Ventura Personal Injury Lawyer - Miscellaneous

Lowenthal Goes After Loophole: New Bill May Prevent Some Insurance Companies From Breaking Promises

James Cool — Wed, 25 Feb 2009 01:34:51 GMT

Assemblywoman Bonnie Lowenthal is a state assembly member who introduced a bill on Monday that would make it more difficult for insurance companies to retroactively deny worker’s compensation claims. The bill, assembly bill 361, attacks a loophole in state law. The loophole currently allows for insurers to refuse payment for medical services and treatments that have already been approved. This is especially difficult for workers that are not able to return to work quickly – workers left to cover expenses that they were led to believe would be covered face additional hardship in recovering from an injury on the job. Will Shuck, Lowenthal's chief of staff, explained that he was surprised at the current state of the law, and remarked that changing it was “about fairness.” He also stated that "What surprised Bonnie, me and everybody else, is that [the insurance companies] can say no [to payment after saying that they’ll cover it]." The lack of fairness is even clearer when comparing worker’s compensation coverage to coverage under a private insurance claim – private insurance companies are required to pay after telling an insured that their medical expenses will be taken care of. Many insureds rely on that, and reasonably so. There should be no less of an expectation when the compensation is owing due to a worker’s compensation claim. If the loophole is not closed, the approval that doctors are required to get from an insurance company before treatment is almost meaningless. Lowenthal captured this fact herself, stating: “if healthcare providers can't rely on the pre-authorization system, there is little reason for having such a system in the first place.”

Currently, doctors call for approval...and they may get it to treat the worker...but then the worker may be stuck with the bill. In a time when worker’s compensation claims are on the rise, it is important that the loophole is closed and insurance companies are prevented from giving insureds the proverbial kick while they are down. Insureds have no reason to oppose the legislation, but it will be important that anyone who might someday wish to file for worker’s compensation support the bill. Even if you do not currently work or have a position that is eligible for workman’s compensation, it’s impossible to tell if you will be. Getting hurt at work always seems to be an outside chance. On the other hand, it may be easy for you to think of someone that has been hurt at work and had to file a worker’s compensation claim. Or may be facing that situation yourself. In either event, we are all invested in increasing protections for people, rather than allowing the insurance companies to step on the little guy as they reach for record profits...even in a recession. If you’d like to voice your support for this bill, please click on Lowenthal’s name at the beginning of this article and then the link that says “Contact Us” on the menu on the left hand side.

Originally posted at InjuryBoard by James Cool

Managing Workman’s Compensation Claims in a Recession: A Growing Challenge

James Cool — Tue, 24 Feb 2009 15:35:33 GMT

With economic woes taking the forefront in most news reports and conversations at the dinner table, it is no surprise that workman’s compensation claims have risen in correlation with layoffs. Some workers may attempt to remain on leave from a position and continue to collect worker’s compensation rather than return to an uncertain, and economically impacted, workplace. Others that have been laid off have filed claims afterward, seeking to use workman’s compensation as a way to make the ends meet after being laid off. There is some concern among employers and managerial staff that workers may attempt to draw out workman’s compensation claims when jobs have been downsized or might be eliminated. This growing challenge for employers and managers was supported by February’s job reports, which indicated an increase in claims.

The current recession is the longest one in 16 years – with unemployment rates being reported around 7.6%. About 600,000 jobs were lost in January alone. In a time where employers are concerned about staying afloat, many of them fail to realize that they may face increased liability for compensation claims as a result of the market’s condition.

State Division of Workers’ Compensation spokeswoman Patricia Ortiz-Wong said claims for workers’ comp have steadily declined in the past eight years, from 931,710 in 2001 to 553,770 in 2008. That trend is not expected to continue in the face of the current recession. Figures from the state also show that the number of claims climbed dramatically from 738,311 in 2000 to 931,710 in 2001, another recessionary period. One claims manager, Mary Anne Hernandez from Pan American Insurance Agency, Inc., predicted that claims and risk managers would see claims go “through the roof.” But other risk managers, such as Dave Dolnick from Brady Cos, a La Mesa Construction Company, was certain that most employees would resolve their claims as soon as medically possible. However, there are legitimate concerns about the extension of worker’s compensation claims. “What we have observed, both somewhat with our own [limited] claims and also in chatting with ... peers, is that claims that are otherwise legitimate become much more difficult to resolve in this kind of a market, when the injured worker doesn’t have the option of a job to go back to,” Dolnick said.

