Regarding the lien reqs. (California)

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Re: Regarding the lien reqs. (California)

Postby drh@palmmedical.com on Wed Dec 12, 2012 2:43 pm

Ozzie,

I enjoyed your wit but none the less there was a lot of none sense mixed in there.

So the next “painter” that walks thru the front door with a broken wrist having 30 mins ago fallen off a ladder will be sent home and he will understand it’s all pending authorization to treat and acceptance of the work order proposed? I guess we won't take an X-ray or issue a wrist brace and submit that expedited 72 hour review may be he hit his head also..okay get a CT scan requested expedited after the claim has been filled, tic tic tic , assigned a claims admin and the second fax had been sent to UR (they probably never got the first one even though we have a confirmation, so sent it in again, no worried that happens). Then we can again submit a new request to have the patient seen by Ortho, who will then see the EE and submit an expedited request for a reduction procedure, or the Neurosurgeon for a post CT Brain bleed to monitor the patient. All of which I can tell you has happen just this year. So these endless rules to police the medical thugs makes the real life day to day care of the injured complicated, endangered and delayed right into the hands of representation. Or do we pull string, make calls to docs we know and get the patient care today, not knowing if our reward will be a $150 lien filing fee or $325 IBR .

Yes welcome to real word where if you end up at a provider that follows every idiotic legislative rule, you might end up maimed or dead.
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Re: Regarding the lien reqs. (California) (California)

Postby ozzie on Wed Dec 12, 2012 7:27 pm

Don't blame me; blame the guys and gals who pulled scams that created this new approach.

What I saw, and every other DA I know of, and what the applicant attorneys I know thought of as a "fun game" to play while making $300k, $400k, and much, much, more, was to run willing co-scammers through the scamming mills and walk away with pockets full of money, laughing all the way to the bank. None of them felt in the least bit guilty, sort of like the Enron cheats and bullies laughing about all the old ladies they burned out making millions.

Same thing happened to penalties: probably a good idea, but certain attorneys made zillions pumping the system for more,more,more, and now - they're almost gone.

And don't just believe me: believe the commissioners, many of them applicant's attorneys, sitting on hundreds of thousands of lien claims still out there; read the Tito case; Google some statistics; check with employer and insurance groups. The scandals were truly scandalous, almost beyond belief. But not quite: they were actual, real, scandals.

Left holding the bag, and the broken arms, are the really injured workers, the real treaters, and a lot of other deserving folks. Killed the goose, folks.
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Re: Regarding the lien reqs. (California)

Postby bvpharmacy on Thu Dec 13, 2012 10:13 am

Ozzie you are so out of touch. The insurance carriers run this industry. The Insurance carriers draft and create every law and regulation, the applicant attorneys never have any say in the legislation or regulations. The insurance carriers are more interested in finding defense attorneys who will work for a flat fee per case, they do not care about results, they just want to show their supervisor the have lowered their litigation cost, if they pay more indemnity. they raise the employers rate. You talk about attorneys making 300K etc, what does the vp at the insurance carrier make, Warren Buffet is in the WC business. How many case have you tried to take nothing when you know the applicant is a fruad? How many have you C&Rd?
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Re: Regarding the lien reqs. (California)

Postby ozzie on Thu Dec 13, 2012 11:35 am

So, I'm out of touch, but comp carriers make so much money they control the world? Then why did CIGA have to pick up so many? And why is there a trial system at all? And why are all those thousands upon thousands of lien cases sitting there with the commisioners so angry about them? All the defense attorneys are lazy sell-outs, and I'm one? You're really not worth the bother.
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Re: Regarding the lien reqs. (California)

Postby bvpharmacy on Thu Dec 13, 2012 11:52 am

Ask the judges. There is no lien problem. Only LA and Long Beach have a back log. Deidra Frank was sent to examine the problem and freaked out, the numbers do not support their statements. They all claim lien problems but they do not have proof to back it up. How many outstanding liens would we have if you sent notice to all lien claimants and actually tried the liens when you C&Rd a case? Do you do cases for a flat fee? How many doctors depos do you do on those cases? CIGA? When your clients got rid of the the Minimum rate law they then dropped their rate to put the small carriers out of business, and the raised rates and controlled the market. When you say the insurance carriers and employers are innocent bystanders in this system you are either towing the party line are uninformed.
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Re: Regarding the lien reqs. (California)

Postby jpod on Thu Dec 13, 2012 1:44 pm

bvpharmacy: Where did you get the statistic that 90% of all cases are C&R'd? That is not even remotely close in my experience. Maybe you mean of those that are contested 90% are settled by C&R but even that figure is way too high especially for the self insurers.

