Defense Base Act Compensation Blog

The Modern Day DBA Casualty

Posts Tagged ‘Defense Medical Examinations’

When do CNA’s Deadly Paper Games become outright lies to Department of Labor?

Posted by defensebaseactcomp on July 19, 2012

How about now DOL ????

Documents showed that CNA reported the highest profits margins, taking in nearly 50 percent more in premiums than it paid out in benefits.

CNA’s Deadly Paper Games

After having defaulted on an Order to provide medical to an Injured War Zone Contractor for over 15 months, after denying for six years prior, CNA provides a computer printout to the Department of Labor Claims Examiner who was charged with  investigating this Default.

Not to give undue credit here, the Claims Examiner was trying to remedy the default per her job description, not confirm that they were in default.

Here is a copy and paste of the body of the correspondence, the full document has been forwarded to the DoL IG for investigation along with computer printout they attached.

Dear Mr Lee

Pursuant to Claims Examiners Kristina Hall’s request of January 3, 2012 and as a supplement to our response dated January 9, 2012, please find enclosed a payment printout showing payments issued by CNA International to medical providers regarding Mr. Clark.  The enclosed printout also shows the recent reimbursement payment of $1,270.34.

Defendents will continue to adjust medical invoices when and as received with accompanying medical reports.
Sounds just like they are paying for Injured War Zone Contractors  Medical over the years.  The reimbursement was for Out of Pocket presented in 2009 and clearly 15 months post order.

Problem here is that these payments were not for provided medical.

One is for a final report, not diagnoses or treatment, requested by CNA prior to hearing , that really made the Doctor mad over wasting his precious time, and the rest are for Defense Medical Examination’s.  Pages 3 and 4 were with held  but we suspect they include the parade of DME’s that were demanded.

The very abusive DME’s that were required repeatedly and outside of his geographic area.  The ones that ALJ Paul C Johnson assisted CNA with.

Not only did CNA represent these DME’s as having provided medical care for this Injured War Zone Contractor when in fact they did not, they reinforced the lie by stating that they will continue to do so.

CNA is currently under investigation for just this kind of unlawful and Overly Zealous Defense in denying Defense Base Act Claims

Unless that is, the DoL IG failed to investigate previous requests or are simply failing to provide documents requested under the Freedom of Information Act.

Posted in AIG and CNA, Civilian Contractors, Contractor Casualties and Missing, Defense Base Act, Defense Base Act Attorneys, Defense Base Act Insurance, Defense Base Act Law and Procedure, Defense Base Act Lawyers, Defense Medical Examinations, Delay, Deny, Department of Labor, Dropping the DBA Ball, Hope that I die, Interviews with Injured War Zone Contractors, Iraq, LHWCA Longshore Harbor Workers Compesnation Act, Melt Down, Political Watch, PTSD and TBI, Veterans, War Hazards Act | Tagged: , , , , , , , , , , , , , , , , , , , , , , , | 5 Comments »

Defense Base Act War Hazards Act: Overly Zealous Representation in Defending Against a DBA Claim

Posted by defensebaseactcomp on June 27, 2012

employer/carrier’s inadequate or overly zealous representation in defending against a DBA claim may be grounds for denying all or some portion of a request for WHCA reimbursement.

So Mr Rayburn how many War Hazards reimbursements has the DFEC denied

in part or whole over the following

Overly Zealous DBA Insurance Company Defense Tactics ?

The use of repeated Defense Medical Examinations with Doctors Over Paid to produce a report detrimental to the claimant, to run them through the drill

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The claims process being drug out for as long as nine years with no end in sight while the defense racks up ever more legal fees, the insco keeps charging administrative fees, not to mention the claimants attorneys fee’s, while the claimant goes without  medical and/or indemnity

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Unnecessary mileage, airfare, lodging, expenses paid out due to due coercing claimants to travel as far as five states away to attend Defense Medical Examinations, Mediations, Depositions, Hearings

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The use of private investigators, some even criminals themselves, to stalk and intimidate injured contractors and their families far beyond simply confirming a claimants status

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The use of  Third Party Administrators to handle claims processes that could easily be done without the added expense and fees.

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Unnecessary fines and interest due to non payment or late payment of  indemnity

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The financial ruination of injured contractors and their families caused by the overly zealous controverting of legitimate claims

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The Temporary Disabilities which are now Permanent due to their failure to provide medical care under the guise of investigating clearly legitimate claims.  Now the US taxpayer is responsible for disabilities far beyond what they ever had to be.

