said Ed Prunier, safety manager at Ball Metal Container in Saratoga Springs.
Some companies are also using a less fun-filled program, known as progressive discipline. At the DuPont plant here, workers face five progressive steps when they suffer repeated injuries deemed to be partly their own fault: verbal warning, written warning, probation, five-day suspension and dismissal.
“There’s like a philosophy that unless your arm is falling off, don’t tell anybody, take the pain, don’t go the emergency room,” said Jerry Graves, a DuPont machine operator who injured his thumb. “Say you smashed your finger with a hammer at home.”
Experts say it is difficult to estimate how often employers in New York retaliate against workers who file compensation claims because there is no tracking of such data. But several studies have found that the perception of widespread retaliation has contributed to the decline in the number of compensation claims in New York and nationwide in recent years.
“There are lots of people out there who aren’t filing claims because it’s not worth the hassle and because of the fear of retaliation by the employer,” said Leslie Boden, a professor of public health at Boston University.
Legal experts say New York makes it easy to fire workers who file claims. The law bars retaliation, but states that as long as an employer has a “valid reason,” like a prolonged absence, the firing is legitimate.
Some of the workers most affected by efforts to curtail claims are immigrants, who make up an increasing part of the state’s blue-collar work force. Many of them do not know about the compensation system, and when they get hurt, their employers often pressure them not to apply for benefits, worker advocates said.
“Their bosses tell them, ‘Don’t go to the hospital. Don’t say it happened at work. I’ll take care of you. I’ll take care of your medications.’ ” said Gonzalo Mercado, executive director of El Centro del Imigrante, a workers’ center on Staten Island. “In most cases, the employer never does any of that.”
Gerver Lopez, for example, was putting up aluminum siding in May 2007 when the scaffolding broke and he fell to the ground, hurting his spine.
Mr. Lopez, an immigrant from El Salvador, could not get up. He said his boss shouted: “Don’t call an ambulance. I don’t want no trouble. I have 30 houses to do, and I don’t want to lose any of them.”
An uncle drove him to Nassau University Medical Center, and doctors there told him that he would never walk again, he said. By the time his two-and-a-half-month stay ended, his medical bills topped $45,000.
Now 22, he remains paralyzed, and is supported by his mother, a waitress.
“The boss said he was going to pay for everything and I shouldn’t say anything,” Mr. Lopez said. “He didn’t give me a penny.”
Hurt on the Job
Fred Willette followed his father into metal grinding, a world of dangerous dust and deafening noise.
At Kodak, where he worked for several years, a machine would collect the dust spun off by his efforts. But when he took a similar job at Addison Precision Manufacturing, a metal-parts factory in Rochester, he said his new bosses did not want to spend the $3,000 for such a machine.
“They said, ‘All we have to do is provide you with a dust mask,’ ” Mr. Willette said.
So for seven years, he said, he did what he was told, grinding tools that are used to make parts for rockets, snowmobiles and medical equipment.
Then the shortness of breath began. One day he passed out and was rushed to the emergency room, the first of several trips. The doctors initially thought it was asthma. But on a return visit, a doctor asked him what he was grinding. “Tungsten carbide with cobalt,” he replied.
It turned out he had hard-metal pulmonary disease, which, like black lung disease, can be hobbling, even fatal.
Mr. Willette said that in March 2000 he told his bosses he was going to apply for workers’ compensation to tide him over until he recovered. They fired him the next day, he said, a position the company disputes.
“They were saying: ‘You’re a liability. You’re getting all these people involved. We don’t need you,’ ” he said. He was 48 at the time.
Robert Grey, a claimant lawyer, said New York’s law against retaliation “is close to useless, both as a deterrent and a remedy.”
The courts have said employers can fire a claimant who misses too many days or if they need to hire someone to do the claimant’s work. As a result, lawyers seldom pursue retaliation cases, said Michael T. Berns, a member of the state Workers’ Compensation Board until last June. “The burden of proof is with the claimant,” he said. “It’s a very difficult burden.”
Some states take a tougher stance. In Oregon, claimants retain the right to be reinstated to their job within three years of filing a claim, so long as they are still able to do the job.
Mr. Willette said that even after he was dismissed, the company challenged his claim. A private investigator for its insurance carrier began parking outside his house and trailing him to the doctor and the supermarket, he said.
“At first we thought it was the police,” Mr. Willette said. “But the cops said, ‘He’s a private investigator watching you.’ ”
Rodney Champagne, one of the owners of Addison Precision, declined to discuss Mr. Willette’s case. “I’m not really interested,” he said.
But the company’s insurer said in official filings that the lung disease stemmed largely from smoking, not metallic dust. The company’s chief executive, Robert Champagne, said during the compensation trial that he was concerned about his workers’ safety and that Mr. Willette had not been fired for filing a claim. He was sent home, he said, because he was upset and shaky at work and had not brought in a requested note about the medication needed to control his stress-related seizures.
After leaving Addison, Mr. Willette held a few lower-paying jobs for a few months, but his breathing did not improve, and he slipped into a depression for nearly a year. He felt too short of breath for his favorite pastime, fishing.
Now he spends his days watching television. Occasionally he visits his father, gathering strength to go out for an hour or two by using an oxygen tank at home.
He now receives benefits, $278 a week. But because the company challenged his claim, those benefits did not start until 18 months after he was let go.
“You feel very low from what they put you through,” he said. “They try to grind you down.”
As the sixth president in the Curtis Screw Company’s 100-year history, Paul Hojnacki wants the company to survive another century in Buffalo, the city where it was founded.
But Mr. Hojnacki is so angry about the state’s workers’ compensation system that he sometimes talks of moving the factory, which makes precision auto parts. He denounces the delays in settling cases, complains about the “pro-worker judges” and about the way some employees, he said, are allowed to milk the system. Most of all, he indicts the costs.
Curtis Screw, he said, spent $4,900 per employee in 2007 for workers’ compensation coverage for its 220 workers, more than 10 times what it cost at its factory in Cornelius, N.C.
“The cost of this monstrosity,” he said of the system, “has to be taken into consideration because it’s driving businesses out of New York State.”
Mr. Hojnacki said the compensation bill represents 2.5 percent of the Buffalo plant’s revenues, at a time when manufacturers often have profit margins of 3 percent. At the plant, where wages average $15.50 an hour, compensation costs translate into $2.50 for every hour that employees work, he said.
One of the reforms the state has pushed through in recent years reduced compensation premiums for many companies by 20 percent, but Curtis Screw self-insures, so it has yet to see any savings.
“New York State, prior to the reform, was one of the most expensive states in the country for workers’ comp,” said Kenneth Adams, the president of the Business Council of New York State. “With these reductions in premiums, the cost of workers’ comp for most employers has fallen into line with the average of other states. But if you’re in manufacturing, it can still be a significant cost.”
Mr. Harden, whose family-owned furniture company was founded in 1844, bridles at paying $1,800 per employee for compensation insurance. He complains that a compensation judge in 2004 ordered his company to pay $400 in weekly death benefits for life to the widow of a driver who died of pneumonia while making a delivery in Texas.
“It wasn’t from anything on the job,” Mr. Harden said of the death. While acknowledging that some compensation was in order, he said, “we feel the terms of our payments are excessive.”
Mr. Hojnacki says he is similarly upset by the $200,000 his company pays out annually to 15 former employees who have been classified as having permanent partial or permanent total disabilities. Nearly all of them, he said, were terminated for poor performance, then filed for compensation.
“We have 15 people that we terminated that we cut a check to every week, some that date as far back as 1993-94,” he said. “It’s absolutely ludicrous. Even with the workers’ comp reforms, this legacy cost we literally have to pay until these people pass.”
