I can\’t help but say, might as well throw in the towel on persuading most of these folks, Jim. They are not going to read Berardinelli\’s book. They don\’t know anything about McKinsey and Co. They only know who butters their bread and feeds their families.
Plus, this is a claims website. The companies have indoctrinated their employees to see fraud in a large percentage of claims. That is one the ways they get good people to do bad things, and all the while think they are instead serving the stockholders and humanity. But you have to admit…with the kind of information floating around about how the insurance industry cheats people, it is going to make these poor claims handlers (who are usually, I think, very good people) feel overly sensitive and defensive. You or I would feel the same way. Some of them…not so much Jewel, get so touchy that they start sounding like little rat terriers, ferociously yapping and attacking anytime someone sticks a sharp stick in their cage.
There are damn sure employees who will fake injury or exaggerate it and commit fraud. There are damn sure companies which set up systems that encourage highly sharp and aggressive claims practices, and it happens every day. Both of these facts of life are part of the human condition, and just as sure as there are good people, there are also plenty of crooks.
Jewel doesn\’t sound like a crook. Neither does Tim. \”Polyanna\” and a couple others sound like dunces, but the world needs dummies too, I guess. If they ever get hurt they will be the first ones to file suit and adamantly yell fraud. Now Bubba, he\’s an intelligent man, but Bubba, it does make a difference to have walked a mile in someone else\’s hospital slippers. It makes a difference in outlook.
Thanks to all for your comments. It is what makes the world go round.
Well, it would be wrong for me to comment and pass a judgement on the guy in this story one way or the other, since there is not enough information. I was just making the general point that I think an IW should get what\’s owed them, not 5 or 10 times more. 10 million would seem like a lot to many people, but again we don\’t have enough information in the story to make that judgement. I\’ve said repeatedly that if 10 million is fair in this case, then the guy should absolutely get it.
I\’ve been an IW, and fortunately for me it didn\’t injure my ears. :-)
You know Jewel. If you read back I told you that the information about the fraud was on the national news program and in the papers. Sorry, Couldn\’t tell which news program since it was quite a while ago but it was something like 20/20 or Dateline.
Sure, there are some that have been video taped and were wrong. Thing is, it\’s a very small percentage compared to the actual injured workers out there. I\’ve known people that have lost everything they owned because of WC.
What you don\’t seem to understand is that the insurance companies (WC) are many times more fraudulant then the few that are bucking the system. I can\’t go in and video tape the coverstations of people turning down injured workers. I can\’t prove the kickbacks or the raises they get from it. What I have done is tape a converstation catching my own voc rehab case worker in several lies. I\’ve caught another voc case manager (different company since the other was now gone) secretly altering my medical appointments. These are groups that WC hire to do there dirty work. I know a specialized WC attorney (not mine) who went to an insurance seminar where WC agents (plural) were asking him how to work a case to the advantage of the insurance company. He had to tell them he was NOT an attorney for the insurance company. It is a disgrace! These my dear are all FACTS! Sorry if they aren\’t in the books for you. You will have to take my word on it.
Sorry if you think I\’m not very bright but that is part of your problem. You seem to think that you are better then everyone else for some reason and that\’s just not right. I\’ve also known people that have been video taped. That video wasn\’t used because they did nothing wrong. Your photographers were extremely aggressive. Why is it that the insurance companies won\’t let the doctors do there job??? Not only that but some people including myself have been treated like a criminal for being hurt. That\’s not right either. Many have done nothing wrong other then get hurt. So does that mean that EVERY injured worker is lying??? That\’s how they are treated. No, nothing can be done to the insurance companies, they are never held liable for anything. An insurance company will go out of there way to make the injured workers life a living hell. That is also a fact.
My wish???? Is that every person that works for the insurance company ends up on this system. Only then will they find out exactly the insurance company treats the injured worker. Honestly, there is not enough money to live on from being injured. The monies that are faught for at the end is to maintain medical treatment and medication in the future. Problem is, WC refuses to pay it without a fight. It\’s all figured out in a formula yet WC will drag it out as long as possible. The other thing WC is good at?? Refusing calls, refusing to reply and also refusing to do what was agreed to even after they had signed the papers. If the injured worker did anything like this they are booted from the system. Nothing happens to the insurance company.