New and reopened claims can be especially problematic to assess given these circumstances – even when the claim is legitimate and not solely the result of fear of job loss, downsizing, or a shaky market. This means that claims and risk managers are bound to be more vigilant than in more prosperous times. Businesses may reevaluate and extend their own insurance coverage, but it is more likely that businesses may revise and revisit job descriptions. Risk and claims managers may also be notified to require additional documentation and approach claims with increased skepticism. All of this means a harder road towards coverage for those with legitimate claims. If you have had a claim recently, it may be helpful to consult an attorney. Additionally, you may want to review and keep on hand a current copy of your job description, especially if you’ve heard that your employer is considering changes.

Originally posted at InjuryBoard by James Cool

What the Tort Reform Folks Don’t Tell You…

James Cool — Fri, 30 Jan 2009 01:57:47 GMT

Rush Limbaugh will not mention it on his radio program and Bill O’Reilly will deny its truth, but the latest data shows that the cost of insurance to employers is declining and so are the costs of employee medical benefits. Contrary to conservative myth, litigation is not driving up the cost of insurance and more tort reform legislation is not needed to stem the tide of ever-increasing insurance premiums. The fact is costs are going down.

Risk and Insurance Magazine recently released a report evaluating the effect of 2003 workers compensation system reforms. Risk evaluates the passing grade received by California’s workers compensation system given by the Commission on Health and Safety and Workers Compensation. Risk explains that:

“The CHSWC is a joint labor-management body created by the Legislature in 1993. The commission is charged with examining the health and safety and workers comp systems in California and recommending administrative or legislative modifications to improve their operation. As part of its mandate, the CHSWC published the report card”

Risk evaluated the data within the report and concluded that the cost of workers compensation continues to fall. The study revealed that the average rate of workers compensation premium per $100 of payroll is $2.40 which is lower than premiums were in 1994. The study attributes much of the success in lowering costs to the 2003 reforms which “were aimed at controlling medical costs, updating indemnity benefits and improving the assessment of permanent disability.” The 2003 reforms focused heavily on structural and systemic changes which lowered costs from within through deregulation and modifications to the way insurers and doctors did business, not tort reform.

The study also found that:

“Most injury costs appear to be leveling off…..after the reforms, the average costs for all of the types of injuries declined from 2004 to 2006, with the exception of psychiatric and mental stress. From 2006 to 2007, researchers said the average cost for some types of injuries, such as carpal tunnel/repetitive motion injuries, back injuries, and psychiatric and mental stress appeared to be leveling off. At the same time, slip and fall injuries increased, and other cumulative injuries decreased slightly.”

Tort reform advocates, many of whom were proponents of the 2003 reform, may interpret this data to mean that further legislation is needed to cure remaining problems. However, this is misleading. The data as interpreted by Risk reveals that the current reforms have worked and that many of the fears and concerns which prompted the 2003 reforms have been allayed and no further legislation is needed.

As recently as 2006, California Governor Arnold Schwarzenegger praised the 2003 reforms. His press release celebrating the anniversary of the reform legislation notes that that changes reduced costs by getting injured workers the immediate treatment they need to get back to work faster. In other words, even the conservative “governator” concedes that a proven method of lowering insurance premiums and health care costs to employers is by reforming and optimizing the way big insurance and large employers do business. Oftentimes, these simple reforms are overlooked in the debate over tort reform with proponents decrying “run away juries” and “predatory lawsuits,” rather than focusing on the real, underlying causes of increased insurance costs.

