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Thread Title: 8 YEARS OF TTD AND STILL GOING STRONG!!
Created On Friday March 11, 2005 1:47 AM

motormouth
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Friday March 11, 2005 1:47 AM

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As a senior adj. I thought that I had seen the worst of the worst and being a temp for the past three years, I usually was assigned the bottom of the barrel cases that just needed to go away. Anyway I was on the forum SCREWEDBYINSURANCE.com and answered a question for an IW. Long and short of it, I represent him now. History: beat up on the job 1997, SCIF admits to basically skin and contents injuries but then begins their usually messy job and subsequently starts denying treating for admitted body parts. When I subbed in, ttd benefits had been cut and SCIF was trying to assert a credit for overpayment of ttd of $57K against the PD and starting asking the IW for repayment. Upon reading the benefit printout I noticed that they were not paying this max wage earner (used car salesmanager!!) max rate and hence, not paying the increase in ttd rates over the years. My IW had not received any benefits since 8/04, had AME's scheduled through the end of 2005, blah blah...MSC on 12/28/04 with Minute Order to pay the retro TTD ASAP, pay the doctors, continue the ttd until the last AME report was in. I reserved the issue for P&I (new sb8995814 garbage) requested a wage statement at that time...blah blah.. WELL ...SCIF finally JUST paid my IW the retro TTD (at the wrong rate) TOO LATE fools...NEW MSC on the issue of nonpayment and non compliance with the previous minute order from the MSC on 12/28/04 coming up in two weeks, however this time, I have calculated what they owe on the bumps in ttd rate, what they owe for the late checks and have a good cause issue for the 5814 penalty. The underpayment of ttd comes close to 150K not including 4650 and interest....
BYE THE BYE....TOTAL TTD PAID ON THIS GUY.....$228k
TOTAL MEDS: $420k

wow...what a file....I love it....feels good to right the wrongs without my hands being tied by my employers.

Yadah
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Friday March 11, 2005 5:38 PM

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Interesting title of your post, motormouth.

"8 years of TTD and still going strong!".... is that some kind of a Freudian slip or what? You seem to revel on your client's inability to return to any type of suitable gainful employment. Sounds like a pretty nifty cash cow you found surfing the message boards. If this were in another context, I'd say, "Way to go!", but not this time...... I've read posts of various applicant attorneys in this Board, and they sound like they are driven more by an intrinsic desire and passion to help the injured worker, than by lining their checkbooks.

Goodness, who would think to Google the internet with "screwed%by%insurance"...?

motormouth
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Saturday March 12, 2005 2:22 PM

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Yadah,,,I am sorry that you completely misunderstood my intentions in this post. I personally believe that no one needs to be on ttd longer than two years. I feel that that is enough time to figure out what the permanent restricitions are and let the IW move on. Unfortunately, this has not been the case with my IW as he has been shuffled from one doc to the other reminiscent of the wild early 90's. (In fact some of the same docs and attys) Just by that bias alone, the adjustors on the file felt that my IW was malingering. However, if you consider the fact that he was 56 when he was beaten up by a couple of thugs while in the course and scope of his employment and completely caught off guard...Oh and did I mention two shattered kneecaps, dislocated shoulders, broken face with a baseball bat, entire spine stomped on, etc.? If this would have been my case, it was have been set up as a catastrophic loss and reserved accordingly given the age of the IW. But, NO NO NO....give it to a junior adj which doesn't believe that he is that injured, a crappy applicant attorney who only sees dollars sign and a defense pulled by the strings of the adj. and top it off with MILL DOCS and I am talking the worst of the worst...If an adjustor were to see this combo of attys and docs that are on this file...FRAUD is screaming at you...but this is legit and mismanaged.
We are finally at the point where the IW wants to control his own destiny any not have to ask permission to go potty!!
We are looking at structured settlements with a Medicare setaside...meanwhile IW is going downhill and fast.
SO......
I do not revel in this "CASH COW", but feel nothing but sorrow for the way he has been propelled through this system that we call workers compensation.

Sorry for the misunderstanding..

motormouth
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Saturday March 12, 2005 10:19 PM

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oh..I almost forgot Yadah...since I am not an attorney, where are my cash cow fees going to come from? This IW, as most IW's, deserve to be treated like human beings. Who was it that said.."Treat others as you yourself would like to be treated...??