Chad, there nothing wrong with making a profit. All these big companies do that but it\’s at the expense of others. Sure make a profit but don\’t sit there and deny honest claims just to make more money. The injured worker doesn\’t look at it that way only the \”business people\” (insurance companies) do.
Sure this is an extremely large amount. I don\’t know the case but if a jury saw the evidence against the company and felt that strongly that this person should recieve such an award then that\’s it. The injured worker proved their case. I personally have never known or heard of a person, other then this case, that ever got a decent settlement. Maybe there is a lesson here to the insurance companies. Maybe it\’s time to quit messing around with the injured worker or they will be caught. Who knows?
I can\’t say either way if the judgement was right or wrong. Only the people that were in the court.
You know Chad, it\’s your ignorance speaking here. Why would you put someone down for there opinion? I happen to agree with Jim. You just don\’t get it.
First of all….. why on earth should the injured worker have to get an attorney to begin with??? Why is it that nothing is done until the injured worker gets an attorney??? That\’s what it takes to get a claim taken care of. That right there tells a person that the insurance company does not play fair. Everyone knows that the injured worker will not get information on there own from an insurance company. They will not treat a person as person. Try treating people as a human being rather then a number that you can delete. You will only learn about his, and I hope it never happens to you…… if you end up on the system. You will have a big change in attitude. How many years are you willing to fight for your health??? How much are you willing to go into debt to fight for your medical? Are you willing to loose your house and your family? That\’s what it comes to when you are injured. We aren\’t talking about a sprain or a strain here either. We are talking true damages to the body that are not repairable or repairable to the point where you suffer everyday and have to take pain medication for the rest of your life. Yes, that\’s a real plus for your future. Not to mention the damage these medications do to you.
Chad- Sorry about the lack of direct deposit. Someone should work on that for you huh?
Charles- I would say that was a well thought out post. Respectful, even if not everyone agrees with your points (and I am not taking either side here).
Can you tell I don\’t have enough to do? I like posting, it gives me something to do. For the record, I do not work in claims. I also do not \”pick sides\” because, like everyone else, I do not have enough info. It\’s funny how Jim always responds to my posts though. I re-read EVERY single comment he had posted before I posted mine. I made sure I wasn\’t confusing any of his reponses with those of nameless (still not convinced they are not one and the same). I saw one direct reference to a source for his \”facts\”-
\”The original WC decision was can be found on the Iowa Worker\’s compensation commission website under \”decisions\”. Look under 2003 decisions for Zimmer v. Norwest Financial.\” Great- a source, but just one. I guess I\’ll give you Colussus even though I don\’t know anything about it. So, two sources.
Then you stated \”Noone has refuted the FACT that insurance company profits for the first 9 months of 06 exceeded 467 billion dollars.\” Where did you get that fact?
I have no problem with your point of view, but I do have a problem with your misrepresentation of mine. And, to me that means you obviously did not read (or you did not comprehend) my posts. So, stop making comments about me. They were stupid, and not only that, extremely immature. I did not insult you, so grow up, ok? Thanks!
Anyway, I am one of those people who thinks the world isn\’t fair. I think the truth should always be told, no matter who is at fault. That means, if the injured worker isn\’t \”lying\” they should win. Conversely, if the injured worker is not really disabled (ie: busted through surveillance), the insurance company should not have to pay. Uhm, isn\’t that what we are all striving for? Fairness? I know it doesn\’t happen, but that was exactly my point.
great post; the world is very unfair and always will be. If it wasn\’t so unfair, I would be in charge of it and have one of my employees post on this site for me!
Ha ha! I say that all the time- \”It is what it is.\” But now, just watch all those activist types jump on you (and me) though and say \”Do something about it!\” Pretty funny since half of us would fight one way and the other half another way. So, there would be no point huh? One can never win.
No, the world isn\’t fair. Sure, it would be nice if the truth came out. I won\’t. Why? Because no one wants to be at \”fault\”. Fault means you did something wrong and must take responsibility. The work place can be a dangerous place at times. This is the reason for employers to have workers comp. To insure that someone who does get hurt is taken care of so the employer doesn\’t have to take it out of there pockets. Just like having car insurance.