The Buffalo factory self-insures because Curtis Screw finds it cheaper to pay its compensation costs itself, rather than use an outside insurer. Mr. Hojnacki said his yearly compensation expenses include $850,000 to cover medical expenses for current workers, replacement wages for those workers and state assessments to finance the comp system.
Mr. Hojnacki cited a machinist who worked at Curtis Screw for several years and then filed a claim for a back injury.
“We did surveillance on him,” Mr. Hojnacki said. “We had a videotape where this individual was doing work on his house, lifting sheets of drywall and carrying them around and taking them from the outside to the inside by himself. We took it to the judge. The judge ruled, ‘We find that the individual was having a good day.’ ”
The worker was classified as having a permanent partial disability, for which, Mr. Hojnacki said, the company pays him $400 a week.
“The workers’ comp judges are totally sympathetic with the workers,” he continued. “One judge told me, ‘It’s workers’ comp. It’s not employers’ comp.’ ”
One reason that Curtis Screw’s costs are so high, Mr. Hojnacki acknowledged, is that his company has so many injuries, including a half-dozen workers who have had costly surgery for carpal tunnel problems. None of his workers in North Carolina have ever received compensation for such an injury, he said.
“We have 25 injuries each year, and of the 25 the vast majority are legitimate situations where people scrape a finger or slip or twist a knee,” he said. “The vast majority of workers, they can’t wait to be released from workers’ comp and come back to work. For them, workers’ comp is exactly what it should be — it compensates them for the short period they’re out. But then there’s this small group of employees that play the system.”
Mr. Hojnacki said that with his company facing competition from China, high energy costs and a devastating downturn in the auto industry, it cannot afford to be saddled with illegitimate compensation claims.
“It’s just devastating that you can have people who take advantage of the system,” he said. “They are taking money that we could be sharing with other workers.”
At FTT Manufacturing in Geneseo, the safety bingo pot starts at $25 and increases $2 for every day without an injury. Each day a number is drawn, and workers keep tabs on their game cards.
If someone gets bingo after 20 days, the winner receives $65, but the pot continues to grow until an injury is reported. The maximum pot is $150.
“We didn’t want to give them something cheesy — where people say ‘big deal,’ ” said Wade Smith, co-director of FTT’s safety programs.
Within a year of introducing the game, he said, injuries fell by a third at the company, which makes high-precision parts for many industries.
The game was set up for FTT by an outside firm, Safety Pays, which has sold bingo games to more than 3,000 companies and is converting the clamor over compensation costs into profits.
Safety Pays provides a format for the game, plus bingo boards, cards, balls and “Winner’s Circle mini-posters.”
“The individual,” Safety Pays says in its advertising brochure, “who at one time alleged the occasional ‘backache’ in order to get a couple of extra days off will be hard-pressed to do so when his co-workers are anticipating a financial windfall by winning a jackpot.”
Mr. Smith said injured employees are never subjected to more than some good-natured “locker room pressure.”
But many safety advocates and labor unions are worried about the growth of such programs, which the Occupational Safety and Health Administration considered banning in the 1990s.
Robert K. McLellan, former president of the American College of Occupational and Environmental Medicine, told the House Education and Labor Committee last year about a worker who told his doctors he had hurt himself at home when the injury had really happened on the job. The worker later admitted lying because he did not want his co-workers to lose a promised steak dinner.
Last year, the committee’s staff criticized these programs, saying in a report, “Since workers are human and inevitably make errors, the consequence of rewards or punishment is often a failure to report incidents, rather than a reduction of injuries.”
Seth Marshall, founder of Safety Pays, says the games promote healthy peer pressure that increases everyone’s focus on safety and discourages workers from reporting fraudulent injuries.
At the DuPont plant here, officials base performance bonuses in part on how many injuries occur at the plant. But they say they never want to deter the reporting of legitimate injuries.
“All safety incidents, regardless of size, are to be reported and investigated,” said Beth Turner, DuPont’s director of global operations safety, health and environment.
Wendy Hughes, however, says she believes DuPont punished her when she crushed her thumb one day in 2002. The brakes of her forklift failed, she said, and when she tried to stop the forklift with her leg, her thumb got caught between it and a cabinet.
Doctors did a bone graft and inserted six pins in her thumb. She said DuPont seemed eager not to have her report a lost-time accident to OSHA, so her supervisors ordered her to return to the factory directly from the emergency room.
Ms. Hughes said she was not given any days off to recuperate. Instead, she was ordered to spend her days biding time in the factory’s break room. When other workers complained about seeing her there, she said management ordered her to spend each day inside a four-by-six closet where protective work clothes were stored. DuPont declined to discuss her case, citing privacy concerns.
“All my co-workers started saying things like, ‘We’re not going to get any performance-based bonus,’ ” she recalled. “ ‘There go our safety bucks for the quarter.’ ”
I was working in disabilities at the time, and I injured my back ‘catching a client’ who slipped out of the mechanical swing. I instinctually went to catch him and it resulted in me injuring my back. I was only 22 at the time, and had no idea how to deal with it. I was paid for a few weeks by workcover, but the whole process was just too stressful to continue, so I gave up.
My bosses at the time bullied me no end about ‘dropping the claim’ it was incredible. I was treated like a liar and was made to feel like a fraud. I also remember having to see about 5 doctors who made me strip naked to observe my back – something I found completely humiliating and off putting. I eventually stopped turning up for appointments because the stress wasnt worth it. I left the job and didn’t really think of it again. As I applied for another job I had to disclose the workcover claim, the boss asked me if i would change what i did that day – and I said no. I would not let the client fall on the floor if given the chance. Suffice to say I didnt get the job!
I am not permanantly disabled by any stretch, and I think I was a milder case most definitely – but that experience (which was brief) gave me a glimpse into the system and how it manages to bully and coerce people away from seeking their entitlements. I wonder how many others ‘just give up’ because the stress isnt worth it.
There is massive social pressure too – I didnt want to be ‘one of those compo bludgers’ like you see on today tonight! (How ridiculous!).
Thank you for sharing your story with us, S, much appreciated. Again, it really shows what the system is about and how it truly works. If we, injured workers are treated like that on the job, is it a wonder that we are treated like criminals by the insurance companies and seen as fraudsters and malingerers by the community?
For those of you who wonder if workcover insurance employees (e.g case managers) receive performance awards when they send injured workers back to work, you can now be assured that they do in fact receive blood and pain money for sending injured workers back to work, yes even when they are not able to return to work!
In many cases a primary care doctor (e.g GP) will fill out a certificate of capacity indicating their patient is not capable of any work and the workcover insurance Case Manager will obtain a second opinion from a workcover insurance “Medical Advisor”, or worse that of a so called independent medical examinator who provides a dissenting opinion.
The Case Manager will thus be eligible for a performance bonus by ignoring the primary care doctor’s opinion and informing the injured or disabled worker that they must return to work, thus fulfilling her commitment in forcing a disabled or injured worker back to work when they are not capable of performing any work.
And although the evidence gathered is from Canada, undoubtedly the same “rules” apply in Australia.
Great system, eh!
Performance bonuses for forcing injured workers back to work
Like A Thrown Cat, Tristar Insurance Group Lands On Its Feet With Bonuses For Christmas
After a year and a half like a cat on a hot tin roof, Tristar Insurance Group, aka Tristar Risk Management, passed out Christmas bonuses to their entire staff on Friday, December 17th.
