Defense Base Act Compensation Blog

The Modern Day DBA Casualty

Racketeering and Comp: When the Denial of an Injury is an Injury

Posted by defensebaseactcomp on December 14, 2009

Food for thought all of you injured contractors who have been denied by AIG and CNA.  We’ve been saying all along that these denials are criminal.

How many of you continue to be sent to Houston (from out of state to boot!) to see AIG’s hired guns for DME’s,  that they misleadingly call IME”s, over and over again?  Why would you travel out of state to do this when common sense and the law do not require you to leave your geographic area (50 miles).  Why do your lawyers suggest that you do?

Only the DoL can arrange an IME, an Independent Medical Examination.  If the insurance company, their claims adjuster, or their lawyer arranges it it is called a Defense Medical Examination.  Nothing Independent about it.

How have so many contractors lost their claims due to testimony by Dr. Griffith?

Another one from Worker’s Comp Insider

Racketeering and Comp:  When the Denial of an Injury is an Injury

Imagine you work as a commercial driver for a long-established trucking firm that self-insures for workers comp. You are injured on the job. You seek benefits under the comp statute. The TPA handling the claim refers you to a company doctor. The doctor determines that the injury is not work related. The adjuster for the TPA denies the claim. End of story?

Not quite. What if you shared your story with five other employees, all of whom filed comp claims, all of whom saw the same doctor (a family practitioner), with the same result: claim denied by the same adjuster at the TPA? A coincidence or a conspiracy?

Five employees of Cassens Transport in Michigan concluded that there was a conspiracy to deny their claims. They filed suit in federal court, alleging a violation of the Racketeer Influenced and Corrupt Organizations Act (“RICO”). A district court dismissed their claims, finding that their individual claims did not constitute a “pattern” of activity and that invocation of the RICO statute would violate the McCarren-Ferguson Act by interfering with state regulation of insurance.

The U.S. Court of Appeals for the 6th Circuit reviewed the case and overturned the district court’s ruling. Now the U.S. Supreme Court, by declining to get involved, has upheld the Appeals Court. The Appeals ruling is a fascinating document which explores the nature and definition of racketeering, the relationship of workers comp benefits to insurance and the roles of state and federal governments. It’s required reading for attorneys and highly recommended for all others.

Criminal Acts?
The district court has been ordered to reconsider the allegations. The five Cassens drivers allege that Cassens, their self-insured employer, Tina Litwiller, a claims adjuster for the TPA Crawford and Co., and Dr. Saul Margules conspired to deny their comp claims. (While you might expect Dr. Margules to be board certified in occupational medicine, he appears to be a family practitioner.) The Appeals Court does not address the substance of the allegations: it simply rules that denial of the workers comp claims might involve a violation of the RICO statute and thus is appropriate fodder for the federal courts.

Some folks are alarmed that the feds are getting involved in what is usually a state issue. That might be a problem, but let’s not lose sight of the delicious prospect before us. During the course of the new hearings, plaintiff attorneys will seek access to some fascinating communication records: between Cassen and Crawford, detailing the status of individual claims; Ms. Litwiller’s claim notes; and communications between Crawford and Dr. Margules, who had so much difficulty finding a connection between a given injury and work. As much as I enjoyed the Appeals Court’s discussion, I am really looking forward to the nitty-gritty details of the proceedings in the district court. (You don’t suppose that some of the written and electronic communications have disappeared, do you?)

At heart, this is a very serious matter. The five employees allege that they have been unlawfully denied the protection of Michigan’s workers comp law through a conspiracy of company, TPA and doctor. If the allegations are proven, if the accused violated the RICO statute, they will face the consequences of a criminal conspiracy. In the Insider’s burgeoning annals of fraud – employee, employer, attorney, doctor, agent, insurer – this case will surely offer one of the more compelling narratives