For a copy of the full, very long report card you may visit this link

Originally posted at InjuryBoard by James Cool

Insurance Commissioner Rolls Back Regulations that were Enacted to Protect Disabled Workers as Democrats and Disability Lawyers Voice Fears

James Cool — Fri, 23 Jan 2009 16:23:41 GMT

Disability insurance policies are sometimes provided as part of an employment package, but individual disability insurance policies are also sold to people who do not have group disability insurance coverage available through their employers. These insurance policies are part of an entire class of protections that employers and individuals can purchase, which generates big business and a need for oversight to protect consumers. Regulations handed down by the state and federal government are generally administered and developed by the Insurance Commissioner of the state. California’s Commissioner Insurance, Steve Poizner, has recently come under fire by his predecessor, Lt. Gov. John Garamendi, for proposing regulation changes that will weaken consumer protections.

Those changes include rolling back regulations that were meant to prohibit insurers from reducing group disability insurance benefits to account for pensions, workers' compensation payments or wages that the policyholder might receive. Poizner countered the criticism and concerns about less protection for workers by explaining that offset clauses that reduce benefits in disability policies are “already illegal” and that rolling back the regulations was “the essence of cutting red tape.” This raises questions about why Poizner felt that the changes were necessary, especially when many are calling for legislative action in other areas. Many believe that the disability insurance providers may have the effect of harming the foundation the state has for controlling offsets. Without the regulations, it may be more difficult for the state to restrain insurance companies looking to reduce their exposure when workers are disabled and file a claim.

Poizner’s predecessor, a Democrat, and some attorneys who deal with disability insurance issues say that insurance companies will “do what they want” and that this would be a “disaster for policy holders.” In a time where the removal of regulations makes people think of the failure of the business and accounting sectors, and places the name of Enron on the lips of concerned parties, many question whether there will be severe problems on the horizon once the regulations are rolled back. Garamendi warned that “some of the biggest scandals in the last decade took place in the disability sector: denial of claims, denial of coverage and using offsets...All sorts of things were going on to deny benefits to policyholders, so I wrote regulations to deal with that.”

With those regulations going back, disabled workers may wait with bated breath to see the effects it will have on insurance coverage and claims. If you have been disabled at work and are having difficulty or concerns related to your insurance coverage, you may want to speak to an attorney. An attorney may also be able to assist you if your insurance company uses potentially illegal offsets to reduce your payout following a disability claim.

Originally posted at InjuryBoard by James Cool

Investigations Prompted by Failure to Comply with Stop Order, Obtain Workers Compensation Insurance

James Cool — Sat, 17 Jan 2009 20:45:31 GMT

Sections 3550-3553 of the California Labor code require that employers have workers compensation insurance, which pays benefits to s matter. Last week, California Labor Commissioner Angela Bradstreet referred two San-Francisco area construction companies to the District Attorney’s office for a failure to comply with a stop order and failure to maintain the required worker’s compensation insurance. After inspections in mid-October, the construction companies were ordered to stop working until the required insurance was obtained. Bradstreet explained the stop-work order, reminding employers that “illegal operations have a negative impact on our state's economy and they do not provide the protection legally afforded to California Workers.” When neither of the companies, Struct-Tech Group, Inc. and Glenside Construction, did not comply with the order, the referral to the DA’s office was almost immediate.

The owners of Struct-Tech Group, Inc. and Glenside construction companies are facing court dates this month and face between $2,000 and $5,000 in penalties for the violations. While the penalties are not assessed per evaluation, Bradstreet commented that "the actions of the Labor Commissioner and District Attorney should send a strong no tolerance message to employers who seek to violate California's worker's compensation laws."Perhaps more importantly, the stop orders have no doubt had an impact on the day-to-day operations of the companies, demonstrating the necessity of meeting the labor code’s requirements.

If you employ even one employee, you may be required to carry your own worker’s compensation insurance. California’s Department of Industrial Relations provides information for employers to help them comply with the law. If you are interested in learning more about the workers compensation that you may be required to provide, you may want to visit them online. If you have questions or need advice regarding workers compensation at your place of work or within a company you own, you may want to speak to an attorney.