“I can report that we handed out Christmas bonuses to all of our staff on Friday”, Tom Veale, Tristar’s Owner and President, reported in an email earlier this week. “Everyone got one no matter what their position. Units with exceptional audit scores got an extra bonus…”
In spite of having their Long Beach claims office burn to the ground as a result of an electrical fire less than two years ago, in April of 2009, and a serious embezzlement and grand theft ring uncovered by an audit on the Los Angeles County account in 2009, precipitating the arrests of four former Tristar employees along with two other vendor owners in September of 2010, Tristar owner Tom Veale last Friday embraced success and thanked all his employees with a Christmas bonus, each and every one.
Twenty short months ago, Veale got a phone call from the Fire Department between 9 and 10 pm on April 28th, 2009, telling him that his Long Beach claims office building at 2835 Temple Avenue in Long Beach (Signal Hill) California, was on fire. “You might want to come down here”, the caller said to Veale.
The loss of the building was total, but the data was recovered due to a sophisticated back-up system, Veale had put in place some seven years prior called the SAS-70 process, created and put in motion for him by Deloitte & Touche.
For a few to several days after the fire, all the Tristar offices had some email problems and the telephone system company-wide was dysfunctional, but within three to four weeks the Long Beach office had made a full recovery in temporary quarters while the systems company-wide were back up and running glitch free. Then, just a little over a year later, the Long Beach claims office building was fully rebuilt as a state-of-the-art, energy efficient masterpiece of high tech lighting and power sources.
If that destruction and recreation effort wasn’t enough, less than a year and a half after the fire, Tom Veale had to face the reality of a discovered embezzlement. In his Santa Ana claims office, which handles the workers’ compensation claims for the County of Los Angeles, a grand theft scheme was discovered involving three Tristar workers’ compensation claims professionals who had, while in cahoots, made excessive payments to a couple of Transportation Companies and a Private Investigations firm out of the L.A. County funds. The two claims examiners, a claims payment clerk, and the vendor owners were all family members, consisting of husbands and wives. The three former L.A. County claims unit employees and two of the vendor owners are now in Los Angeles County Jail. One of the vendor owners is out on bail.
Veale has vowed to never conceal or cover-up any embezzlement that has ever occurred at his company. He stated in March of this current year, before any arrests were made from this current ongoing investigation over the L.A. County embezzlement debacle, that he would fully prosecute any Tristar employee caught stealing from Tristar and its clients. He is adamantly committed to obscure no case of grand theft from the public view. He wants to put out the message that the claims examiners in the industry who are dishonest cannot come to work for Tristar and think they can pull their scams, because if they do they will be fully prosecuted.
“We want to be known as an Employer of Choice”, Veale expressed. “We hope that this (the bonuses) will make a big impact on our team members’ Christmases.”
According to many articles and insiders’ stories, workcover case managers are all stressed out (and yes most are real sourpusses) because of large caseloads. They can’t put out enough fires in a day let alone make real progress towards resolving cases. The phone rings constantly, emails pop up endlessly, big decisions need to be made in a second, paperwork grows exponentially. The meetings, seminars, conferences, deadlines and just sheer craziness of their work day are exhausting.
Believe it or not, the workcover case managers are the lucky ones!
Imagine living the life of an injured worker for a day. Pretend for a moment you have a back injury. All back injuries are serious. A simple sprain/strain, in the moment, is extremely painful. Your first challenge is getting enough rest. A peaceful night’s sleep no longer exists in your life. Each change of position increases your pain level and finding a comfortable position for sleep is as good as impossible. Your sleep is continually interrupted and you have to adapt to sleeping positions you would never have considered prior to your back injury. Sleeping for three to four hours at a time is a dream!
Then, the alarm clock blares, and it is time to begin your day. Everything you do seems to make your back pain worse but you keep moving, you have to. The world doesn’t stop just because you injured your back. You manage to get yourself ready for the day. Your family has to fend for themselves because the most you can do is take care of yourself at the moment. Your top priority is taking medication in hopes that the edge will be taken off the pain. Then your day can really begin.
Maybe today you will find out whether your MRI has been approved. It is nerve wracking wondering whether you have a herniated disc instead of a back strain. Maybe tomorrow your surgery will finally be approved. All the material you have on hand and read indicates the sciatic pain that is causing numbness in your leg all the way to your toes is a more serious condition. But there is nothing you can do to hasten the approval process. The frustration and emotions, and the sleep deprivation you are experiencing seem to make the pain worse. You don’t understand why you keep on having to go to independent medical doctors who are not even trained nor qualified in the field of back injuries or back surgery. The on-going paperwork from the workers’ compensation insurance company is very confusing and endless. Every time you call for clarification you receive a voicemai or get put through to music-on-hold. You have called ever changing case manager for three weeks and still have not spoken to a real person yet. You wonder about retaining a lawyer but everyone you share your story with tells you it’s too soon. And, it seems, everyone has a workers’ compensation horror story to tell. Your head is spinning from information overload and all you really know is that you hurt and want it fixed.
Along with the pain, you worry. Worrying becomes your job. What will you do if you can’t return to work? You don’t have any other skills. Why oh why didn’t you continue your education when you had the opportunity to do so? What will you tell your three children if you have to move because you can no longer afford your home on temporary total disability income? What will you do if benefits end and your condition has not resolved? Will your husband/wife stay with you if you can’t return to work and s/he has to take on all the household and family responsibilities? This just can’t possibly be how your life ends up after all the years of hard work you have contributed. Who can you turn to that can actually help you through this process, help you get proper medical care, figure out return to work options and help you get your life back?
Can you turn to the case manager?
You, the so called “claims professional”, the experience case manager, must put yourself in the shoes of your injured claimant every day. Sometimes that is hard. After years in the industry, there are a percentage of injured workers that are not honest or ethical about the details of their injury or their condition. Everyone who is a veteran in this industry knows that. However, those fraudulent or exaggerated claims account for less than 1% of all claims and the majority of the injured are in genuine pain and are very much afraid about the potential consequences of the injury to their lives. Perhaps it is time that all case managers think about what injured people are going through and how frightening it must be. Provide them the resources they need. Return their phone calls promptly, practice patience in explaining the process, do your best to authorize services quickly and move treatment along for the injured worker. Speak to the doctors if necessary, many of them will welcome your calls. Work with the employer to return the injured worker to suitable (read SUITABLE) work as soon as possible. And, please, do everything possible to give the injured worker back their life.
You are being paid for doing your job, so do it well please. Before my injury I used to be a specialist nurse, think about it, would you like to be treated like a criminal in a hospital bed because you are taking up space, or because you injury or illness is not as important as your neighbour’s injury/illness? Would you like me to have denied you medication, clean linen or a wound dressing because I needed to save money for the hospital? Think about it…
It takes one second for an accident to occur that changes your life forever. Realise that you – dear case manager – could easily be one of the statistics and try to walk in your injured worker’s shoes every day. Play it forward, you never know when you might need a helping hand in the future.
Wanting sex 1,440 times a day may turn heads with workcover judges, case managers and – government officials…
“I am a writer/poet, artist, sculptor, musician, wood artist, wordsmith, businesswoman, mother, ex-wife, retired postal worker, driver, fragrance designer, student, photographer, jokester, painter, and furniture designer. …acts like she is 32, her love meter reads “inferno,” and she thinks about sex 1440 times a day” writes a woman on a social site (see Social Security Disability Blog)
It’s good for the disabled to have a positive self-image and sex life but some people who adjudicate workcover or Social Security might think this woman is faking.
You need to be positive and promote yourself on dating sites like LavaLife but the downside is your enemies may think you are not injured or disabled.
Posting about your fun activities as a disabled or injured person struggling to get by in life may be a pastime that costs you benefits. Some judges, claims adjudicators, case managers and workcover insurance companies have been using Facebook and other social media to find out if you are cheating on your claim.
