Appearance technique

The judges in San Diego WCAB often will allow up to two non show appearances with no justification without consequences.

One tactic that I have been using seems to increase the appearances.

When I receive the notice of hearing, I mail a copy of it with a proof of service by mail to the defendant.

This solves three things.

1. You can show service has been made at least twice.
2. You can show service was made even if the Board address file was incorrect. ( happens a lot with the companies leaving the state)
3. The defendant knows you filed the DOR and may settle ahead of time.

Simply filing the DOR does not work as it can take over a year for the hearing to be scheduled after a DOR filing.

Often I find the return mail envelopes ( multiple) in the Board file of the Board issued notice to defendant.

Are Workers Compensation Insurance Carriers Ever Prosecuted for Fraud?

Ok, The Workers Compensation Judges don't like sanctioning the insurance carriers.
The current Insurance commissioner has never prosecuted an insurance carrier for fraud.

http://www.californiaprogressreport.com/2008/03/why_hasnt_insur.html


Hundreds of Millions miss-appropriated by State Compensation Insurance Fund.

http://www.mystatefraudstory.com/

Thousands of QMEs hanging up the shingle.

Yes, everything is running smoothly, no problems here.

BYE BYE QMEs

There is significant anecdotal evidence ( every QME we talked too) that payers are paying faster to QMEs that are defense friendly. Applicant friendly QME reports are often paid late without statutory penalties and sometimes requiring a lien to be filed. Judge’s are having a hard time getting unbiased AMEs. AMEs are usually orthopedic doctors and make their living from surgery. Nearly all of them are on MPNs ( Medical Provider Network ). Many have found themselves removed from the MPN if they write Applicant friendly AME reports.

Yet another reason why QMEs are leaving the system.

The 4500 number of QMEs on the DIR website is more realistically closer to 2000 and falling.
During Seminar promotion, phone calls were made to the 4500 list. The MAJORITY of the QMEs were no longer practicing or not planning to renew the credentials.

Apportionment fiasco

Would you believe the disgusting Gaul of an AME doctor saying that a person's race is apportionable? Then try the defense attorney going along with it. Now that you have stomached that get ready for a judge signing off on it!

Video and story

http://www.10news.com/news/15479665/detail.html

Here are more examples
http://www.signonsandiego.com/news/business/calbreath/20080217-9999-1b17dean.html

Milton Jones Testimony

http://www.calchannel.com/search.php?date=022708&source=All&type=All&title=&Search=Submit

The sound has been fixed

click on the industrial relations link

Watch from the 20 min mark to see the Milton Jones testimony

The AME on the case.

Alvin Markovitz, M.D.
11600 WILSHIRE BLVD., STE512
WEST LOS ANGELES CA 90025
310-473-5067

From the Judge's mouth

The following quote is from a retired workers Compensation Judge.

"I haven't seem much to show me the new improved evaluation system and accompanying orgy of rule making has improved the process. Evaluation whether in represented or unrepresented cases is increasingly resembling Frankenstein's monster, with various bits and pieces falling off and being added at random. This is of course, one person's opinion and I don't wear a robe or a horsehair wig these days..."

About the Emperor

Perhaps I should be tad less cryptic about the EMPEROR reference in the heading.

The reference is to a children's story where the Emperor is told the clothes are invisible to anyone who was either stupid or not fit for his position. Despite not seeing his own clothes, the Emperor parades himself naked rather than admit there is a problem.

http://en.wikipedia.org/wiki/The_Emperor's_New_Clothes

The parallel that I am suggesting is the State government entities that are in control of Workers Compensation in California are well aware of the problems, but the official policy everything is fine.

Everything this is so fine that:

QMEs are leaving the system in droves

The injured worker many times find that the panel of three QMEs submitted to them no longer perform QMEs requiring a request for another panel.

As of this writing there are no new classes to train new QMEs

In some specialties, you can no longer form a panel of three QMEs

In some cases it can take over a year to get an AME report

It is hard for some accepted claim injured workers to find a doctor that will treat them.

Injured workers often have difficulty in finding legal representation if they had a prior injury, due to the new apportionment laws.

The begining

Smarterce.com is an educational site for the continuing education of QMEs and soon other professionals. As such, an effort has been made to stay away from the political side of Workers Compensation in California.

This Blog spot can open the discussion on the state of affairs in California Workers Compensation without compromising the ideals of the educational site.

Much of what is happening in Workers Compensation reforms has nothing to do with providing better care to the injured worker. Power plays, corporate and government corruption are becoming daily occurrence.

My pet peeve currently, is the reliance on the WCAB to penalize the fraud when the judges want nothing to do with it.

I have been in the QME system since the first group of QMEs. I thought I had a good grip of what was happening in the system. My eyes were opened wide when I started to appear at WCAB hearings.

There I saw:

$100,000 bills for strained backs.

Judge wad up file and throw at the attorney because they were on another judge's preprinted paperwork.

Injured workers crying because the insurance carrier, despite more than one order to provide care, had not.

Judge proudly proclaim, " I never have and never will issue sanctions".

I will add more to the list as we move on, believe me there is much more.