Insurance Companies Stripping Medical Records

“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 !!

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

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?

AIG, CNA, ACE must also fulfill their legal and moral obligations

President Obama Friday to BP

“Now, I don’t have a problem with BP fulfilling its legal obligations,” he said. “But I want BP to be very clear, they’ve got moral and legal obligations here in the Gulf for the damage that has been done. And what I don’t want to hear is, when they’re spending that kind of money on their shareholders and spending that kind of money on TV advertising, that they’re nickel-and-diming fishermen or small businesses here in the Gulf who are having a hard time.”

TO:  President Obama from one of our British DBA Casualties

I am so pleased that at long last the President of the USA has decided to make sure people meet not only their LEGAL obligations but also their MORAL ones.

Oh then my disappointment kicked in when he was referring to BP. I agree that BP should meet its obligations in the clean up in the Gulf. I was also pleased to see that he did not want to vent or shout or scream about it but to keep a clear head to resolve the problem.

As for the shrimp fisherman who appeared on TV wanting his life to get back to normal after six weeks,  my heart goes out to him.   However, try three years.   I too would like my life back to as normal as it can be.

Well Mr President let me shout, vent and scream for you.

STOP THE SOUND BITE- MEET YOUR MORAL AND LEGAL OBLIGATIONS

BP HAS HAD LESS THAN TWO MONTHS TO SORT THIS OUT.

YOU SIR HAVE HAD NEARLY EIGHTEEN MONTHS TO MEET YOUR MORAL AND LEGAL OBLIGATIONS TO STOP THE ABUSE OF INJURED CONTRACTORS AT THE HANDS OF THE AMERICAN INSURANCE INDUSTRY AND THEIR OVER PAID ATTORNEYS.

YOU CONTINUE TO ALLOW THEM TO COMMIT FELONIES KNOWING THEY WILL FACE NO SANCTIONS FOR DOING SO.

NO INVESTIGATION IS CARRIED OUT.

THE DOL CONTINUE TO MEET THESE PEOPLE IN CANDLESTINE MEETINGS.

THE  BUZZ WORD IN THE INDUSTRY IS RISK MANAGEMENT

WELL SIR IN CASE YOU DIDN’T KNOW IT MEANS HOW CAN WE PAY LESS NOT HOW CAN WE MEET OUR MORAL AND LEGAL OBLIGATIONS.

Ah that feels so much better I hope you read this sir so next time you appear in the international media spouting off about MORAL obligations you do not look like a complete fool because the rest of the world has access to the internet and reads these things.   We get the US news channels over here so you are on TV all the time.   I hope the UK media pick up on this.  I am sure they will as I have written too them.

One last point, my claim is over one million dollars, I look forward to receiving every single cent and not some compromised deal,  your words sir not mine.

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

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