As the Jonathan Ginsberg, a disability lawyer, says in his article
So, if you use Facebook or mySpace or any of the hundreds of other social media sites, I strongly recommend that you spend a little time learning about the privacy features, and that you restrict access to your profile to people who you know well. You should also keep in mind that anything you post or do on-line may reappear, so be very careful about your on-line activities.
Make your Facebook profile private and protect yourself. Make it private from everyone but your real friends and that does not include you ex-spouse, or past friends who might be jealous and try to turn you in.
Don’t laugh. I get emails weekly from nut balls who think I am pretending to be injured/disabled. There is a significant part of the population who display latent hostility and anger towards the injured or disabled in general.
I call also report that I get two or three emails a year from unhappy ex-wives or ex-friends who would like nothing better than to mess up a former friend’s claim. A couple of years ago, I represented a claimant who was approved, but then had his approval withdrawn when a former friend sent links to his web site to Social Security, which then triggered an investigation.
Facebook and social media are one of the few regular social outlets for someone too weak to use more than two fingers. Not many people will put a sad sack face on the Internet. Who wants to read that kind of profile? People will put their best foot forward, talking about their hobbies and other fun activities.
One time I put on a social site I like horse riding and scuba diving along with my picture in a wheelchair and my arm in a cast. I have a twisted sense of humor so what? 😉
Being injured or disabled is not fraudulent but it may affect your workcover benefits!
This article is not intended to help fraud artists who are only a tiny fraction of the millions Australians with injuries or disabilities needing assistance. However, there is a negative thought process in the establishment working to deny Social Security or workcover and other benefits to the injured and the disabled. We are branded shirkers or malingers which is another form of hatred displayed towards the injured/disabled.
I don’t know anyone who would chose to be injured/ disabled. It’s not fun. We’d all rather be working and making a decent living not scrounging to live at the poverty line.
If you are injured or disabled you know what activity you’d like to do but can’t. Some days we want to rage against life but that’s a waste of time. Some of my friends says I’m lucky to be able to “advocate” for the injured and the disabled and prick a pin in politicians and the pompous. Now that’s a sense of humor 😉
The hurt workers wait on benches at the Queens office of the New York State Workers’ Compensation Board.People like Hopeton Watkis, 64, a laborer, who lost two teeth when he fell and hit a wheelbarrow. Or Rajcoomar Jagan, 50, a construction worker, who injured a leg falling off a scaffold. Or Vicki Marquez, 32, a retail sales associate, who hurt her elbow hauling clothes.
They come to the board seeking authorization for medical treatment and replacement wages — in short, a quick and fair resolution from a system set up to replace fractious court fights between employers and employees.
What they find instead is a subbasement of the legal world, a $5.5 billion-a-year state-run bureaucracy that, an examination by The New York Times found, struggles to treat workers with due speed, protect employers from fraud or mute tensions in the workplace.
These struggles are particularly evident each day in Queens, the state’s busiest hearing office, where The Times spent 18 months attending hearings, reviewing cases and interviewing participants, virtually none of whom defended the system as efficient.
At some hearings, as judges looked on, lawyers chatted on cellphones, cracked bawdy jokes or read newspapers during testimony. Expert witnesses seemed biased to the point of caricature. Claims dragged on, but hearings seldom exceeded a few blurred minutes, rarely proved conclusive and were conducted in baffling shorthand.
Mr. Watkis waited two years to get his front teeth fixed. Ms. Marquez had to postpone elbow surgery for a year until the board allowed it. Mr. Jagan exhausted three years trying to get compensated, only to be denied all benefits, a decision that stunned even some insurance company lawyers.
“Comparing Supreme Court, say, to this is like comparing a hospital to a MASH unit,” said Anthony Pizza, a lawyer for insurance companies. “A lot of it is meatball justice.”
Workers’ compensation systems across the country are troubled, and reform efforts are under way here. But New York, a pioneer of the concept and home to the nation’s second-largest system, has some signature claims to dysfunction and is widely recognized as the most adversarial.
Though its commissioners largely function as a legal tribunal, most are not lawyers but relatives or allies of politicians, appointed usually without regard to experience in the field.
Though many cases turn on medical evaluations, the board has not had its own medical director for nearly a decade. Decisions are often driven by the opinions of doctors certified by the state as so-called independent medical examiners. Yet claimant lawyers and treating doctors say these examiners often understate workers’ ailments to win business from the insurers who pay them.
Fines for infractions are usually small, and some insurers ignore paying them for years without consequence. A few months ago, New York City agreed to produce $1.1 million in penalties, some years overdue.
Workers are known to fabricate claims, while employers can be equally uninhibited about pressuring injured workers against filing for compensation, or punishing them if they do.
And everywhere the system tolerates delays that can make the injured wait months or years for money and care. Statewide, in about one in six cases, insurers dispute that injuries are real or were suffered on the job. Until recently, these cases had averaged nearly nine months to resolve. And many of them remain unresolved years later.
Even unchallenged cases plod on. A.I.G., the insurance company, said a review of its 2007 New York cases found that those involving missed work took on average 802 days to reach a final stage, 30 percent longer than in the rest of the country.
A recent task force study found that when insurers reject a medical procedure, say, an operation, it takes more than three or four months for the board to settle the dispute. The delay can mean that injuries heal slowly or improperly, and in 75 percent of those cases, the worker’s need for the procedure is upheld.
Zachary S. Weiss, the chairman of the compensation board since late 2007, said that given the scope of what needs to be done, change must be incremental.
“There are millions of things I would like to correct and I’d like to correct them all immediately, and I can’t,” Mr. Weiss said.
State officials do say that as imperfect as it is now, the system used to be much worse. Before he resigned, Gov. Eliot Spitzer managed to pass a law that sliced costs and gave workers more money. Until then, New York’s system had achieved the neat trick of being both among the most expensive for business and the stingiest to workers.
The board has recently found an interim medical director. But the intended overhaul has yet to deliver on many of its other goals and does not address some of the most stubborn flaws.
One target for improvement is basic record keeping. No one has ever documented, for example, the extent of worker fraud, though accounts of bogus claims have dominated news accounts of workers’ compensation for years.
Actually, while the system has a lengthy history of being cheated by employees who exaggerate injuries, experts say they believe more substantial fraud and misbehavior are woven through the process in less obvious ways that hurt workers.
“This is a terrible thing to say,” said Dr. Robin Herbert, co-director of the occupational and environmental division at Mount Sinai Medical Center, “but if I had a health problem at work, I’m not sure I’d file a workers’ comp claim. It’s the Wild West of health insurance.”
Mary Jeffords, the head of Injured Workers of New York, an advocacy group, says she knows of numerous disabled workers so ground down by the process that they begin to unravel.
“I’ve talked to workers that held a gun to their head as we talked,” she said.
Waiting for Help
George Vasilescu’s reaction was immediate. He tossed his head back, thumped his feet.
“No more,” Mr. Vasilescu, who is deaf and mute, signed. “I beg you. No more.”
Mr. Vasilescu, 64, a hotel steward who hurt his back, neck and wrist, had just been told by his lawyer that the judge wanted him back for another medical exam, another hearing, another delay, after four years churning through the system.
It is a good day at the Queens hearing office when there is only one such outburst.
Few people think about workers’ compensation until they wrench their back or lose a thumb and become one of the roughly 140,000 new cases filed statewide each year. Those with minor injuries often sail through the process.
But so many workers have been so frustrated or mistreated that they don’t even submit claims when they are injured. Instead, they improperly use regular medical coverage. Or they apply only for Social Security disability or welfare. Costs rightly borne by employers are then billed to the general public.
