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Thread Title: Help re When I/W Doesn't File a Claim...
Created On Monday February 02, 2009 4:41 PM

sstanz
Junior Member

Posts: 9
Joined: Sep 2006

Monday February 02, 2009 4:41 PM

Any advice on what steps to take when an injured worker is treated at at facility (i.e. hospital) but then doesn't appear that he/she is going to pursue a w/c claim or case. No w/c case on file per edex and the employer, a construction company, isn't responding to requests for w/c carrier info. Unable to locate patient as well. Should I just consider this a lost cause?

Any help or suggestions is greatly appreciated!
Thx

Signed,

Frustrated...

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jonbrissman@verizon.net
Senior Member

Posts: 377
Joined: Oct 2003

Monday February 02, 2009 7:30 PM

Order a WCIRB coverage search to identify the carrier or TPA, then file an Application for Adjudication of Claim. Contact the IC or TPA and ask for payment in full (up to $10,000) per L.C. Sect. 5402, and a copy of the acceptance or denial letter to the employee. When the IC or TPA ignores you again (as is likely), file a Declaration of Readiness to Proceed.

Since the employer had not disclosed its coverage information, the likelihood is that the claim was not promptly accepted or denied. Defendant has liability for up to $10K in treatment that occurs prior to the acceptance or denial.

Sect. 5402 is one of the few provisions of SB899 that favors medical providers. Your lien might have been a write-off before SB899.

JCB

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sstanz
Junior Member

Posts: 9
Joined: Sep 2006

Tuesday February 03, 2009 9:34 AM

Thanks for the info, i'd proceed as suggested, however, just discovered a new bit of info which is the employer (a "construction company") admits he has no w/c insurance...

any hope under these circumstances?

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appliedpsych
Member

Posts: 69
Joined: Dec 2005

Tuesday February 03, 2009 9:54 AM

The Special Funds Unit pays claims to injured workers under certain circumstances through two special funds:

Claims are paid from the Uninsured Employers Benefits Trust Fund (UEBTF) when illegally uninsured employers fail to pay workers' compensation benefits awarded to their injured employees by the Workers' Compensation Appeals Board. Certain steps must be taken before and after the issuance of an award in order to receive benefits from the UEBTF. Guidelines are available from DWC's Information and Assistance Unit.

The Subsequent Injuries Benefits Trust Fund (SIBTF) is a source of additional compensation to injured workers who already had a disability or impairment at the time of injury. For benefits to be paid from the SIF, the combined effect of the injury and the previous disability or impairment must result in a permanent disability of at least seventy percent. The fund enables employers to hire disabled workers without fear of being held liable for the effects of previous disabilities or impairments. SIBTF benefit checks are issued by State Compensation Insurance Fund after issuance of an award by the Workers' Compensation Appeals Board and upon authorization by DWC's Claims Unit.

Filing a claim with the UEBTF

If you were injured on the job and think your employer was illegally uninsured, you may apply to the UEBTF for any benefits to which you might be entitled. Filing a workers' compensation claim with the UEBTF is a complicated process. Contact an information and assistance officer at a local DWC district office for information and assistance. UEBTF-Claims forms are available here.

Reports

Report of Uninsured Employers Benefit Trust Fund in compliance with Labor Code ﾧ3716.1( c )
Report of Subsequent Injuries Benefit Trust Fund in compliance with Labor Code ﾧ4755(d)
Report of Uninsured Employers Benefits Trust Fund Job Classification data

Publications

How to Properly Obtain Jurisdiction Over an Uninsured Employer in Workers' Compensation Cases
An article by DIR attorneys Steven A. McGinty and Anthony Michel in the Summer, 1999 issue of Workers' Compensation Quarterly, published by the Workers' Compensation Section of the State Bar of California.

Special Funds Unit news

Aug. 12, 2008 Division of Workers Compensation issues advance checks to special fund recipients version

Directory of UEBTF offices

Los Angeles
320 W. 4th Street, Suite 690
Los Angeles, CA 90013
(213) 576-7300

Oakland
1515 Clay Street, 17th floor
Oakland, CA 94612
(510) 286-7067

Sacramento
2424 Arden Way, Suite 355
Sacramento, CA 95825
(916) 263-2774

Here's the link: http://www.dir.ca.gov/dwc/claims.html

Edited: Tuesday February 03, 2009 at 9:56 AM by appliedpsych

Posts: 53
Joined: Aug 2005

Tuesday February 03, 2009 4:04 PM

I would suggest that you request payment directly from the employer. Tell them that if they fail to pay to will be required to report them to the Unisured Employers Fund for legal proceedings. If you get no response or an unsatisfactory one then i would go forward with the UEF.