If a worker gets injured on the job it\’s an accident not a fault. Once they are on WC the next step is that the employee is let go. Few companies will take an employee back with restrictions. Lets say if the IW now has restrictions canceling out those who are not injured very badly. Minor injuries the employee will usually go back to work. If an IW has severe damage resulting in surgery they will not have a job to come back too. That\’s just the way it is.
Then the IW has to get authorization for doctors appointments. This is where things get messy. When sergury is required the insurance company will fight to keep it from happening. Then you go to mediation and make your arguement. Yes, all the doctors that you have seen said the surgery is a must. The insurance company then says, fine, we will go to court. The court date comes around and low and behold….. the court date is cancelled and your surgeries and all your medical is approved. In the meantime, you have spent months in pain trying to get relief from pain and so on. More damage has now occured due to the delay. If the insurance company would just accept the results from the doctors, let the injured worker get fixed he can heal much faster, go back to work and the insurance company would probably save thousands if not millions of wasted time. Instead, the insurance companies drag it out which creates so many problems. People aren\’t in it for the money, they are wanting to heal and get better.
Why it gets so complicated is beyond me. The insurance company would rather force you out of they system with no care at all. Better yet, if you die they save a bunch more money.
There is a formula for those how have perment damage. Why then does the insurance company want to renig on there own formulas for further medical care or monies for further medications and such? It\’s all laid out but the insurance company won\’t follow there own rules which in turn hurts the injured worker.
It\’s this way, the insurance company has more back with there excuses, loop holes then an injured worker can keep up with. The insurance companies make and change the rules all the time leaving the injured worker out to dry.
I am impressed nameless. You are not claiming to state facts, just presenting your opinions. I agree that SOME insurance companies jerk claimants around (which I have said since almost the beginning) but you are still missing the point that some insureds jerk around the work comp carriers. That is a FACT since there are many surveillance tapes of claimants who are injured yet are working at other businesses and still collecting work comp. That was my only point. I asked for your sources of information to back up your \”facts\” simply to verify their validity. You chose to ignore my (and others\’) request for sources. I had no choice but to believe you made them up. I am sorry that you feel the Work Comp carriers are out to get people. I don\’t believe they should be doing so (as that is certainly not fair); I also don\’t think people should claim they are injured and take money while they feel well enough to work at another job doing the same thing (as that is also unfair).
And I agree with you about fault. But work comp is no fault insurance. So, no matter what the reason, the insurance company needs to pay. But, why should they pay for a non-existent injury? (And I am not referring to this case)
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I can\’t help but say, might as well throw in the towel on persuading most of these folks, Jim. They are not going to read Berardinelli\’s book. They don\’t know anything about McKinsey and Co. They only know who butters their bread and feeds their families.
Plus, this is a claims website. The companies have indoctrinated their employees to see fraud in a large percentage of claims. That is one the ways they get good people to do bad things, and all the while think they are instead serving the stockholders and humanity. But you have to admit…with the kind of information floating around about how the insurance industry cheats people, it is going to make these poor claims handlers (who are usually, I think, very good people) feel overly sensitive and defensive. You or I would feel the same way. Some of them…not so much Jewel, get so touchy that they start sounding like little rat terriers, ferociously yapping and attacking anytime someone sticks a sharp stick in their cage.
There are damn sure employees who will fake injury or exaggerate it and commit fraud. There are damn sure companies which set up systems that encourage highly sharp and aggressive claims practices, and it happens every day. Both of these facts of life are part of the human condition, and just as sure as there are good people, there are also plenty of crooks.
Jewel doesn\’t sound like a crook. Neither does Tim. \”Polyanna\” and a couple others sound like dunces, but the world needs dummies too, I guess. If they ever get hurt they will be the first ones to file suit and adamantly yell fraud. Now Bubba, he\’s an intelligent man, but Bubba, it does make a difference to have walked a mile in someone else\’s hospital slippers. It makes a difference in outlook.
Thanks to all for your comments. It is what makes the world go round.