All that is flawed with the system can be witnessed daily inside the stubby building at 168-46 91st Avenue in Jamaica, one of three dozen redoubts statewide where cases get heard. It doesn’t take long there to grasp how proceedings have devolved into something out of Kafka, who was himself once a compensation claims examiner.
Cases are delayed for any of myriad reasons, or no reason. When the Workers’ Compensation Research Institute recently studied speed of payment among 15 states, it found New York the slowest to pay workers their first check.
“These people are not chattel,” said Neil Abramson, a claimant lawyer. “They’re human beings.”
In Queens, it often takes four to six months from the time of injury to get before a judge, a period during which a worker may not receive care or wages. Typically cases are decided piecemeal — months can pass before both sides even agree on how much a worker earned — and so that first encounter may begin a procession of hearings that become stretched-out wars. Any appeal had once meant another six to nine months for a ruling, though since the board made recent changes many have been coming much quicker.
Three-quarters of the appeals are by insurers.
An insurer appealed, for example, when Ms. Marquez sought surgery for her injured elbow in 2007. The appeal, which the board found particularly weak, meant the surgery did not get approved until a year later.
To accelerate cases, the board has increasingly allowed some involving lesser injuries to be decided by a claims examiner, instead of a judge. The examiners are not required to have legal or medical training, or even a high school diploma, and lawyers and judges say their decisions often contain errors. Judges must review the rulings, but some admit it often gets done hastily.
Largely because of delays and litigiousness, only about a third of the state’s 66,000 active licensed doctors take compensation cases. One of those who does, Dr. Miron Fayngersh of Brooklyn, said he had 41 outstanding bills for a single case, one a year old.
“The percentage of denials is worse in workers’ comp than in any other area in my experience,” said Dr. Robert Goldberg, former head of the Medical Society of the State of New York.
One case that seems to exemplify the broad faults is that of Richard Frank, a forklift driver for New York City Transit. After he had a work accident in 1991, the agency prolonged his case for years, ignoring judges’ orders, according to court rulings.
After a September 1995 hearing was adjourned because his employer had furnished illegible evidence, Mr. Frank told his lawyer “the Transit Authority is going to kill me.” That night he died of a heart attack. He was 50.
For a decade, the agency then contested whether his widow was due death benefits, until an appeals court ruled in 2005 that his death had been caused in part by the agency’s “unlawful coercion” and “disgraceful conduct” in resisting his claim.
Claimants who typically wait months to talk to a judge are surprised by the lightning speed of hearings. Eight minutes is typical. A trial can run a half-hour to an hour. Some matters finish in a minute or two. Often workers don’t even get to speak. Sometimes they wait outside while their lawyers perform.
Vera Rutherford, a substance abuse counselor whose carpal tunnel case had plodded along for two years, asked, “Is it normal for a person to go in there and say nothing and have people decide their life for them?”
One day, Fernando Tenorio, a school safety officer hindered by a knee injury, emerged from his hearing, dazed by its velocity: four minutes flat.
For months, Mr. Tenorio had received no money. Now, his lawyer, Mark Allen, explained to him, the case was adjourned for another few weeks for an investigation, though he would be paid something while waiting.
As Mr. Allen put it, “Six weeks is like tomorrow around here.”
But Mr. Tenorio blurted out, “There’re some other things I want to tell you.” He had lost his apartment and was cooped up in his brother’s basement; his bank account was empty.
Mr. Allen halted him: “Forget about personal. They don’t think of you as a person. They think of you as a file with a dollar sign on it. They don’t care if you can’t put food on the table or put braces on your daughter. You’re thinking of this logically. I stopped thinking that way a long time ago. This is comp.”
New York’s workers’ compensation system was born in 1914, an idea of great promise that grew in part from great tragedy, the Triangle Shirtwaist Factory fire that killed 146 garment workers in 1911.
The state, one of the first to adopt such a program, founded the system on a simple bargain. Hurt workers, who previously had to prove their employer’s negligence in court to get compensated, now would get medical care and wage benefits automatically. In turn, they would be barred from filing suit.
At its most basic, that no-fault insurance system is the same today. Essentially, companies buy compensation insurance and their premiums underwrite the cost of running the system and all claims. Virtually all employers must carry coverage.
Hearing rooms across the state are filled, not with office workers, but with people who make biscuits or work construction or strip beds: physical laborers who often live just above society’s safety nets.
These workers confront a law that is maddeningly complex. In its barest form, it requires workers to report an injury to their employer within 30 days, then file a claim with the compensation board. If the insurer doesn’t object, it is generally required to begin medical and wage benefits within a few weeks.
But if information is missing, as is common, the clock doesn’t start until it is submitted, so payments often start much later. Disputed cases are frequent, require judicial intervention and can take months or years to resolve.
There are no cost-of-living adjustments, so payments can lag behind wages. A plumber who has New York’s longest-running claim, from a back injury in 1937, gets all of $6 a week.
Given its tortuous nature, it’s no wonder the system has figured in some of New York’s noir moments. For 16 years in the 1940s and 1950s, George Metesky, the so-called Mad Bomber, concealed bombs around New York in a rage precipitated by the rejection of his claim.
Changes introduced in 2007 mean that for the first time since 1992 the maximum weekly benefit will rise, in stages, from a flat $400 to what will next year and thereafter be indexed to two-thirds of the state’s average wage, a cap of about $760. But the reform also ended payouts that could last a lifetime for workers with permanent partial injuries, like an impaired back. Now these awards generally expire within 10 years.
Those adjustments were designed to correct a longstanding paradox of the New York system: how it could be one of the most expensive for employers yet have one of the lowest payouts to workers. Experts say that although the wage benefit was low, insurance rates were steep because the state, unlike many others, had no time limit on payments for permanent partial disabilities.
New York not only had a high level of these injuries, it also had one of the more litigious processes, which further drove up costs.
Today, even with the payout increases, New York lags behind many states. Injured workers in Iowa can get about double New York’s limit.
John F. Burton Jr., professor emeritus at the Rutgers School of Management and Labor Relations and an expert on workers’ compensation, feels that systems nationwide have become less fair to workers, in part because the political balance has tilted toward management.
“In general, it’s not economics that is driving this,” he said. “It’s that employers have gotten the upper hand.”
In New York, average premiums have fallen over the last dozen years (though they vary enormously among employers), as have claims. But the perception reigns, driven in part by insurers, law enforcement and the news media, that the system is expensive because it is bloated with embroidered claims.
Fraud does occur, not only when workers feign injuries, but also when they stay out five weeks when four would suffice. In 2007, the authorities arrested a bus driver, receiving compensation for a hurt shoulder, who Brooklyn prosecutors said had been touring Europe as a drummer in a rock band.
But experts believe far more money is siphoned by employers that illegally underpay premiums by underreporting the size of their work force or by doctors who fabricate bills.
Some defects are addressed by the latest changes. For example, “rocket docket” rules are being applied to speed up initially disputed cases, and while not everyone has embraced them, some progress has been made.
“We want our comp system to do so much,” Mr. Weiss said. “And it should do so much. And it does so little.”
As head of the compensation board, Mr. Weiss, who earns $120,800, directs the system, which employs 1,500 people. The other commissioners earn $90,800 and primarily rule on appeals that bubble up from local offices.
Commissioners often work from home, reviewing opinions generated for them by board lawyers. Just five of the current 11 commissioners are lawyers.
Last year, after a dozen years as a commissioner, Michael T. Berns wrote a book titled “Behind the Closed Doors,” which he describes as a kind of apology for a system where, he said, workers suffer in part because some commissioners know too little about the relevant law, work just a few hours a week and do not read many of the decisions they sign.
“The whole push is a numbers production,” he said. “Quality is irrelevant.”
The board members are appointed by the governor in a process long regarded as dominated by politics.