Medical only claims make up the majority of cases to begin with (I have worked at places where MO claims were 80% of the volume but I think 50% is a better figure state wide), indemnity cases with no PD would be second, indemnity cases with PD settled administratively without a hearing but with a stipulation with open medical approved by a judge would be next. Disputed cases that are compromised would be next and tried cases would probably be last.
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Re: Regarding the lien reqs. (California)

Postby bvpharmacy on Thu Dec 13, 2012 1:48 pm

90% of litigated cases. Litigated cases make up most of the cost in California
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Re: Regarding the lien reqs. (California)

Postby spreare on Thu Dec 13, 2012 3:38 pm

To Ozzie,

I was thinking you are so surprised regarding the amount of profiteering in the system when we live in a capitalistic society and the role of every business it to come up with a business model that maximizes profits. Until we turn into a socialistic society that's how its going to be in healthcare or any industry. It just so happens that in this case the legislator believed that in order to help preserve capitalism,(ie lower employer costs) they had to "reform" the system" and make it harder for providers to make a profit. That's all this is. All I can say as a DC in this system I gave it my best and do what I can to be "fair and balanced" whether its doing a PQME, or treating a patient. Did I take liens? Oh yeah, lots of them. I didn't want to hassle with UR, because I cannot stand a doc in another part of the country who never had face to face with the patient, wearing underwear and drinking coffee, making decisions about my patient -- no to mention the large number of denied claims that I have taken and have necessitated liens.
So what am I doing now? well see. cutting down QME locations from 13 to 10. :(
Taking more regular folks, cash, ins,pi, medicare, to make up for my expected losses in this work comp system that I has been good to me and my family. Oh, and Celexa too.
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Re: Regarding the lien reqs. (California)

Postby ozzie on Sat Dec 15, 2012 1:11 pm

I like that bizarre idea that this is capitalism and "everything goes." It gives the blow-off to those of conservative bent who argue so strongly against legalizing prostitution, dope smuggling, child prono, you name it. I'm sure that under such theories, my taking your car, money, house, etc. by use of assault rifle is completely OK. It is, after all, free enterprise. As is my dumping of lead, mercury, and radioactive waste where I want, especially if its my own property. Or property I took from you, which is now mine by right of better force.

Our society, however, is built on a system of laws, first, so that normal human expectations are generally fulfilled - e.g., someone gives a promise, we promise in return, and we all expect the promises to be performed; we expect others to respect our lives and our property; and so on. Second, laws prevent others from taking actions that the rest of society believes are inappropriate: we don't draw and quarter folks of other political persuasions, or petty thieves, or even murderers, and we prohibit dumping toxic waste wherever we want, even if it is our property. Now.

Proceeding under the concept that "this is capitalism and cheating is ok" works for some in Wall Street and many other big businesses, but its still cheating.
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Re: Regarding the lien reqs. (California)

Postby spreare on Sat Dec 15, 2012 1:55 pm

Ozzie in another post you said that workers comp is not supposed to be about all these people making money, but about providing benefits to IW. I hope I didn't misstate. But what happens is, people go to work everyday and try and make a living. for example, I go to work everyday and try to make a living as a DC treating patients in the system. So, for me, it becomes about me earning a living and supporting my family. none of the providers, AA, etc are supposed to work for free, or within a socialistic system. Everyone in business, including the firm you work for, is for profit. So when you say sarcastically, "everything goes, like on Wall street," now you are getting into the ethics of business practice, and not everyone runs their business for ethics. Many businesses put profit above ethics, that's why their is over-utilization of treatment in workers comp, medicare, private ins, etc. There are some great providers out there that only do things that are essential to the patient, and never do procedures for the effect it will have on their production. If we had all providers like that there would be much less need for regulation. All I am saying is, don't be surprised we got where we are. We have a capitalistic form of economy. The pigs get fat sometimes in capitalism, and when they get too fat, at the expense of other piggies, they fat ones get slaughtered.
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