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jonbrissman@verizon.net
Senior Member

Posts: 377
Joined: Oct 2003

Tuesday February 03, 2009 5:01 PM

Rider001, be careful. Threatening the employer with disciplinary action or civil or criminal sanctions by a third party (UEF) in order to gain an advantage in a dispute is a violation of the State Bar's Rules of Professional Conduct (for attorneys). I recognize that you are likely not an attorney, but there may be a civil equivalent making such actions either a misdemeanor or felony. You can report the uninsured employer to the UEF for legal proceedings, but you can't threaten the employer with the possibility that you will report them if they don't do what you want. Before you embark on such a course of action, you ought to research the California Civil Code in depth; better yet, find another strategy.

JCB

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steve appell
Senior Member

Posts: 1017
Joined: Feb 2005

Wednesday February 04, 2009 9:24 AM

"there may be a civil equivalent making such actions either a misdemeanor or felony."

Jon: How about blackmail and/or extortion ?

-------------------------
Steve

A government which robs Peter to pay Paul can always depend on the support of Paul.
- George Bernard Shaw

Posts: 53
Joined: Aug 2005

Wednesday February 04, 2009 10:32 AM

I agree my suggestion was not well written and one should us tact if going that route. Can you really extort money rightfully owed? My intentions in the eariler post were not to blackmail or anything like that. I don't even know why i would be trying to help an unisured employer avoid penalties in the first palce. Thanks for the eye opener.

Go ahead with your app. Make sure to get a letter for the IW stating they do not want to pursue their case. Get your case number and file for a lien conference. Let the employers deal with the legal consequences of their actions. Maybe someone on this forum will get some business as a result.

Edited: Wednesday February 04, 2009 at 11:03 AM by rider001

Posts: 53
Joined: Aug 2005

Wednesday February 04, 2009 11:36 AM

Under that thinking wouldn't all demand letters be considered extorting before filling a case. Not necessaryily talking about comp.

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steve appell
Senior Member

Posts: 1017
Joined: Feb 2005

Wednesday February 04, 2009 12:45 PM

Here's some classic extortion and/or blackmail:

"Pay within 20 days, or I will file a DOR"

-------------------------
Steve

A government which robs Peter to pay Paul can always depend on the support of Paul.
- George Bernard Shaw

Posts: 53
Joined: Aug 2005

Wednesday February 04, 2009 1:36 PM

Extortion maybe not blackmail. From my understaing blackmail does not exists if the party has reasonable grounds for making the demand.

Is it really extortion if you just point out the obvious by outlining a cheaper more monitarily efficent course of action? Aren't most settlement offers structured in that matter?

In theory lien claimants are extortion artist then? If you don't pay my bill I will file a lien. If you dont address my lien i will file a DOR.

I have a lien settlement letter from an attorney stating if i don't withdraw my valid lien they will file a DOR. Do i have a case of extortion here?

I feel so dirty and cheap. Thanx Steve.

Edited: Wednesday February 04, 2009 at 1:46 PM by rider001

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jonbrissman@verizon.net
Senior Member

Posts: 377
Joined: Oct 2003

Wednesday February 04, 2009 6:21 PM

One needs to draw a distinction between legitimate remedies and everything else. It is legitimate, not extortionate, to tell defendant to pay a lien or you will file a DOR and place the matter on calendar for a hearing. It is extortion or blackmail to tell a claims examiner to pay your lien or you will report to the police that the examiner embezzled from his employer, even if true. You can report the examiner's crime to the police, but you cannot threaten to do so in order to coerce certain behavior out of the examiner.

Rule 5-100 of the State Bar's Rules of Professional Conduct says:

(A) A member shall not threaten to present criminal, administrative, or disciplinary charges to obtain an advantage in a civil dispute.

(B) As used in paragraph (A) of this rule, the term "administrative charges" means the filing or lodging of a complaint with a federal, state, or local governmental entity which may order or recommend the loss or suspension of a license, or may impose or recommend the imposition of a fine, pecuniary sanction, or other sanction of a quasi-criminal nature but does not include filing charges with an administrative entity required by law as a condition precedent to maintaining a civil action.

