Ever notice how normal working people who finally get the promotion from worker to management seem to take on a new personality. Control over others is not only exciting but addictive! Many good workers have done the "Jackal/Hyde" maneuver to exercise their control and at the same time trying to still be one of the good ole boys/girls!
Picture Frankenstein's monster when the surge of electricity went through his body. Pure unstoppable power! Pure disregard for the way he was before (dead) and now the ability to place fear while controlling others.
Then as they climb the Corporate ladder and refine those "power" skills, their distant past as a normal worker fades. No longer do they take breaks or lunch or attend after work events with the working class. They are now part of the "management" class and rubbing shoulders with others of like kind and quality.
This upward mobility not only in the private sector but in Government is identical! The power brokers and grabbers just want more and more power. Often times when interviewed most who have reached almost the top will say they "love the chase!"
How many "bosses" have you worked for where you have seen this transformation take place? Many like the maggots that evolve into a fly, and few that evolve from a caterpillar into a butterfly!
If you are one of those with the power, tell me where I'm wrong! Show me that power over others is often a good thing! Give me examples where that power is used for good!
While I'm in no way saying that we do not need "leaders" and "rules & regulations" we just need those people to retain much of the roots from where they came!
POWER TO THE PEOPLE
DISCLAIMER:
All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.
Thursday, February 25, 2016
Tuesday, January 5, 2016
Labor Code Violations: Delay or Deny TPA agrees to pay large fine.
Sedgwick Agrees to Pay $1.129 Million for UR Violations
5.0- by Greg Jones (Western Bureau Chief)
- State: California
- Topic: Top
According to information provided by the Division of Workers' Compensation, the Audit and Enforcement Unit investigation resulted in 75 "mandatory administrative penalties" against the third-party administrator.
The investigation of 274 files that were adjusted at Sedgwick's office in Long Beach uncovered violations of Labor Code Section 4610, which establishes the rules for utilization review. According to a document provided by DWC spokesman Peter Melton, the violations include allowing someone other than a licensed physician to modify, delay or deny requests for authorization and failing to issue timely responses to requests for authorization.
Another document with more details on the audit results and the allegations was not immediately available Monday. Melton said the DWC needs to review the document to ensure it does not disclose personal information about applicants.
Sedgwick did not make anyone available for a telephone interview on Monday, but instead emailed an unsigned statement in response to inquiry by WorkCompCentral.
"There was a settlement reached, but the most important part of our statement is Sedgwick's commitment to ensuring injured workers receive the best possible care when they need it so they are able to return to full health and productivity," Sedgwick said.
Bert Arnold, president of the California Applicants' Attorneys Association and a partner at Boxer Gerson in Oakland, said on Monday the terms of the settlement appear to be a "nice start." He said he's happy to see the DWC investigating UR practices and would like to see the agency target more claims handlers and carriers.
Arnold also said he's not aware of any other times the DWC has assessed a penalty exceeding $1 million for claims handling violations. At the same time, he said he doesn't know how the amount of the fine in the case of Sedgwick compares to the amount of money the TPA saved through the alleged violations.
"It would be interesting to know how much was denied that generated a million dollar penalty," he said. "If it was more than the million dollars, that's a bad thing. I think they should be penalized more than what they denied."
Jesse Ceniceros, president of Voters Injured at Work, said a $1.129 million penalty is "probably a slap on the wrist" for Sedgwick and he doubts it will "change the way they do business."
"Unless an insurance company is forced to pay the price for their actions in a more expedient way, it's not sending out the message (the DWC) should be sending out when denying care and treatment, especially when it costs a life," he said.
Sedgwick did not admit to any wrongdoing or liability in the settlement agreement approved by Division of Workers' Compensation Administrative Director Destie Overpeck on Dec. 30.
The third-party administrator must submit a detailed statement of corrective measures taken in response to the findings of the Audit Unit within 60 days of Overpeck approving the agreement.
The settlement also requires Sedgwick to provide the DWC with copies of internal UR audits it conducted regarding its account with the Kroger Co. since Feb. 10, 2012. And it must provide the DWC results of all internal audits of claim files adjusted by Teresa McDivitt.
McDivitt was the adjuster on a claim filed by Charles Romano, who was injured in December 2003 while stocking shelves for Ralph's in Camarillo. After undergoing surgery on Aug. 29, 2005, he contracted methicillin-resistant staphylococcus aureus that shut down his lungs and kidneys and paralyzed him below the shoulders.
Romano sought treatment for the infection at Ventura County Medical Center and Medi-Cal footed the bill because Sedgwick refused to authorize hospitalization.
In October 2006, a workers' compensation judge issued an amended finding and award holding Romano sustained an injury to his left shoulder and that the infection was a compensable consequence of the injury. The judge ordered Sedgwick to pay all reasonable medical expenses, but the Workers' Compensation Appeals Board in a 2013 decision said the third-party administrator delayed paying for some services and refused to authorize others.
Several times, McDivitt denied treatment or refused to authorize a treatment request "without consulting with a medical professional and without referring the request for treatment to utilization review," the WCAB said.