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The PTSD Suicides caused by the Insurance Companies, their claims examiners, and their attorneys

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The break up of families caused the constant pressure and abusive tactics used by the Employer/Carrier

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The forced acceptance of inadequate settlements or stipulated agreements due to starving the claimant out for years on end and/or threatening the claimant and family that if they do not accept the inadequate settlement they will make them miserable for the rest of their lives (see The Weaponization of the Defense Medical Examination)

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Unfairly denying the claimants attorneys fees in order to discourage good attorneys from handling these claims

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FECA BULLETIN NO. 12-01

XI. Miscellaneous

1. DFEC requires, before acceptance of any WHCA reimbursement claim, that the employer/carrier has made only reasonable and prudent efforts in presenting all meritorious defenses against a DBA claim without regard to whether the case is eligible for WHCA reimbursement. An employer/carrier’s inadequate or overly zealous representation in defending against a DBA claim may be grounds for denying all or some portion of a request for WHCA reimbursement.

CECILY A. RAYBURN
Director, Division of Planning, Policy and Standards

Posted in ACE, AIG and CNA, Chartis, Civilian Contractors, Contractor Casualties and Missing, DBA Attorneys Fees, Defense Base Act, Defense Base Act Attorneys, Defense Base Act Insurance, Defense Base Act Law and Procedure, Defense Base Act Lawyers, Delay, Deny, Department of Labor, Hope that I die, Injured Contractors, KBR, Political Watch, PTSD and TBI, Suicide, Veterans, War Hazards Act | Tagged: , , , , , , , , , , , , , , , , , | 7 Comments »

Defense Base Act: The Weaponization of the Defense Medical Examination

Posted by defensebaseactcomp on May 15, 2012

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

Posted in ACE, AIG and CNA, Civilian Contractors, DBA Attorneys Fees, Defense Base Act, Defense Base Act Attorneys, Defense Base Act Insurance, Defense Base Act Law and Procedure, Defense Base Act Lawyers, Defense Medical Examinations, Department of Labor, Dropping the DBA Ball, Follow the Money, Independent Medical Examinations, LHWCA Longshore Harbor Workers Compesnation Act, Misjudgements, Political Watch, PTSD and TBI, Racketeering | Tagged: , , , , , , , , , , | 2 Comments »

How much does an Independent Medical Examination Cost?

Posted by defensebaseactcomp on May 10, 2011

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.

Posted in Civilian Contractors, Defense Base Act, Defense Base Act Attorneys, Defense Base Act Insurance, Defense Base Act Law and Procedure, Defense Base Act Lawyers, Defense Medical Examinations, Department of Labor, Independent Medical Examinations, Injured Contractors, LHWCA Longshore Harbor Workers Compesnation Act, Racketeering | Tagged: , , , , , , , | 7 Comments »

How far can you be sent to a Defense Medical Examination ?

Posted by defensebaseactcomp on March 29, 2011

Coercion: the act of compelling by force of authority

Forcing an Injured Contractor to drive or fly far out their geographic area to go to Defense Medical Examinations which are falsely referred to as Independent Medical Examinations is among the most abusive tactics in the insurance companies arsenal.

They are often aided by the Department of Labor’s Claims Examiners going against their own rules and regulations.

ALJ Paul C Johnson even aided CNA by ordering that an injured contractor travel outside his geographic area.  Not because there weren’t plenty of doctors in this injured contractors area, just because CNA’s hired guns were not there.   The injured would lose his claim by not “obeying” this biased order.

What happens when the insurance company defies an order signed by an ALJ to provide medical to an injured contractor?  Nothing.  This is not to say that the order was his idea, we’ve never seen him award anything to anyone in a decision.

It is so blatantly obvious why the insurance company does not simply hire a doctor in the injured contractors geographic area for an unbiased second medical opinion.  They are hiring expert witnesses who will provide them with a report in their favor then provide testimony that will back them up if necessary.

Longshore Procedure Manual

e. The Employee shall submit to any special examination as may be requested by the employer at such place as is designated by the DD but at a place reasonably convenient to the employee.

(See section 7(d) of the Act and 20 C.F.R. sections 702.403 and 702.410.)
20 CFR 702.403 – Employee’s right to choose physician; limitations.
The employee shall have the right to choose his/her attending physician from among those authorized by the Director, OWCP, to furnish such care and treatment, except those physicians included on the Secretary’s list of debarred physicians. In determining the choice of a physician, consideration must be given to availability, the employee’s condition and the method and means of transportation.
Generally 25 miles from the place of injury, or the employee’s home is a reasonable distance to travel, but other pertinent factors must also be taken into consideration.