Well, it would be wrong for me to comment and pass a judgement on the guy in this story one way or the other, since there is not enough information. I was just making the general point that I think an IW should get what\’s owed them, not 5 or 10 times more. 10 million would seem like a lot to many people, but again we don\’t have enough information in the story to make that judgement. I\’ve said repeatedly that if 10 million is fair in this case, then the guy should absolutely get it.
I\’ve been an IW, and fortunately for me it didn\’t injure my ears. :-)
You know Jewel. If you read back I told you that the information about the fraud was on the national news program and in the papers. Sorry, Couldn\’t tell which news program since it was quite a while ago but it was something like 20/20 or Dateline.
Sure, there are some that have been video taped and were wrong. Thing is, it\’s a very small percentage compared to the actual injured workers out there. I\’ve known people that have lost everything they owned because of WC.
What you don\’t seem to understand is that the insurance companies (WC) are many times more fraudulant then the few that are bucking the system. I can\’t go in and video tape the coverstations of people turning down injured workers. I can\’t prove the kickbacks or the raises they get from it. What I have done is tape a converstation catching my own voc rehab case worker in several lies. I\’ve caught another voc case manager (different company since the other was now gone) secretly altering my medical appointments. These are groups that WC hire to do there dirty work. I know a specialized WC attorney (not mine) who went to an insurance seminar where WC agents (plural) were asking him how to work a case to the advantage of the insurance company. He had to tell them he was NOT an attorney for the insurance company. It is a disgrace! These my dear are all FACTS! Sorry if they aren\’t in the books for you. You will have to take my word on it.
Sorry if you think I\’m not very bright but that is part of your problem. You seem to think that you are better then everyone else for some reason and that\’s just not right. I\’ve also known people that have been video taped. That video wasn\’t used because they did nothing wrong. Your photographers were extremely aggressive. Why is it that the insurance companies won\’t let the doctors do there job??? Not only that but some people including myself have been treated like a criminal for being hurt. That\’s not right either. Many have done nothing wrong other then get hurt. So does that mean that EVERY injured worker is lying??? That\’s how they are treated. No, nothing can be done to the insurance companies, they are never held liable for anything. An insurance company will go out of there way to make the injured workers life a living hell. That is also a fact.
My wish???? Is that every person that works for the insurance company ends up on this system. Only then will they find out exactly the insurance company treats the injured worker. Honestly, there is not enough money to live on from being injured. The monies that are faught for at the end is to maintain medical treatment and medication in the future. Problem is, WC refuses to pay it without a fight. It\’s all figured out in a formula yet WC will drag it out as long as possible. The other thing WC is good at?? Refusing calls, refusing to reply and also refusing to do what was agreed to even after they had signed the papers. If the injured worker did anything like this they are booted from the system. Nothing happens to the insurance company.
Chad, there nothing wrong with making a profit. All these big companies do that but it\’s at the expense of others. Sure make a profit but don\’t sit there and deny honest claims just to make more money. The injured worker doesn\’t look at it that way only the \”business people\” (insurance companies) do.
Sure this is an extremely large amount. I don\’t know the case but if a jury saw the evidence against the company and felt that strongly that this person should recieve such an award then that\’s it. The injured worker proved their case. I personally have never known or heard of a person, other then this case, that ever got a decent settlement. Maybe there is a lesson here to the insurance companies. Maybe it\’s time to quit messing around with the injured worker or they will be caught. Who knows?
I can\’t say either way if the judgement was right or wrong. Only the people that were in the court.
You know Chad, it\’s your ignorance speaking here. Why would you put someone down for there opinion? I happen to agree with Jim. You just don\’t get it.
First of all….. why on earth should the injured worker have to get an attorney to begin with??? Why is it that nothing is done until the injured worker gets an attorney??? That\’s what it takes to get a claim taken care of. That right there tells a person that the insurance company does not play fair. Everyone knows that the injured worker will not get information on there own from an insurance company. They will not treat a person as person. Try treating people as a human being rather then a number that you can delete. You will only learn about his, and I hope it never happens to you…… if you end up on the system. You will have a big change in attitude. How many years are you willing to fight for your health??? How much are you willing to go into debt to fight for your medical? Are you willing to loose your house and your family? That\’s what it comes to when you are injured. We aren\’t talking about a sprain or a strain here either. We are talking true damages to the body that are not repairable or repairable to the point where you suffer everyday and have to take pain medication for the rest of your life. Yes, that\’s a real plus for your future. Not to mention the damage these medications do to you.