Commissioner Candace K. Finnegan is a former personnel director for a state psychiatric facility, and also a close friend of Libby Pataki, the wife of former Gov. George E. Pataki. Ellen O. Paprocki had been assistant director of the New York State Fair, and is also the daughter of John O’Mara, who was an adviser to Mr. Pataki.
Frances M. Libous, a former nurse, is married to Thomas W. Libous, a ranking Republican state senator. Mark D. Higgins, recently appointed by Gov. David A. Paterson, is a longtime union official and brother of Representative Brian Higgins, an upstate Democrat.
“It is political employment for the politically connected,” said Richard A. Bell, a commissioner. He once served as the board’s executive director, and his wife worked as an executive assistant to Mr. Pataki.
While politics is a factor in appointments, several members said those selected are nonetheless qualified.
For years, judges and lawyers say, politics also played a role in who got hired as district administrators to run the system’s 11 district offices. The posts, created a decade ago by state lawmakers, paid $104,080 a year. But critics said the administrators’ duties were light and little different from those of the district managers they were brought in to supervise.
This month, the board simply did away with district administrators, leaving two regional administrators in their stead, millions of dollars having been spent to no clear end.
Injured and Indigent
Carlos Pabon, a parks department manager and an Army veteran, hurt his back and neck when someone opened a door into him in a Bronx storeroom in 1997 and knocked him down a flight of stairs. Tossed into the cumbersome workers’ compensation system, he has never left.
Initially, the system took care of his injuries and Mr. Pabon, now 50, stayed on the job, earning up to $60,000 a year. But his pain worsened over time, he said, and he began to miss days. In the summer of 2006, his doctors advised him to stop working.
New York City arranged for him to get an independent medical exam. That doctor felt that Mr. Pabon’s doctors were wrong. He had no disability. He could do his job without restriction.
In January 2007, the wage benefits he had been receiving stopped because of the independent doctor’s report.
Michael Serres, Mr. Pabon’s lawyer, sought to challenge the doctor by having him testify. But nearly a year would go by before he did.
In the meantime, Mr. Pabon, who said he wrestled with grinding pain, could not live on a tiny military pension and the slim disability income of his fiancée, Grace James. The bank seized his car. He reached the limit on his credit cards and pawned his jewelry. He went on welfare.
In November 2007, the city’s doctor finally testified. He stood by his report. Another hearing in Queens was scheduled.
The matter was still unresolved last year when a city marshal arrived at Mr. Pabon’s apartment with an eviction notice. It was Valentine’s Day. Mr. Pabon was eight months behind on the rent.
In a bone-chilling wind, they left: Mr. Pabon, Ms. James, their child and another from Ms. James’s previous relationship. A third child was at school. They juggled what they could carry, including their bird. After depositing the children with a relative, Mr. Pabon and Ms. James rode the A train all night. The next evening, they slept in the boiler room of an apartment house.
Soon, they landed in an echoing homeless shelter where they washed their clothes in the tub. Occasionally, Mr. Pabon stole food. “I took cookies, hard salami, half a pint of milk, cakes, doughnuts, small stuff,” he said. “I stole a deodorant stick from Rite-Aid.”
“I worked in the parks taking care of kids, making sure they didn’t get hurt, being a role model,” he said. “Here I am stealing things.”
They moved from one shelter to another. Mr. Pabon began to have nightmares and imagined himself blowing up people. He and Ms. James bickered.
“Look at where we are,” she told him one day. “What kind of man are you?”
The next hearing for Mr. Pabon, his 13th in a case in its 11th year, was set for April 1, 2008.
Mr. Pabon arrived by bus from the shelter. He was penniless.
“I feel so down. I mean, down on the ground,” he told his fiancée.
“This could put someone in a mental hospital,” she replied. “I can see myself sitting in a room in a straitjacket, rocking.”
As the hearing approached, as often happens, the lawyers fashioned a deal. Mr. Pabon was offered $265 a week. By the system’s metrics, he was deemed about 33 percent disabled.
The calibrations of disability can be arbitrary. Few doctors are trained to gauge how injuries restrict a person’s particular work capability. Some workers with frightful injuries are judged 75 percent disabled. But a professor, or an accountant, can often continue a career. Laborers judged 25 or 50 percent disabled often are stuck. Who hires a laborer who can manage half a job?
Mr. Pabon had expected $400 a week, the limit for a case of this vintage. Yet he accepted.
“I need money now,” he said.
After the lawyer’s fee, Mr. Pabon would get a back-payment check of $11,921. Once he satisfied his most pressing creditors and bought clothes for his family, he expected to have maybe $7,000 left.
He still would be unable to work and without a home.
John Vos, the lawyer for the insurer, saw the deal as an effort “to meet in the middle.” He said he had no idea how injured Mr. Pabon was — “I’m not a doctor” — and that the cyclical hearings were simply the norm.
Compensation cases are like serials without endings. Over the next eight months, Mr. Pabon was sent to two more insurance exams, had two more hearings, got his rate raised to $350 because of continuing depression and had a kidney removed.
He continues to live in a shelter.
Joking and Settling
The compensation lawyers in Queens are a clubby bunch. Often they go to greasy spoons for burgers and pizza, claimant and insurer alike, piling into the van of Ed Hilfer, a claimant lawyer.
Few students in law school imagine a career as a workers’ comp lawyer or judge. For most, it is an accidental destination. Many say they chose it because of the hours. Hearings go from 9 to 4, and judges and lawyers often fly out the door minutes after their last case.
Fees for claimant lawyers are set by judges and come out of awards to workers. Insurer lawyers get paid whatever they negotiate. Rewards for claimant lawyers in Queens typically arrive in dribs and drabs of $50 and $100 fees, augmented by sweeter windfalls from settlements.
For both sides, it is a volume business: the more hearings, the more fees, thus the incentive to keep cases alive.
For workers, a lawyer can be an essential brace. In Queens, though, a claimant is commonly represented by a firm that specializes in workers’ compensation law, not an individual. So if there are six hearings, a different lawyer might handle each one. Sometimes a freelancer steps in when the assigned lawyer is overloaded.
As a result, some hearing lawyers have never spoken to the client, and have barely studied the file. The same hasty preparation is often true for the insurance lawyer and the judge. Even preparation for trial testimony might get done in a few stuttering moments in the waiting area.
During one hearing, a claimant’s lawyer asked his client a question in Spanish. That went poorly, since the man was Armenian.
“There was a judge I was talking to and he said there are only two ways in my court that your fees would be cut: if you’re not friendly or if you’re not willing to compromise,” said Mr. Pizza, the insurance company lawyer. “I said, ‘What if you’re not prepared?’ He said that doesn’t matter.”
Between hearings, the lawyers’ room has the feel of a college social club. Lawyers play pinochle. Watch hockey fights on YouTube. Joke about judges, like the “Cruise Director,” whom they mock for roaming the halls. Or they check the “meat chart,” which lists awards for lost body parts, based on a grisly schedule that codifies missing limbs with weeks of wages.
The rate for an arm is 312 weeks of wages. A leg gets 288, a big toe 38, the index finger 46. Rates fluctuate by state, for no apparent reason. Lose an index finger in Idaho, it’s 70 weeks.
Despite the esprit de corps, the opposing lawyers have clashing worldviews about the system.
A few years ago, Mark Allen represented a delivery driver who had injured his back lifting packages. The next day, the man told his manager the pain was so bad it hurt when he pulled on his socks. The insurer said: not a work injury; he must have hurt himself putting on his socks.
“If you fell out of a tree when you were 5 and you have a knee injury when you’re 55, they’ll say it was the tree,” Mr. Allen said.