Injured Contractors have been flown or told they had to drive from as far as five and six states away to see AIG’s Fabulous Four Defense Medical Examiners in Houston or they would lose their claim.

Many of them traveled to see the notorious Dr John Dorland Griffith because their attorney told them they had to.

Threatening an injured contractor with the loss of benefits due them under the Defense Base Act if they do not travel unreasonably to see the insurance companies defense medical examiner/expert witness amounts to Coercion under any legal definition.

Worse, many  injured contractors are not being provided necessary medical by these companies while being coerced into traveling to see these whores.

Posted in AIG and CNA, Defense Base Act, Defense Base Act Attorneys, Defense Base Act Law and Procedure, Defense Base Act Lawyers, Defense Medical Examinations, Department of Labor, Dropping the DBA Ball, LHWCA Longshore Harbor Workers Compesnation Act, OALJ, Racketeering | Tagged: , , , , , , , , , | 2 Comments »

Insurance Companies Stripping Medical Records

Posted by defensebaseactcomp on March 2, 2011

“Several stories detail possible fraud or questionable actions practiced by at least several major insurance carriers, but ignored and unpunished by regulators.

The WFAA-TV series has revealed how some insurance companies send peer review doctors medical files “stripped” of records important to the possible approval of workers’ comp claims.

Those peer review doctors who routinely deny care receive lucrative contracts, while those who approve care fail to be rehired.”

Thanks to Barry for putting this together with links at

Deadly Insurance Companies Organized Crime

WFAA revealed that the Texas Workers Comp Commissioner was a former insurance company lobbyist, and when he denied that WFAA showed his lobbyist business card !!!! HE LATER RESIGNED !!

Posted in ACE, AIG and CNA, AWOL Medical Records, Contractor Casualties and Missing, Defense Medical Examinations, Follow the Money, Hope that I die, Political Watch, Racketeering | Tagged: , , , , , | 5 Comments »

Doctors Who Work for Insurance Companies

Posted by defensebaseactcomp on July 5, 2010

ACIIA Doctors Who Work for Insurance Companies

What kind of Doctor would find it necessary to supplement their income by performing  Second Opinion Medical and Psychiatric Examinations on Disabled Veterans and Contractors, often one in the same ?

These second opinions are normally used against the injured contractor to deny benefits.  Often payments are discontinued immediately after one of these “second opinion’s” based solely on this report despite treating physician reports that are in direct conflict.  It can take years and years before a contractor will have the opportunity to dispute these purchased reports.

Why would the insurance company insist that you travel far out of your geographic area to see one of their doctors as opposed to  choosing  one of the many available in the town or even state that you live in?  The DoL and some ALJ’s even support this abusive practice.

Would you put your life in the hands of a Doctor who chose to work for AIG, CNA, or ACE ?  They do have a choice….

The crew over at American Contractors in Iraq and Afghanistan think that people who might unwittingly choose one of these doctors to be their treating physician someday ought to know who they work for.

You can give them a hand by visiting their page and letting them know who AIG, CNA, ACE paid to provide a second opinion on your disabilities. DME Doctors

But please feel free to discuss insurance companies hired gun doctors here.

Insurance Company Drs. Paid to Second-Guess Disabled Veterans and Contractors

Posted in ACE, AIG and CNA, Civilian Contractors, Contractor Casualties and Missing, Defense Base Act Law and Procedure, Department of Labor, Follow the Money, Political Watch, Racketeering, Zurich | Tagged: , , , , , , , | 6 Comments »

Deposition by telephone: Hello, are you there Dr. Griffith?

Posted by defensebaseactcomp on July 1, 2010

Does  AIG’s  discredited  Defense Medical Examiner Dr. John Dorland Griffith sit in on doctor’s  depositions that are done by telephone?

Does he not announce his presence?

Do the Defense Attorneys not admit on the record that someone else was listening in?

How would you know if something like this had happened in a deposition on one of your doctors?

This would be wrong, right?

Posted in AIG and CNA, Civilian Contractors, Contractor Casualties and Missing, Defense Base Act Law and Procedure, Department of Labor, Misjudgements, Political Watch, Racketeering | Tagged: , , , , , , , , , , , , | Leave a Comment »

 
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