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Thread Title: Should I push for sanctions
Created On Thursday January 22, 2009 8:51 AM

7dayweekend@mindspring.com
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Thursday January 22, 2009 8:51 AM

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Secondary PQME reqeust, letter signed by both attorneys, report done in two weeks, forty pages.

Adjuster calls and says they're not paying for it.

We say, "Your attorney signed the cover letter."

They say, "Too bad, it was a mistake."

We say, "Too bad, it's your mistake, so know it's our fault because we trusted you?"

They say, "We're not paying it."

My thought is that on day 61, file a lien and go for sanctions. The nerve.

Yes, we do have a call into the attorney.

noricorp
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Thursday January 22, 2009 11:35 AM

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What insurance co?

Chirple@earthlink.net
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Friday January 23, 2009 1:50 AM

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Send the bill with a cover letter to the defense attorney reiterating what the adjuster said to you. Notify the attorney that you intend to seek full payment with penalties and interest via lien. That you will NOT back down on penalty and interest 5 years from now when the case is finally settled and you have to pursue your lien and the poor defense attorney is offering up fee schedule to resolve.

Michaelb
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Friday January 23, 2009 8:09 AM

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Zenith tried the exact same thing with me.
They paid after I filed the lien.
Unless you have the reasons for not paying in writing, sanctions will be hard to get.
The carrier will likely just admit to paying late.
Most judges rather chew broken glass than issue sanctions.

I asked for penalty and interest as was paid them.
You will need to use a cover letter outlining it as the new liens do not have space for penalties and interest.

Good luck

appliedpsych
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Friday January 23, 2009 1:14 PM

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Like 'noricorp' asked in an earlier post, what is the insurance company. That would help us all be extra diligent and careful in dealing with them.

Also curious which side the report supported.

stewshe@comcast.net
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Friday January 23, 2009 5:18 PM

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7day,

I'd suggest a letter to the adjuster, confirming your conversation, cc both Defense and Applicant Attorneys, as well as the Claim Supervisor and Claim Manager of the location. Then add a last cc to the Audit Unit. including a complaint form saying, "see attached letter."

That should get the adjuster's attention. I suspect the adjuster will think twice about doing something like this again. They should realize their attorney has authority to bind them to pay for reports requested. It sounds to me as if you have a newby adjuster still wet behind the ears.

In any event, to put icing on the cake, at the bottom of the letter add "Exhibit A," just to let them know you are serious about getting paid!

Good luck!

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ymcgavin@socal.rr.com
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Friday January 23, 2009 6:36 PM

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Hi 7Day,

I agree with Stew in regards to CCing the AA and DA, as well as the Audit Unit. If the AA has any sense, he will seek a LC 5814 penalty.

In regards to the Audit Unit, today, I see them as a toothless tiger. About a year ago, just after the last manager retired, Bob Walensa, I dropped in to visit with their office in SAC and had a chat. I will not reveal with whom I chatted, but from what I heard, nothing is really being done. The news story about UR and audits, here on WCC earlier this week, supports my theory that in reality, nothing is being done.

While there, I asked one of the Audit Unit employees about how they were doing on audits, in particular, for the close to 100 specific UR complaints submitted by me, with all the attached documentation necessary to prove-up my assertions. The person I spoke with told me that "We have been doing random audits and have found widespread compliance."

I responded by asking, once again, whether they had looked at the specific files for which I had submitted a complaint. Again, I was told: "We have been doing random audits and have found widespread compliance."

I scratched my head, then asked that person at the Audit Unit to answer my question. That person again gave me the canned response: "We have been doing random audits and have found widespread compliance."

(During this visit, another Audit Unit employee informed me that the Audit Unit had, in essence, been defunded, and that they had to hire temps to conduct "random audits" --- so I am not surprised at the the WCC news story. Considering our current 'budget crisis,' I do not see any targeted audits in the near future.)

As much as I dislike seeing this type of inaction, I believe that we will not see a zealous Audit Unit like we had when Casey Young was our AD, and Mark Johnson was the Manager of the Audit Unit --- until this governator is gone with the wind in 2011 --- and then, only if we get a progressive governor.

As a sidenote, I am tempted to download all the LC 5814 penalty convictions, outlined in the WCAB panel decisions here on WCC, for the purpose of seeing if any IC or TPA has sustained at least 2 different LC 5814 penalty convictions --- the minimum number necessary to qualify for a LC 5814.6 conviction.

It might be interesting to publish an "open letter" to the DWC with evidence that some entity, such as SCIF in SAC, has sustained 2, 3, or 4, LC 5814 penalties that were upheld on appeal, and publicly ask if there will be any action taken.

Hmmmm. If only I had more hours in the day. If somebody else wants to do this, consider that you can get full access to all WCAB panel decisions, since July of 2007, for one month at a cost of $35.00. (I'm sure that David will correct me if I am wrong about the pricing.)

York McGavin
ymcgavin@socal.rr.com

Zorro
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Friday January 23, 2009 8:24 PM

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Nothing important here... or below.

Edited: Friday January 23, 2009 at 8:28 PM by Zorro

Zorro
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Friday January 23, 2009 8:27 PM

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"We have been doing random audits and have found widespread compliance." Just another facet to the same system.

Nothing is going to change until the ones really affected, namely, the IW's, get into the act, but don't hold your breath. The whole thing, as I said before, is deterministic, a fancier way of saying que ser￡, ser￡. If you dont complain loudly enough, you're not hurt that badly. Don't bother us.

Perhaps Garamendi.... What am I saying?? Nothing will change substantively.

Z

TOBDNCNG@aol.com
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Saturday January 24, 2009 5:47 AM

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VotersInjuredAtWork.org (VIAW.org) is working on legislation on behalf of injured workers. We don't do anything that I know of in the area of sanctions though. I could be wrong though. Will David correct me if I am wrong? LOL

You can go to our website to see some of what we are doing.

Be well York, And thanks for all you do for your clients and us! I would still like to work for you someday if I can ever get to feeling better.

Glowing,

Marygrace~

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