Yadah
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Saturday March 12, 2005 11:38 PM

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I don't think that's going to faze you one bit, motomouth, you seem to be pretty creative. You seem to have found yourself a client or two from surfing the Internet, and of course how noble it is to bring in your inside information on insurance company inefficiencies to help the poor injured workers. Hey it's free enterprise and I tip my hat to you for that. It just amazes me how quickly you backpedalled, acting all humble and "for-the-people" in response to my post, when in another post a day or two ago, you were all rah-rah for applicant attorneys to "wake up", "there's money to be made". Frankly, on that case where you thought the defense attorney was an idiot for offering $3k? Maybe that defense attorney sensed your lack of respect for your own client, as you wrote "Who in the hell starts up VR after nine years of interruption?" (Yep, you tell me, moto.) You've probably gleaned from now that I am a claims adjuster and I appreciate the fact that you, as all claims adjusters before you and will follow you, will be overworked and underpaid. That's a business reality that unfortunately has a significant effect on the system. But to mock and be outright mean about it? You got to draw the line somewhere in a professional forum like this. Go back and read your posts. You sound more like a disgruntled ex-claims adjuster out for a pound of flesh, than a true advocate for the injured worker. And don't preach to me about the Golden Rule after words like "TOO LATE fools" come out of you. Give me a break.

Edited: Saturday March 12, 2005 at 11:39 PM by Yadah

motormouth
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Sunday March 13, 2005 2:44 AM

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motormouth
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Sunday March 13, 2005 5:30 AM

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Whats the matter, Yadah..hit a nerve with your claim handling skills? No, I bet that you are the SCIF adjustor that has this file approaching million dollar plus settlement... NoNo..I take it back, you are the adjustor that attempted to assert the credit of overpayment of ttd by $57,000.00 against the PD when There was no overpayment of ttd as the IW is being treated by no less than eight physicians, none of which have had him P &S simultaneously. Wait a minute..I recognize you now..you are the adjustor that denied the home health care for his surgeries on the right hand (CTR) and left knee meniscal repair done simultaneous because you were of the belief that he could ambulate without the use of an arm and a knee....Disgruntled ex-examiner? Well...I am still a senior claims specialist and my temp adjustor rate is currently $45.00/hour. I have been an examiner off and on for almost twenty years and still get that sense of anticipation and the thrill when reviewing a file for the first time. Call me crazy..but I still love my job and haven't had "examiner burn out"yet...have come close..How many times yadah, has a file been transferred into your pending and when you start reviewing it, the first thing that pops into your mind is..."What the hell was the prior examiner thinking?" How many times have you crossed your fingers on a Hail Mary C & R that was full of wraparound issues that in essence disguised the fact that the carrier behaved VERY BADLY only to breath a sigh of relief when it gets approved without being set on calendar for "Adequacy issue"? How many times did you review a new file only to discover that prior examiner on the file was woefully undertrained and that no notices were sent out? You then had to hurry up and send out a plethora of notices (beg./end ttd...pd delay...etc.) all at once with a couple of checks and a couple of SIP4650 checks thrown in for good measure to an unsuspecting IW only to confuse him/her more? As a temp examiner, I get the files that take up a couple of shelves! I get the ones that the prior examiners have attempted to bury their mistake only to have it resurface and smell putrid now...I have learned a very important thing in this business..tell the truth no matter no much it hurts, fess up to the mistake that you made that have now turned that small little file into the grunting behemoth in the corner..and it will eventually get better..if not...move to another carrier and pray that the file and the mistake you made doesn't catch up to you.....
Let me ask you something, Yadah.....
How many files do you have on repetitive pay? TTD/VRMA/PD? Those are the easy ones..3-4 months without having to look at time makes life good, doesn't it...just drop the mail to the file...REDIARY the file and add the usual bull for the employer to read..ie. IW still treating..blah blah...still in plan...no plan...paying out PD STip/Award..WHATEVER... Unwatched.file...guess what happens? An unrecoverable gross overpayment of TTD/PD/ VR outside of the cap because there hasn't been a plan in six months... This then is why my IW has had 8 years of continous ttd on a file that should have had some type of disposition as early as 2000. (DOI 2/12/97) Am I rubbing it in a little too much for your liking? Well too bad...Its not the adjustors fault, but I can say that there have been lots of times that I reached for the skinny one instead of the fat one knowing full well that the file with six inches of unattached mail was going to take a long....long....time....
How many times have you put off filling out the C &R because of the following:
1. Need to raise the reserves meaning endless paperwork and justification for the reserve increase to multiple people and then the questions as to why this wasn't brought to the highers up's attention sooner, SO YOU LET IT SIT
2. Need to do a home office report with CORRECT VERBAVE
3. Need to actually read and understand the file.

It seems like you are not getting the jist of what I am saying, Yadah...Examiners have a hard job...but that doesn't mean that you don't have to try to do something. We are here for a reason and if you can't do the job, don't come in every day and fake it because eventually you will be discovered and the only one that will truly suffer is the IW that has had to put up with incompetent adjustors.

