Defense Base Act Compensation Blog

The Modern Day DBA Casualty

Posts Tagged ‘DME’s’

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 »

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

Posted in AIG and CNA, Department of Labor, Racketeering | Tagged: , , , , , , , , , , , | 7 Comments »

 
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