On the insurer side, Nicholas Rupwani typifies the many lawyers who view the system as a worker fraud trough. One day he recounted the case of a pet store clerk bitten by a rat who said her injuries had been serious and the experience traumatizing. Yet, Mr. Rupwani noted, her MySpace page showed her throwing darts in a bar and indicated she might start a pornographic Web site.
Mr. Rupwani said he felt bad for workers who suffer crushing injuries — but not too bad. “If you’re a secretary with a torn meniscus who is losing her house, go back to work,” he said. “It might hurt, but people work through the pain.”
When workers moan during hearings about family strife and ruin, he said, “that’s when I tune out.” His theory is that the more people broadcast their situation, the more likely they are fakes.
“Sometimes the claimant is sitting next to you and doing this quiet sobbing,” Mr. Rupwani said. “That’s when I usually recommend that the insurer put them under surveillance.”
He said he recommended surveillance about once a day.
Both sides talk about how inconsistent decisions are. “The law allows some leeway,” said Mr. Pizza, “but there shouldn’t be eight different ways of doing things. ‘I won’t allow depositions,’ ‘I will allow depositions,’ ‘I’ll only allow 15 minutes a witness.’ You shouldn’t put justice on a time clock.”
A popular option in the last decade is a cash settlement under which workers close their cases in exchange for a lump payment to cover living expenses and medical bills.
For some workers, a settlement might allow them to start a business or get a degree. For others, they are economic quicksand, one-time payouts that some people find hard to resist. A state task force found that those who accept them are typically lower-paid workers, with average wages of about $19,000.
Insurers relish settlements because they end their exposure. Claimant attorneys relish them, too. They typically extract a 10 to 15 percent cut.
But do workers know what they’re choosing?
The lawyers routinely say clients are “adults.” But the compensation system is so puzzling that even a Queens judge abandoned her own case years ago out of frustration. And there are lawyers in Queens, regulars at the hearing office say, who undersell settlements, pushing low-ball deals on workers just to pocket a quick payday.
No comprehensive studies have examined the impact of settlements, though limited academic studies tend to find them problematic.
“If it were my case, I wouldn’t take one,” said Thomas Gleason, a former executive director of the board who is now a deputy executive director of the State Insurance Fund, New York’s biggest workers’ compensation insurer. “Some guys get $50,000 or $60,000 and go out and buy a new car — or go to the casino.”
Jorge Manzano, 31, a lumber company driver who hurt his back lifting a cement bag, was offered a settlement in 2007. His lawyer negotiated a $12,500 payment, but Mr. Manzano felt that was insufficient and hired a new lawyer.
At a hearing, his new lawyer asked, “What do you want?”
He said, “Like double.”
The insurance lawyer agreed to $20,000. After a legal fee of $3,000, Mr. Manzano would get $17,000.
His lawyer, who knew almost nothing about the case, made a quick fee, the insurer concluded its exposure and the compensation board closed one more file.
And Mr. Manzano?
He said he plucked the $25,000 number out of the air. His friends warned him not to settle. What if he needed surgery? After all, he could barely hold his daughter. “I’m like an old man,” he said.
But his motivation, as it so often is in the compensation universe, was simply to escape the stultifying system.
“I don’t want to come here and feel like I’m begging,” he said. “Frankly, I’ll take just about anything, just so I don’t have to see this place ever again.”
What is obvious to me is that workers destroy or disable their bodies for life for mere pennies. you may not think carpal tunnel syndrome if a big deal until you realize that she ruined her hands for someone else’s pocket book and now has this for life. Think about it that way. If you go to work and fall, you live with the injury for the rest of your life while your employer just goes and hires someone else. People in white collar jobs don’t understand this. I injured my shoulder for life. It will never be the same and it impacts everything I do, and I hurt it for a mere dollars an hour. The job is long over and done, the money spent, but my shoulder… it will never be the same.
How do people with chronic pain and their partners maintain a healthy, exciting sex life?
Chronic Pain: Stop it from Sucking the Fun Out of Your Sex Life
by Kal Cobalt
Though chronic pain has become a more medically-recognized condition, whether as a complication of another diagnosis or an unexplained phenomenon existing by itself, one frontier remains: How do people with chronic pain and their partners maintain a healthy, exciting sex life?
“Chronic” And “Pain” May Not Be What You Think They Are
We’ve come a long way in understanding the problem of chronic pain. Fewer doctors dismiss the issue, and most of us know someone who suffers from it for one reason or another. But there’s still plenty of confusion about what chronic pain actually is, and there’s certainly no pat way to handle it thanks to the variety of how our bodies have trouble. Explaining chronic pain is often difficult and sometimes impossible, even if you ask a chronic pain sufferer to do it.
Take me, for example. It may be hard to believe, but I didn’t even know I’ve had lifelong chronic pain until a few months ago. Between a high pain tolerance and a tendency to assume that physical things I experience are normal, I figured everyone’s shoulders burned by the end of most days and sudden, incapacitating back spasms were what people meant by “lower back ache.” Everyone has everyday aches, to be sure, but for someone like me who worked normally with a dislocated rib for a month and has walked around on a partially dislocated hip without painkillers, I’m hardly able to put myself on the 1-to-10 pain scale appropriately.
While some parts of my situation are unusual, most of us with chronic pain share the inability to tell what is “normal” and what is not, we deal with inconclusive and confusing attempts to help from the medical community, and many of us have perfectly good days (or even weeks or months) before chronic pain comes unexpectedly knocking once more. As you can imagine, all of this can make sexual encounters the not-so-fun kind of roulette.
Do Ask, And Do Tell!
Rule #1 of any relationship should be honesty, but this goes double for intimate situations involving people with chronic pain. If your partner has a chronic pain condition you’ve heard of, remember that everyone’s experience of pain is unique. You need to ask about your specific partner’s experience of pain and what specific triggers you can avoid when you’re between the sheets. Similarly, if you have chronic pain, your chances of enjoying some pain-free nookie increase dramatically when you can articulate what you know about your condition.
Since chronic pain is hard even for doctors to pinpoint, you can expect that no matter how thorough your conversation is, it can’t cover everything, but discussing what you can beforehand can help hugely in the moment. For example, I’m extra flexible, which is great fun in bed — but my hips and back can seize up or go out if you look at them sideways. I explain this to my partners and tell them that if it happens, I will yell “HIPS!” and they should stop everything, without trying to move me even if I’m in a funny position. And then, of course, I give them a wink and a nod and explain that if I shout anything that isn’t “HIPS!” they should absolutely keep going, heh heh. (There’s no reason why The Pain Talk can’t be foreplay. Don’t let anyone tell you otherwise.)
Communicating When Bodies Don’t
It’s hard sometimes to know if pain will derail a date. On Tuesday, I might be able to put my ankle behind my head, and on Wednesday, getting out of the car can be an ordeal. The cuffs used to spread-eagle me on the bed might feel sexy and comfortable when they go on, and five minutes later my back will stage a full-on revolt — or worse, my back will give me the “just a warning, I’m about to make your life a living hell” twinge and I’ll ignore it because whips and chains and mouths are a whole lot more fun to concentrate on.
No amount of communication can prevent every flare-up, but simple check-ins from time to time between partners can go a long way. While it might break the mood to ask or be asked “How is your chronic pain with what I just did?” (well, unless you’re into medical scenes…), checking in doesn’t have to be that explicit. My household deals with a variety of chronic pain complaints, and over time we’ve come to learn one another’s signals. We more or less operate under the “if you see something, say something” rule (or maybe I just think about it that way because Big Brother is a hot fantasy) — if someone stiffens up in a funny way, or makes an unusual noise, or a limb that often causes pain is in an awkward position, that’s cause to ask a question in a non-invasive way. If you’ve laid the groundwork for communication, simply asking “Is it good?” or “You okay?” or “how’s that arm?” should be enough to bring a partner’s attention to the potential problem without bringing the lovin’ to a screeching halt.