With regards to my nine years of retro ttd benefits added to a potential uncapitated rehab plan...It goes like this...
Once the defense atty received my notice of rep, he contacted me and made no mentioned that IW was QIW in 1996 and had not completed a plan...He made no mention of the fact that there was no formal interruption notice. He tried to tell me in simple terms that I could understand as I was not an attorney that the case had little or no value orthopedically because there was substantial apportionment to a 1967 MVA. GIMME A BREAK NOW...He had absolutely no respect for me thinking that he could sneak the unaddressed VR right by me and that I wouldn't notice. He was surprised at the demand and then the RU103 and most definitely surprised by the D&0 denying retro and ordering the carrier to pick up rehab at the cap.

With regards to the eight years of ttd...;You are darn right I am going to slam SCIF's face in this...Even on a very "exhusband called "type of day, I couldn't write such terrible letters to an injured worker and then to add insult on top of insult..demand repayment of the allleged overpayment of TTD when the IW was treating with no less than eight doctors, none of which would even get him to P &S simultaneously. There have been 22 adjustors on this IW's file and counting.

Creative? I believe that creativity = claims examiner. You have to learn the socratic method of reasoning..There are more ways to arrive at the answer "4" other than "2+2". (this might get a little hard) It's called....THINKING OUTSIDE OF THE BOX...

Surfing the internet for clients? Could have said "trolling for clients" and I would have taken it the same way...What's the matter, Yadah? Jealous? Please..get over yourself...Don't have to surf for clients..and don't get paid for it either.. Actually don't even have to look for work, it comes to me and waits for when I am finished with the assignment or special project that I am currently working on. AND DO YOU KNOW WHY YADAH?
The files that I will be assigned are SOOO messed up that in the30 -60 day wait time for me to start...it will be okay...IW is on REPETITIVE PAY..

Grow up and face the facts that we examiners/adjustors/hearing reps sometimes get in WAY OVER OUR HEADS..and all we can do is our best which requires admitting to a mistake and asking for help to fix it.

sfex
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Sunday March 13, 2005 7:03 PM

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Are we done with the mudslinging yet?

We're all here to do our jobs afterall. To be successful, you have to respect the people you deal with on a daily basis. You may not agree with their points of view, and that's fine, but throwing insults at each other isn't going to make anyone "better" than the other.

That said, I definitely think being creative is the key to being a successful claims examiner. I've put myself on the line a few times with decisions I made to do things differently. Some companies and supervisors appreciate the creative approach, others get a bit nervous because "that's not how we do things."

Frankly I don't want to know how things are done in a given situation. I'll figure out my own way.

There is definitely more than one way to get a good result in claims. Those of us working in offices that allow us the freedom to experiment are fortunate.

scrapindee
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Monday March 14, 2005 8:21 AM

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Motormouth: How does one get an independent claims examination of a file? Who pays the bill, IW? IC? What about confidentiality? I would like more information.

Contact info for you????

Yadah
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Monday March 14, 2005 9:58 AM

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<< Whats the matter, Yadah..hit a nerve with your claim handling skills? >>

To be honest, no. That's OK, because I know the quality of the work I put out, and I don't need a message board to validate my existence as a claims adjuster. I have happy claimants, employers, managers, attorneys and (heaven forbid) happy and contented lien claimants. Maybe not all of us can be rays of sunshine but I digress.

I think you missed my point entirely. What got my ire is that you gloat and raked over the coals, claims adjusters ("fools", you called them, right?). And then say, treat injured workers how you want to be treated, or something to that effect. It's pretty much amusing how you think the Golden Rule was created only for injured workers. No, reality check here: it applies for all living things, even bad claims people. Equally-amusing is when people grab the "Grow up!" clutch in any argument. Something I would expect to hear from an AI message board, not here.

Trust me, I work my files with the mindset that I could be an injured worker in the future. Adjusters are a WC-claim waiting to happen, what with our chronic computer use and repetitive hand work.

I have little tolerance for people who gloat, that's all. Somebody in this message board once posted, and I admired her for that, when she said something about she doesn't have to post her good results, she takes the position there is no need to do so, nor does she think it is good manners. "When you reach the end zone you act like you have been there before and will be there again, you don't celebrate." (Yes, Armenta... I saved THAT one.)

And no, I don't work for SCIF but I'm sure the SCIF members on this message board, the ones who are diligent and hardworking, are probably not amused by all this. You just don't burn bridges in workers' comp.

