Defense Base Act: The Weaponization of the Defense Medical Examination

The Defense Base Act Insurance Company is entitled to have Defense Base Act Claimants see a physician that they choose to provide them with a second opinion regards the injuries that you have filed a claim for.  These examinations are in no way Independent Medical Examinations as the Insurance Company and their Attorneys deceptively refer to them as.

These Insurance Company Second Opinions, or Defense Medical Examinations, come at a heavy price to the US Taxpayer.  The Insurance Companies pay much higher amounts to hire doctors that will give them a report unfavorable to your claim and also be willingly to back up these statements in Depositions or straight to a Judges face at hearing.  You are entitled to reimbursement for the expenses you incur attending these.  The DME can be a very expensive undertaking.

Very few DBA Claimants exercise their rights to have these doctors researched by a professional, not travel outside of their geographic area, take an advocate with them (preferably your attorney or a nurse), have the scope and purpose of the Examination clearly defined, or most importantly to video the examination. 

It must be you who pursues these protections because your DBA Attorney is not likely to suggest or pay for them despite your entitlement to them.  Your attorneys failure to assert your rights only enables the insurance companies and their bloodthirsty attorneys and claims adjusters.

You are required to “cooperate” not play dead.

One very prudent restriction on these DME’s used to be that the Insurance Company could not make you attend one more than every three years.  At some point that we cannot ascertain this restriction was removed. 

So  began the Weaponization of the DBA Defense Medical Examination.

Currently the DME is being utilized as a weapon to intimidate DBA Claimants to accept negligent settlements.

Even though you have an order in place you are told if you do not immediately attend a DME your payments will cease immediately.

Even though your claim is currently under the jurisdiction of an ALJ awaiting a decision you are told to fly across country for several days of DME’s.   Just prepping you for the settlement offer.

Your attorney presents to you a ridiculous offer for settlement along with the threat that if you do not accept it the Insurance Companies Attorney promises you DME’s every year and surveillance by their private dicks $$$ for the rest of your life.

We cannot always be certain who is manning the weapon.  As of late there is a barrage of Friendly Fire.

No doubt that the casualties are always the DBA Claimant and the US Taxpayer.

It has never been more true that After Injury the Battle Begins

Or more clear that this program is lacking oversight of any kind

Nuclear Workers Data Breach Revealed

Huntington News  March 29, 2012

Craig, CO – The Alliance of Nuclear Worker Advocacy Groups (ANWAG) has learned and is “extremely disturbed” that the Department of Labor’s Office of Workers’ Compensation Programs (OWCP) failed to inform claimants that one of their medical contractors, Impairment Resources LLC, had computer files stolen on December 31, 2011.

These files contained claimant names, addresses, social security numbers, and medical records. ANWAG was alerted to this issue by a claimant’s authorized representative, Gary Vander Boegh, who forwarded this article on the break-in: http://www.databreaches.net/?p=23593.

I confirmed with OWCP Division of Energy Employees Occupational Illness Compensation that they were notified of this breach in early February. Yet almost two months later they are still trying to identify which claimants have had their records breached,” stated Terrie Barrie of ANWAG. “I’m appalled that OWCP did not immediately issue a general warning that some of their claimants may have had their protected information stolen.”
“The lack of timely notification to the affected people seems egregious,” added Faye Vlieger of CWP. “I am highly indignant with OWCP withholding the facts. It shows a certain highhandedness of OWCP to assume there will be no damage done by the break in.”

Please see the original and read more here

Defense Base Act Defense Medical Examinations: Rewriting the Report

As a Defense Base Act Claimant you are required to submit to an examination by a physician the insurance company chooses for a second opinion.  These examinations are often improperly (fraudulently ?) referred to as Independent Medical Examinations which are something very different under the LHWCA/DBA.

Doctors who will do this work for insurance companies are generally known to write reports favorable to the insurance company.  Otherwise they would not continue to reap the large fees they receive for a single visit and much larger fees for being deposed under oath or testifying live at an ALJ hearing.

On occasion a DME Doc will actually acknowledge the claimants true diagnoses or simply not deny it vehemently enough to suit the insurance company that hired them.  So the insurance company asks them to rewrite the report, sometimes even telling them exactly how they want the report worded.

When the DME Doctor does not comply some insurance companies will go so far as to have another physician who has never even seen the patient, rewrite the report in their favor, and without your permission to use your private medical records.  This may be referred to as a Peer Review.

We know they do, we have some of the emails and the reports.

Add to your DME preparation list a signed HIPAA form directing the DME Doctor to provide your treating physician with any and all medical reports regarding you.  Your treating physician will have these forms and prepare them for you.

You are entitled to any and all reports, lab results, test results, regarding your medical.  You will probably have to have your attorney subpoena these but never ever allow them to not provide them.

Congratulations Dorothy Clay Sims

Casey Anthony Trial : Not guilty verdict in death of daughter Caylee

Dorothy Clay Sims, whose name DBA Claimants remember for her work in exposing AIG’s infamous Dr G ,Dr John Dorland Griffith, was a major part of the legal team that just secured a not guilty verdict in the Casey Anthony trial.