Originally posted at InjuryBoard by James Cool

Lincoln on E-Mail, and Presidential Resolve

William Grewe — Mon, 03 Nov 2008 15:34:39 GMT

Today, a new man will be tapped by the country to assume the reins and guide us upward for the next four years. The crowds will fall silent and signs will come down. The issues and challenges, seen and unseen, will remain as the winner awaits a January inauguration. While times have changed since Abraham Lincoln sat in the White House, what his resolve shows is timeless. His use of the telegraph, as seen through his wartime messages, reflects his style, commitment and focus whether or not his actions were popular. See the brief article at the link above.

Originally posted at InjuryBoard by William Grewe

Mixed Martial Arts And Product Liability?

William Grewe — Fri, 10 Oct 2008 13:02:30 GMT

Some forces in the fast-rising sport of Mixed Martial Arts scrambled to keep their footing in the wake of a statement by victorious fighter Seth Petruzelli, this week, that he was encouraged, pre-fight, by promoters to fight his popular opponent Kimbo Slice standing up. The implication is that, unbeknownst to viewers and ticket buyers, one contestant was asked to compromise his skill set so as to present a better show. Simply, while packaged as nearly a "no holds barred" spectacle presented on a cage-like platform ringed by an exuberant crowd an invisible hand might have sought to tweak Saturday night's battle between Petruzelli and Slice shown on CBS. The fledgling sport does not have a visible core commissioner as does MLB, the NFL and the NBA with whom the buck stops and credibility is the call of the day. Consistently, television networks and producers when any program involves chance, such as game shows, go to the extreme to protect their viewers from any possible misleading content. Promoters have denied any payment or suggestion to Petruzelli that he keep the fight off the mat. Petruzelli, who won the fignt in 14 seconds, backed-off his statement that promoters

"hinted to me, and they gave me the money, to stand and trade with [Slice]. They didn't want me to take him down. Let's just put it that way."

Petruzelli later said that any money paid was a knock-out bonus. What is undisputed is that the fight was a product advertised and sold to patrons and viewers as a match where both contestants were to compete to their fullest within the applicable rules. Whether they got what they paid, or tuned-in, for is not so clear. While the demographics and ratings for MMA are stunning, CBS might now be rolling its eye.

Originally posted at InjuryBoard by William Grewe

Avoiding Investor Fraud

William Grewe — Thu, 09 Oct 2008 17:44:17 GMT

A Los Angeles County jury might not have recovered the cash for victim-investors but it put the wrongdoer, a member of their church, in line for up to 15 year behind bars. The defendant rubbed shoulders with fellow churchgoers to the tune of over $2 Million. Gaining their trust through faith while on a path to their pocketbooks, Defendant Phoebus Smith followed a route which has become all too common: A crook infilitrating a social body and cloaking himself in the shared purpose and good feelings of the group all the while betraying a generous trust. The Securities and Exchange Commission has seen it so often that they warn against it along with other investment dangers. Now, while the defendant changes his address, the victims of Smith must search for what is left of their money and protect what is still within their grasp.

Originally posted at InjuryBoard by William Grewe

Ventura Baristas to Share in Recovered Tips

William Grewe — Fri, 21 Mar 2008 12:21:10 GMT

A California state court has ruled in a class action suit brought on behalf of baristas that the coins in the tip jar should not have been shared with managers, under California law, and, therefore, the company must repay the baristas. Should this ruling hold, it could affect other California employers who used a similar practice.

Originally posted at InjuryBoard by William Grewe

Utah Man Sentanced for Investment Fraud

Shannon Weidemann — Thu, 20 Mar 2008 06:32:58 GMT

A Utah man that frauded investors out of $15 Million. He coerced people to invest in his car sales and leasing business. A judge sentenced him to five years in federal prison for his crime.

The indictment says Wynn employed investor recruiters and held seminars to get people to sign on. Wynn allegedly told investors their investments would be monitored in a third-party escrow account and would be secured by property valued at 150 percent of the investment. Prosecutors say those claims were untrue and that those charged with holding the investment funds were not bonded escrow agents.

Wynn plead guilty to the charges in a plea bargain. The judge also ordered the man to pay back the $15 Million to all of the investors. People in California, Idaho, and Arizona were victims of the fraud. The defendant hoped to forgo prison time in order to work and pay them back.

Originally posted at InjuryBoard by Shannon Weidemann