(C) As used in paragraph (A) of this rule, the term "civil dispute" means a controversy or potential controversy over the rights and duties of two or more parties under civil law, whether or not an action has been commenced, and includes an administrative proceeding of a quasi-civil nature pending before a federal, state, or local governmental entity.

______

Using Steve's definition, I have blackmailed him on several occasions. It's kinda fun, and I look forward to doing it some more.

JCB

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STEVEPSCA@YAHOO.COM
Junior Member

Posts:
Joined: Jul 2007

Thursday February 05, 2009 2:50 PM

I love this side when there is lively discussion !
And appreciate the levity... but regardless of the outcome here, that ER, if in fact is illegally uninsured, should be referred to the proper authority for prosecution.
This is exactly the basis for the difficulties we as IW's, and you as 'pros' face with this system.
Whether it's not carrying the coverage at all, attempting to declare this EE as an 'independant contractor', (a possibility here) or simply under reporting wages... it's fraud.

Sorry for interrupting... proceed.

Posts: 122
Joined: Sep 2004

Friday February 06, 2009 10:09 AM

Also, unless Frustrated (ORIGINAL POSTER) is an atty, the CA. RPC WILL NOT apply to them, as a private individual, or a billing person in a facility.

As JonBriss was so kind to provide us with CA. RPC 5-100,

"(A) A member shall not "....................

Back to your regular scheduled programming.....

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postscript2
Senior Member

Posts: 639
Joined: Sep 2006

Friday February 06, 2009 12:31 PM

If it was a one time visit with a follow up or none at all, then it doesn't have to be reported to the I/C for a "minor" injury and may be construed as 1st aide.

Just my 2 cents.

Bill the ER and proceed with regular collection proceedings and save yourself the grief.

LCS

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sstanz
Junior Member

Posts: 9
Joined: Sep 2006

Wednesday February 11, 2009 9:36 AM

Seems the best (& legal) soloution is to get a ltr from the I/W saying they don't want to pursue their case and then take it from there.

I want to say thanks for the well-rounded discussion & insight.

Posts: 122
Joined: Sep 2004

Wednesday February 11, 2009 9:42 AM

Check on Zabasearch.com for the patient. You may be able to find their address there.

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postscript2
Senior Member

Posts: 639
Joined: Sep 2006

Friday February 13, 2009 11:54 AM

You can't bill the i/w directly, it's against the labor code and if the ER tries, it's a misdomeanor and punishble by 3x the amount collected.

LCS

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jonbrissman@verizon.net
Senior Member

Posts: 377
Joined: Oct 2003

Friday February 13, 2009 5:47 PM

Postscript2, nothing you said is relevant in this situation. LC Sect. 3751 prevents a provider (not the ER as you stated) from directly charging the patient IF the patient has filed a workers' compensation claim. In this situation, the initial post specified that there is no WC claim pending. So nothing prevents the provider from charging the patient directly. However, I think that's an inferior remedy when compared to the $10,000 in ER liability under Section 5402.

JCB

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postscript2
Senior Member

Posts: 639
Joined: Sep 2006

Sunday February 15, 2009 2:35 PM

OK, my goof. No DWC-1, then "technically" no claim, per "Honeywell." However "knowledge" of a claim by the ER and the fact that they are uninsured complicates matters. Well, I'll be interested in seeing how this one plays out! I used to get these all of the time and more often than not, the ER paid the bill, shut their mouths and disappeard.... (however they were insured or TPA's--big difference).

LCS

Code: 3751
Title: Cost of compensations; no employee payments

(a) No employer shall exact or receive from any employee any contribution, or make or take any deduction from the earnings of any employee, either directly or indirectly, to cover the whole or any part of the cost of compensation under this division. Violation of this subdivision is a misdemeanor.

(b) If an employee has filed a claim form pursuant to Section 5401, a provider of medical services shall not, with actual knowledge that a claim is pending, collect money directly from the employee for services to cure or relieve the effects of the injury for which the claim form was filed, unless the medical provider has received written notice that liability for the injury has been rejected by the employer and the medical provider has provided a copy of this notice to the employee. Any medical provider who violates this subdivision shall be liable for three times the amount unlawfully collected, plus reasonable attorney's fees and costs.

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