The board said Sedgwick continued to delay and deny care until Romano died on May 2, 2008 from cardiorespiratory arrest, respiratory failure and pneumonia caused by the MRSA infection. Sedgwick didn't make any payments for medical care on the case until June 23, 2008, according to the WCAB.
The WCAB in 2013 rejected Sedgwick's petition for reconsideration on a February 2013 decision by a workers' compensation judge who proposed penalties of up to $110,000 after ruling that Sedgwick unreasonably delayed or denied medical treatment on 11 separate instances.
While Sedgwick argued, among other things, that it didn't know why Romano needed hospitalization, the WCAB said the argument was "utterly without merit."
The board said McDivitt "studiously avoided information that might lead to the provision of benefits, a tactic that may have saved her employer some money in the short run – at great cost to Mr. Romano – but which clearly violated the demands of (Labor Code) Section 4600."
The WCAB ordered the targeted investigation by the Audit and Enforcement Unit after saying it has "rarely encountered a case in which a defendant has exhibited such blithe disregard for its legal and ethical obligation to provide medical care to a critically injured worker."
DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.
Tuesday, May 5, 2015
WORKERS' COMPENSATION CLAIM VERSUS EMPLOYER NEGLIGENCE LIABILITY CLAIM
Came across a story (unconfirmed) where an adjuster (Workers' Compensation) during the investigation of a death claim discovered the accident was caused in part by the employers negligence.
Seems the employer (a supervisor) removed a safety device from a machine so that production time would not be impacted. This removal did the intended purpose and keeping production high and there were no problems until a newly trained employee used the machine and was severely injured then died.
The adjuster before completing the report discussed the uncovered facts with their supervisor, the claims manager and then the underwriter! Turns out that this insured was a very large account with multiple locations so a decision had to be made about going forward with the facts as presented.
If the death was caused by employer negligence the claim would not be processed as a Workers' Compensation Claim with a death benefit of under $150,000 but handled as a Wrongful Death which in most cases would be a much larger amount, and with the possibility of Punitive Damages (not covered by insurance) being awarded!
The claim was then taken away from this adjuster and completed by an independent adjuster who determined that there was no employer negligence and the claim was paid using the Worker's Compensation Death Benefit!
DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions or comments"! There is absolutely no "legal" bases or claimed legal bases for any of the statements or opinions. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments or opinions!
Seems the employer (a supervisor) removed a safety device from a machine so that production time would not be impacted. This removal did the intended purpose and keeping production high and there were no problems until a newly trained employee used the machine and was severely injured then died.
The adjuster before completing the report discussed the uncovered facts with their supervisor, the claims manager and then the underwriter! Turns out that this insured was a very large account with multiple locations so a decision had to be made about going forward with the facts as presented.
If the death was caused by employer negligence the claim would not be processed as a Workers' Compensation Claim with a death benefit of under $150,000 but handled as a Wrongful Death which in most cases would be a much larger amount, and with the possibility of Punitive Damages (not covered by insurance) being awarded!
The claim was then taken away from this adjuster and completed by an independent adjuster who determined that there was no employer negligence and the claim was paid using the Worker's Compensation Death Benefit!
DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions or comments"! There is absolutely no "legal" bases or claimed legal bases for any of the statements or opinions. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments or opinions!
Saturday, April 4, 2015
United States Postal Service
Like most of you when I send something using the Post Office Flat Rate Envelope rarely do I purchase more insurance. The Envelope comes with $50.00 of coverage which 9 out of 10 times is more than the value of the contents.
I sent some items to my grand children for Easter which included a $25.00 Gift Card to El Pollo Loco! The envelope arrived but for some reason there was no Gift Card inside.
The Postal worker told me that Cash, Money Orders and Gift Cards were not covered by their insurance policy! I asked if the envelope would have never been received would there still be no coverage for the Gift Card? The answer was yes, NO COVERAGE, "Lesson Learned!"
Read the FINE PRINT and if you are going to send a Gift Card be sure to Register it first. That way if it gets lost or stolen you can go online, enter the account number and a PIN and get a new card!
Jeff Weiss
DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.
I sent some items to my grand children for Easter which included a $25.00 Gift Card to El Pollo Loco! The envelope arrived but for some reason there was no Gift Card inside.
The Postal worker told me that Cash, Money Orders and Gift Cards were not covered by their insurance policy! I asked if the envelope would have never been received would there still be no coverage for the Gift Card? The answer was yes, NO COVERAGE, "Lesson Learned!"
Read the FINE PRINT and if you are going to send a Gift Card be sure to Register it first. That way if it gets lost or stolen you can go online, enter the account number and a PIN and get a new card!
Jeff Weiss
DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.
Sunday, December 21, 2014
DISRUPTION
Please read an outstanding article written by Alex Polyakov: Alex is co-founder and CEO of Livegenic, a company that delivers real-time visual technology to help organizations improve customer service and field operation support capabilities.
Here is the link for the article: http://www.livegenic.com/what-does-disruption-mean-for-independent-adjusters
Alex also asked me for my opinion and here is what I sent him!