Sorry, Sfex. This discourse had left a bad taste for me but I just can't sit back and let hardworking adjusters getting an arbitrary bad rap across-the-board, for the 10-20 files on a desk that went out of control. In the grand scheme of things, how many per cent of a lifetime caseload does that really make up?

motormouth
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Monday March 14, 2005 12:48 PM

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I GUESS I HAVE TO CAPITALIZE WHAT I HAVE SAID, YADAH...AGAIN..
SAME THEME....ADJUSTORS WORK VERY VERY HARD....Unfortunately, there are a few out there that dont...but never in any of my postings did i slam everyone....
My gooodness!!!
This all started with me surfing the net and finding from a search engine this site that just amazed me....It was full of horror stories from the injured workers....unfortunately, the title of the website is..SCREWEDBYINSURANCE.com...Then you had to get all uppity on me....
BUT....I must qualify some of my statements..
1. You did not read the postings in its entirety or took something out of context....and then made a comment based on that....The 9 year retro case? Amazing.....you are right...WHO IN THE HECK STARTS UP VR AFTER A NINE YEAR INTERUPTION? The answer...The carrier that didn't file an RU105 and didn't properly shut down the rehab portion of the case...however, the case in chief was ongoing too.
I have total respect for everyone that I work with.. NO RESPECT FOR MY IW? I take offense to that..No respect for the DA that thought that since he only had a hearing rep he could try and pull the wool over my eyes and was completely surprised and taken off guard when I demanded what he knew full well should have been taken care of long ago. He even brought his adjustor to the trial

2. The SCIF case? Well..if you must know..I started out at SCIF-State Contracts right after I graduated from USC. No training, no nada, yadah...and was given a case load of 250+ and no computer and no assistant...Imagine that? Five and a half years in the real trenches of workers compensation and I know that SCIF KNOWS BETTER...The particular adjustor on this file has let herself become biased by reading only the claim notes and therefore, perpetuating an error that had been going on for 8 years..denying admitted body parts, denying treatment, cutting off benefits...etc...THIS WAS AN ADMITTED INJURY ON BASICALLY ALL BODY PARTS....The adjustor that I am dealing with admitted to me that she had not even pulled the file and was working off of the claim notes and that she just didn't have time to pull volume 1/10 to really see what's what. Now, thats just wrong in anyones eyes.

3. I never said in any of my statements that all adjustors are bad. What I did say is that we are all overworked and as a perm adjustors, very underpaid and some of the newbies, really should not be handling cases that are verging on excess carrier level. I have made a total pest of myself with other more experienced adjustors and some defense attys that were more than willing to answer my questions on stuff that I had no idea what I was doing.
JEEZ!!!

None of what I said called for a personal slam. Trolling the internet for clients? Cash cow? Now that was uncalled for. Cmon now..haven't you ever thought of calling one of your IW's at home and giving them the 411 on what was really going on? Haven't you felt like giving them Ron Winters name? Eliot Berkowitz?

I really do love what I do, Yadah or I wouldn't be doing it for this many years. But I firmly believe that many IW don't deserve the treatment that they receive from their harried adjustors. I can honestly say that I have never treated an IW as if he/she were nothing. I have always said...."There, but for the grace of god, go I."
I had bilateral ulnar transpositions and was given modified duties..and my adjustor was a complete wench AND developed an attitude towards me even before we talked.....So, yes I do know what its like to be on the receiving end of the comp system and I was fortunate in the fact that I was not the primary bread winning in the family unlike many of our IWs.
As far as burning bridges go...I am sure that I won't be invited to your next bbq...but I do have repetitive business. Maybe its because Im just a nice guy...

motormouth
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Monday March 14, 2005 12:53 PM

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Scrap:
IME's are order by the Judge and paid for by the carrier. If the QME's are bad, PTP is worse, no one can come to any decision, the trier of the fact then grabs the ball and gives it direction by appointing an IME. Then, the IME's decision is supposedly, final.

scrapindee
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Monday March 14, 2005 5:03 PM

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My ? was about having an independent review of my claims files. Also payroll records. Not talking about AMEs/QMEs/IMEs.

motormouth
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Monday March 14, 2005 5:24 PM

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wow...was I way off in my answer or what? I am still laughing....
You can contact me at beequeen59@aol.com...I know several adjustors that do independent evaluations on claim files...The ones that I have done have been for both applicant and defense and usually the one ordering the IME will be the one paying...Sorry...too funny...meanwhile..home sick and trying to do a file review...

donkottler
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Tuesday September 13, 2005 1:18 AM

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I am not a legal person, just an IW, but I went here looking for a legal answer. I had to reply because I was injured 7 years ago. The IC has delayed and denied continuously from the beginning. I was on state disability one year, have had a neck fusion that did no take, had a lumbar back surgery, then a redo at the VA Hospital(8mm bulge on nerves) because of delay of IC. After 1 12 years of delay, UCLA took out right rib because mri showed pinched nerves, veins, arteries in both shoulders. I have a lot of pain from surgeries, taking Dilauded( morphine derivitive) 4x a day plus es Vicodin, Because of the stress and pain(7-10) every day, two years into this I developed high blood pressure, diabetes, and a heart attack last month where I died but paramedics saved me.

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