7 Responses to “Racketeering and Comp: When the Denial of an Injury is an Injury”

  1. U.S. Department of Labor Office of Administrative Law Judges
    St. Tammany Courthouse Annex428 E. Boston Street,
    1st Floor
    Covington, LA 70433-2846(985) 809-5173
    (985) 893-7351
    (Fax)Issue Date: 08 April 2009
    Case No. 2008-LDA-326OWCP No. 02-141282
    In the Matter of
    ESQ.On Behalf of Claimant
    On Behalf of Employer
    Administrative Law JudgeOn 18 Mar 05, he was in Kirkuk. As he left the mess hallafter lunch, he was hit by a mortar round. It threw him five feet in the air and knocked him out. He was air evacuated to a MASH unit at Anaconda. That is the reason he is is scared of helicopters now.He recalls a nurse holding his hand, having his clothes cut off,and getting doped up. After a week he was transferred to theArmy Hospital at Landstuhl, Germany. He was there about a week and then sent home to Monroe. He was hospitalized for a day, and then released to go home,where he shares ahouse with his mother. I did not find Mr. Gomilla;s findings or opinions to be as persuasive as the fully developed rationale of the more extensively trained andcredentialed Dr. Griffith.Employers psychiatric expert likewise concluded that Claimant was trying to appear ill and inventing an illness. He noted that the MMPI results indicated Claimant was not truthful in his responses, indicating malingeringand rendering the tested unusable for diagnosis.
    See Bullshit as Science
    The expert medical evidence offered by Employer was the most probative and persuasive in the record. The four expert doctors whoexamined Claimant on behalf of Employer issued highly consistent and mutually corroborativeopinions as to Claimants status and ability to work. They found no significantobjective findings to support Claimants subjective complaints, believed he was exaggerating and feigning symptoms, and could return to work. At the outset, I note that I did not find Claimants testimony to be compellingly credible. His appearance and demeanor did not create an impression of reliability.

    Check out the X Files to see if your lawyer is sending clients out of state to DME’s with AIG’s Fab Four.

  2. daffodils said

    This entire DBA system is rotten to the core, and the judges know it and still go along. This email where the AIG pychiatrist Griffith instructs the psychologist to change a psychiatric report is just one more revolting example of what’s going on here:

    From: jdgrifflth@poLnet
    Sent: Thursday, November 09,20064:26 PM
    Subject: RE: Reports –
    May I impose on you to rodo your report in tho form suggested. For example:
    The MMPI scales and indices produced by Mr. Thompson, namely (name scales)
    are consistent with considerable dramatization, exaqgeration and/or Faking. —Steve Rubenzer, PhD

  3. defensebaseactcomp said

    Even Dennis Kucinich asked the Plaintiff’s lawyer who testified at the hearing in June did he know that Dr. Griffith had consistently denied contractors PTSD diagnoses.
    The lawyer did not answer and Mr. Kucinich asked him the question again to which he responded yes.
    This lawyer has known this and continued to tell his clients they must go to him for DME’s.

    The bigger question is WHY?

  4. Barry said

    Please see for proof of racketeeering by numerous insurance companies in numerous types of insurance for injured and disabled humans

  5. Michele said

    Myhusband was an OTR truck driver. 4/07 he was out of state, he unloaded his oversized load, was getting his trailer ready to head north. The trailer fell on his head. TBI and stroke. There isn’t a price on the brain…He lost his speech and right side was paralyzed. Docs said he wouldn’t walk or talk again. He is a miracle, it’s been a long hard road, and he still has a way to go. Why do we have to fight so hard for him to get therapy. He can’t read or write but was pushed back to work. He slipped back in his speech, but the family dr took him off work. This is just crazy. The company knew about the operation of this trailer…they did not bother to tell him of this, train him, and the panel from top was covered. And because there intention wasn’t to hurt Mark, that’s it!

  6. Washington State injured worker said

    Someone also needs to investigate United Parcel Service (UPS) and Gallagher Bassett Services (their self-insurance) for RICO violations against injured workers. The same pattern: refusal of company to allow an injured worker to file a claim, denial of valid claims, bogus paid “IME” doctors who state that there was no injury and release the injured worker to return to the job of injury, no payment of time loss compensation, refusal to return calls, etc.

  7. jjoshuajj21 said

    Here’s a case that make’s the Appellate court become cowards, because they won’t enter an opinion as the law requires them to do, they won’t examine the evidence, and they won’t sign their own judgment. This case is conclusive evidence of the DOL’s refusal to enforce the law, by a lawless means, and the Appellate court is giving them the right to violate the constitutional rights of USA citizens >>> <<<<<

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