Alex,
Having worked for several major carriers and running an IA business for about a 40 year span, and now writing short stories about the dark side of claims, I must say, your article on disruption was outstanding. Very well composed, and researched and your insight is far superior to 90 percent of those up the corporate food chain.
Here in lies the rub or the anomaly! On the surface and what most people see and believe about Insurance Companies is that they are a necessary evil. People reluctantly pay their premiums based on a fear spread by Insurance companies that you need things, very nice things, and you need to protect them from damage, theft, fire or some other such type thing. And regarding real estate or automobiles you own, if you do not insure them the lender will place forced insurance for you!
All this said, as I have said many times, most, not all Insurance Companies sell you a Promise they never intended to keep!
"Bottom Line", "at the end of the day" and "truth be told" (all over used cliches) PROFIT is the one and ONLY motivator! The Stock Holders care nothing for how the profit is made and how many lives (not their own) are forever changed or ruined by the stroke of the pen or keyboard in denying or reducing payment on claims. Overall cost per claim is the prevailing factor along with "how can we deny the claim."
On the more positive side, I would say that any IA organization that wants to stay in business would have to or utilize an in-place team of Virtual Adjusters. Vetted and ready to handle various types of insurance claims. A Virtual Claims Team along with Virtual Managers and Supervisors!
Also an active and updated list of upcoming companies that will soon be specializing in "Drone" operations. The Drones can in fact become the eyes for the initial field inspection. Then if damages warrant a personal inspection and face to face meeting with the insured or claimant, a list of Independent Field Adjusters in major locations along with professional photographers with some insurance background! Technology as you indicated is moving quickly in the insurance claims business, so recognizing those things and adapting how to use them is needed. Real time websites dedicated to keeping the inside adjuster and the insured and or claimant in the loop is also needed!
Again, a very excellent written article and I'm looking forward to reading more of your insight!
Jeff Weiss
DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.
Here is the link for the article: http://www.livegenic.com/what-does-disruption-mean-for-independent-adjusters
Alex also asked me for my opinion and here is what I sent him!
Alex,
Having worked for several major carriers and running an IA business for about a 40 year span, and now writing short stories about the dark side of claims, I must say, your article on disruption was outstanding. Very well composed, and researched and your insight is far superior to 90 percent of those up the corporate food chain.
Here in lies the rub or the anomaly! On the surface and what most people see and believe about Insurance Companies is that they are a necessary evil. People reluctantly pay their premiums based on a fear spread by Insurance companies that you need things, very nice things, and you need to protect them from damage, theft, fire or some other such type thing. And regarding real estate or automobiles you own, if you do not insure them the lender will place forced insurance for you!
All this said, as I have said many times, most, not all Insurance Companies sell you a Promise they never intended to keep!
"Bottom Line", "at the end of the day" and "truth be told" (all over used cliches) PROFIT is the one and ONLY motivator! The Stock Holders care nothing for how the profit is made and how many lives (not their own) are forever changed or ruined by the stroke of the pen or keyboard in denying or reducing payment on claims. Overall cost per claim is the prevailing factor along with "how can we deny the claim."
On the more positive side, I would say that any IA organization that wants to stay in business would have to or utilize an in-place team of Virtual Adjusters. Vetted and ready to handle various types of insurance claims. A Virtual Claims Team along with Virtual Managers and Supervisors!
Also an active and updated list of upcoming companies that will soon be specializing in "Drone" operations. The Drones can in fact become the eyes for the initial field inspection. Then if damages warrant a personal inspection and face to face meeting with the insured or claimant, a list of Independent Field Adjusters in major locations along with professional photographers with some insurance background! Technology as you indicated is moving quickly in the insurance claims business, so recognizing those things and adapting how to use them is needed. Real time websites dedicated to keeping the inside adjuster and the insured and or claimant in the loop is also needed!
Again, a very excellent written article and I'm looking forward to reading more of your insight!
Jeff Weiss
DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.
WAIT
Introduction:
If I had to guess at what percentage of
our lives we “wait” I would go with 90%!
Granted that seems high, but if you take into consideration not only
waiting to see a medical professional, or waiting for “results” but also
waiting for the traffic signal to change, waiting for your transportation to
arrive or your significant other, I think you see my conclusion!
If still not convinced there is also
waiting in line(s) to buy something like groceries, sports tickets, and pay
traffic tickets, boarding a flight or waiting for a train or bus! Babies are born waiting to be sent home from
the hospital, have their dippers changed, be feed and learn to walk and
talk. Religious people are waiting for
their Savior to come, or the end of the world or both! Families are waiting for their children to
come home from an evening on the town, work or military service. Just about anywhere you go you will see a
line of people waiting and you always want to find out why and are tempted to join
the line!
While I’m sure I have missed hundreds if not thousands of ways we
spend most of our lives waiting I think the point is made! Think about some catch phrases like: Wait Up,
Wait for me, Wait a minute, Wait and watch, Wait it out, Wait until the time is
right, and Wait for the light to change to green. In short we are a people
“Global” of “waiters!” Not just in the
USA but in every Country in the World!
We are all “WAITING”
DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.
Thursday, November 20, 2014
BABY'S DELIVERY COMES WITH NEARLY $1 MILLION PRICE TAG
DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.
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