There are a million wedges, pillows, vibrators, and toys on the market that can make sex a more pain-free experience, and as long as they’re used in conjunction with communication instead of as a weak replacement, they’re fantastic! Here are a few to look into.
Wedge pillows made specifically for sex help take stress off joints and muscle groups. (Stacked pillows will do in a pinch, but be careful not to fall over!)
A body pillow can turn spoon-style sex into a delightfully cozy experience.
Wrist cuffs made for suspension, which take the stress off the delicate bones of the wrist, can be used in “normal” (heh) bondage situations with the same benefits, and nearly every restraint can now be purchased with padding or extra-wide for happier joints.
A blanket over the top half of the body can keep someone with temperature sensitivity warm while you’re busy with their bottom half.
Many dildos are available extra-long or with curved handles to help reach your best bits without stressing shoulders.
Most lubricants are available in pump bottles for stiff hands and fingers.
Heat packs, mentholated rubs, Epsom salt baths, and other common treatments for pain can be sexed up with a little imagination. Creativity is pain’s enemy — go for it!
I have worked as a [workers compensation] private investigator for approximately 7 years, handling Worker’s Compensation and Third Party Injury Claims. During my work I was aware of matters that I consider pertinent to this inquiry:
A workers compensation private investigator tells parliament how it really is
Collusion between Investigators and / or Company staff occurred with medical practitioners examining injured claimants, information on such claimants being passed on for identification, location and other purposes. In other words, these medical practitioners were not acting independently of the Insurer.
Film evidence was conveniently edited and / or destroyed if it was not of suitable material for disputation of alleged or claimed injuries.
Bluff tactics were undertaken to persuade claimants to settle their claim. An example of this was attending Court with large film spools casings containing small rolls of film evidence. I also have evidence of:
Doctors providing grossly misleading medical reports to the Insurer’s, such evidence supporting and / or reinforcing an attitude of working in harmony with the Insurer’s as opposed to being independent.
Doctors medical reports and interviews not corresponding,indicative of gross error / corruption / bias on the part of such medical practitioners.
Doctors being unwilling to make amendments to such grossly misleading medical reports when brought to their attention.
Ignoring of cover-up of facts between Doctors / Lawyers / Investigators.
Investigators providing written reports to the Insurers that do not correspond with film evidence, thereby being misleading in their content,yet ignored by Doctors / Lawyers / Court when screened for evidence either prior to or at Trial, thereby indicative of what I perceive to be and evidently tantamount to corruption within the Court/ Legal system, pertinent to Injury claims. An example of this is where a claimant displays restriction in movement and expressions typical of experiencing pain, yet such evidence is ignored.
Selective use of video surveillance by Investigators, in what appears indicative of a cover-up.
Allegations/charges of fraud against the claimant when in essence I believe that the means employed against the claimant were tantamount to fraud.
Claims by a Worker’s Compensation agent, based upon confirmation from the Investigation company, that certain film evidence taken for identification purposes has been discarded, when in fact the company policy reveals that such evidentiary material is never discarded.
Attempts by a Worker’s Compensation agent not to reveal what it terms “sensitive information on the file that potentially could jeopardise the success of ~their~argument which will have ramifications for the management of (their) file and potentially the ‘Scheme’.
Film evidence presented to the Court being largely edited, in what was termed “presentable form… (and / or) abridged into a version” together with corresponding written notes, indicative of questionable procedure within the Court / Legal system, pertinent to Injury claims.
Factual evidence/ exhibits presented to the Court being fabricated for the specific purpose of disputing an injury claim, indicative of questionable procedure within the Court / Legal system, pertinent to Injury claims.
I have compiled cases to this effect for the specific purpose of exposing what I believe to be corruption within the Court/ Legal system, pertinent to Injury claims, and for assisting others to be aware of the true state of affairs within the Court / Legal system. My compilation is continuing. I rely heavily on the Whistleblowers Protection Act 1993 in doing so.
It is my [the workers compensation private investigator] belief, as a result of these experiences, that:
the alleged high cost of disputing alleged fraudulent claims is unnecessary, if not entirely lacking in honesty/ integrity / benevolence/ altruism to society in general.
the methods used are extremely questionable, if not fraudulent themselves, as they are based upon deception of a higher degree by an industry that largely claims itself to be a victim of fraud.
such methods/ aspects require exposing thereof in the public interest.
A Chicago design firm must face allegations that it inappropriately posted marketing updates on an injured employee’s personal Twitter and Facebook accounts while she was in the hospital with serious brain trauma, a federal judge ruled.
As a marketing director for Susan Fredman Design Group in Chicago, Jill Maremont gained a reputation in the city’s interior design community. Her personal Twitter account has approximately 1,250 followers.
Maremont also created Twitter and Facebook accounts for her employer to beef up its social media campaign. Though Maremont stored access information for the work and personal accounts in a locked folder on an office computer, she never authorised anyone to access her personal accounts.
In September 2009, a car hit Maremont while she was running an errand for work. She suffered serious brain trauma and had to be hospitalised.
During that week, however, Susan Fredman posted 17 tweets on Maremont’s Twitter account, promoting the company.
The company also posted entries on Maremont’s Facebook page and accepted at least five friend requests. Maremont asked her employer to stop co-workers from posting on her personal accounts, but the company did not honor her request.
Maremont filed suit last year, alleging that Susan Fredman used her identity to endorse their services without her permission, and violated the Stored Communications Act and Illinois Right to Privacy Act.
U.S. District Judge Amy St. Eve refused to dismiss the case last week, but she did toss Maremont’s Right to Privacy Act claim because the company did not try to impersonate Maremont when posting Tweets and Facebook updates on her accounts.
“It is undisputed that Maremont created a personal following on Twitter and Facebook for her own economic benefit, because if she left her employment at Susan Fredman, she would promote another employer with her Facebook and Twitter followers,” St. Eve wrote.
“As such, Maremont has a protected, commercial interest in her name and identify within the Chicago design community,” she added.
St. Eve also found that Susan Fredman may have violated the Stored Communications Act by using Maremont’s Twitter and Facebook accounts.
“There are disputed issues of material fact whether defendants exceeded their authority in obtaining access to Maremont’s personal accounts,” the 15-page decision states.
Before St. Eve can address whether Maremont suffered actual injury or if Susan Fredman was unjustly enriched, the parties must complete fact discovery.
WorkCover staff from all over Queensland are donating hundreds of gifts and toys for Australian Kids. Yep, to Australian kids.
Supporting the disadvantaged this Christmas
We are proud to once again support the annual The Smith Family Toy and Book Appeal. Every year our people show their support and give generously during our Christmas fundraiser. This year was no exception, with WorkCover staff from all over Queensland donating hundreds of gifts and toys for Australian Kids.
In addition, our people donated tinned and long life foods for our ongoing food drive for Foodbank Queensland, a not-for-profit organisation supplying food and grocery items to welfare agencies that feed the hungry. See some of our donations here.
The Smith Family and Foodbank Queensland do fantastic work all year round helping disadvantaged Australian families and children. Thanks to all of our people for getting involved in our Christmas fundraiser, and well done to everyone out there supporting these worthy causes.
I am very very proud of the Smith’s Family initiatives (and all other Charities), don’t get me wrong but I am somewhat puzzled that the Queensland WorkCover staff prefers to donate gifts and toys to Australian Kids, than to give struggling injured workcover victims (and their families and kids) a food parcel or a little special this Xmas. Am I missing something here?