See

Dr. John Dorland Griffith Exposed, Publicly, Finally

Dr John Dorland Griffith Exposed Case No. 2008-LDA-00287

BRB Overturn’s X Files Case ALJ Paul C Johnson and Dr John Dorland Griffith

Defense Base Act Comp only applauds the work done by Dorothy Sims, and expresses no opinion on the guilt or innocence of Casey Anthony.

Army vet battling private insurer for coverage she feels is due

“The American Psychiatric Association has a very specific and rigid stance against psychiatrists rendering diagnoses on patients they have not examined.”

Injured as contractor in Afghanistan but denied specialized therapy at home

Kevin Graman The Spokesman Review  June 13, 2011

A highly trained helicopter mechanic sits in her Chattaroy home and wonders what will come next: another debilitating brain seizure or the therapy she hopes will help her recover from injury as a result of a mortar explosion 20 months ago in Afghanistan.

Jennifer Barcklay says she is being denied the specialized inpatient medical treatment her doctors believe is her only hope for a normal life.

“These are war crimes, using taxpayer dollars to profit from injuries incurred by people fighting for our freedom,” Barcklay says.

Although she is a U.S. Army veteran, Barcklay, 40, was injured as a civilian working for Blackwater, the private security contractor now known as Xe Services. She and thousands of other civilian employees injured in the defense of their nation have had to navigate an often unresponsive private insurance system.

Xe’s insurance carrier has so far denied Barcklay expensive inpatient treatment known as cognitive rehabilitation therapy, which was recommend by eight Spokane area physicians and mental health care providers.

She suffers from traumatic brain injury, the signature wound of the Iraq and Afghanistan wars, for which thousands of U.S. soldiers are receiving care in military or Department of Veterans Affairs facilities. Like many of them, she continues to endure seizures, memory loss, headaches, tremors and problems with her balance that prevent her from returning to work.

Under the Defense Base Act of 1941, defense contractors must provide medical and disability insurance for their workers in war zones. The premiums are included in the companies’ contract with the Department of Defense.

There have been nearly 56,000 such claims for injuries or deaths from the start of the Iraq war to 2009. That year, a congressional investigation found that insurance companies had collected $1.5 billion in premiums, while they paid out about $900 million in compensation and expenses.

Another World War II-era law, the War Hazards Compensation Act, reimburses the employer or insurer for injuries or death to a worker caused by an act of war. The insurer is reimbursed by the taxpayers for 100 percent of the claim, plus 15 percent for administrative costs. From 2003 to 2010, the federal government paid more to insurers for expenses, $19.7 million, than it paid in compensation, $12.1 million, to claimants under the act.

More than three-quarters of the Defense Base Act claims were handled by American International Group, which was rescued in 2008 by the U.S. government in the largest corporate bailout in history.

An AIG subsidiary, Insurance Company of the State of Pennsylvania-Chartis WorldSource, took months to authorize a neurological evaluation for Barcklay. Now Chartis is refusing to pay for her inpatient treatment.

“Frankly, I am appalled at how many obstacles have been placed in the way of her receiving the treatment she needs,” Spokane neuropsychologist Winifred Daisley wrote in a December letter to Chartis case manager Debra Ragan.

Marie Ali, a Chartis spokeswoman, said she could not comment on individual claims but that the company “is committed to handling every claim professionally, ethically and fairly.”

“We provide the highest level of service to our insureds, which includes the prompt adjudication and payment of claims.”

A spokesman for Xe Services said, “The company has worked diligently with the insurance provider to help ensure Ms. Barcklay receives the level of care and treatment she needs.”

Please read the entire story here

See Also

More Than 70 Members of Congress Demand Cognitive Treatment for Troops With Traumatic Brain Injuries

by T Christian Miller from his series at ProPublica Brain Wars

How much does an Independent Medical Examination Cost?

An Independent Medical Examination as ordered by the Department of Labor or a Defense Medical Examination (Second Opinion) are paid for by the insurance company.

We’ve not yet seen or heard of anyone going to an Independent Medical Examination as ordered by the DoL according to the LHWCA/DBA.  There are guidelines to be followed for an Independent Medical Examination which ensure that the doctors are not insurance company regulars.

We have seen paperwork on DME’s on DBA Casualties starting at $800 and going up to $1,200 per DME.

Expensive for a single examination it would seem.  Often done offsite of the Doctors regular office if they even have one.

And the ante goes up if your exercise your right to have the examination videographed.   We do not mean the charges you will incur for the videographer.   The added charges are more like “risk coverage” or a deterrant to keep the injured from ensuring that the examination is fair.

Your DME is much more than simply the unbiased second opinion that it is represented to be.

The DME Doctor is an expert witness for the insurance company.

They may be asked to submit to a Deposition under oath or to testify in person on behalf of the insurance company for which they will be paid even larger sums.

The IME/DME business is a very lucrative one for those Doctors who choose to do them.

The Insurance Companies can afford them.

Injured Contractors and/or their attorneys are seldom in a financial position to deal with DME’s properly.

This is why so many of you are sent to DME’s by your very own lawyers with no advocate or videographer present even though these costs are legitimate expenses which would have to be reimbursed.

This is ONE reason why the Dr Griffith’s of the DBA have been utilized repeatedly even after being exposed under oath in depositions.