Chad- Sorry about the lack of direct deposit. Someone should work on that for you huh?
Charles- I would say that was a well thought out post. Respectful, even if not everyone agrees with your points (and I am not taking either side here).
Can you tell I don\’t have enough to do? I like posting, it gives me something to do. For the record, I do not work in claims. I also do not \”pick sides\” because, like everyone else, I do not have enough info. It\’s funny how Jim always responds to my posts though. I re-read EVERY single comment he had posted before I posted mine. I made sure I wasn\’t confusing any of his reponses with those of nameless (still not convinced they are not one and the same). I saw one direct reference to a source for his \”facts\”-
\”The original WC decision was can be found on the Iowa Worker\’s compensation commission website under \”decisions\”. Look under 2003 decisions for Zimmer v. Norwest Financial.\” Great- a source, but just one. I guess I\’ll give you Colussus even though I don\’t know anything about it. So, two sources.
Then you stated \”Noone has refuted the FACT that insurance company profits for the first 9 months of 06 exceeded 467 billion dollars.\” Where did you get that fact?
I have no problem with your point of view, but I do have a problem with your misrepresentation of mine. And, to me that means you obviously did not read (or you did not comprehend) my posts. So, stop making comments about me. They were stupid, and not only that, extremely immature. I did not insult you, so grow up, ok? Thanks!
Anyway, I am one of those people who thinks the world isn\’t fair. I think the truth should always be told, no matter who is at fault. That means, if the injured worker isn\’t \”lying\” they should win. Conversely, if the injured worker is not really disabled (ie: busted through surveillance), the insurance company should not have to pay. Uhm, isn\’t that what we are all striving for? Fairness? I know it doesn\’t happen, but that was exactly my point.
great post; the world is very unfair and always will be. If it wasn\’t so unfair, I would be in charge of it and have one of my employees post on this site for me!
it is what it is.
Ha ha! I say that all the time- \”It is what it is.\” But now, just watch all those activist types jump on you (and me) though and say \”Do something about it!\” Pretty funny since half of us would fight one way and the other half another way. So, there would be no point huh? One can never win.
Too bad :(
No, the world isn\’t fair. Sure, it would be nice if the truth came out. I won\’t. Why? Because no one wants to be at \”fault\”. Fault means you did something wrong and must take responsibility. The work place can be a dangerous place at times. This is the reason for employers to have workers comp. To insure that someone who does get hurt is taken care of so the employer doesn\’t have to take it out of there pockets. Just like having car insurance.
If a worker gets injured on the job it\’s an accident not a fault. Once they are on WC the next step is that the employee is let go. Few companies will take an employee back with restrictions. Lets say if the IW now has restrictions canceling out those who are not injured very badly. Minor injuries the employee will usually go back to work. If an IW has severe damage resulting in surgery they will not have a job to come back too. That\’s just the way it is.
Then the IW has to get authorization for doctors appointments. This is where things get messy. When sergury is required the insurance company will fight to keep it from happening. Then you go to mediation and make your arguement. Yes, all the doctors that you have seen said the surgery is a must. The insurance company then says, fine, we will go to court. The court date comes around and low and behold….. the court date is cancelled and your surgeries and all your medical is approved. In the meantime, you have spent months in pain trying to get relief from pain and so on. More damage has now occured due to the delay. If the insurance company would just accept the results from the doctors, let the injured worker get fixed he can heal much faster, go back to work and the insurance company would probably save thousands if not millions of wasted time. Instead, the insurance companies drag it out which creates so many problems. People aren\’t in it for the money, they are wanting to heal and get better.
Why it gets so complicated is beyond me. The insurance company would rather force you out of they system with no care at all. Better yet, if you die they save a bunch more money.
There is a formula for those how have perment damage. Why then does the insurance company want to renig on there own formulas for further medical care or monies for further medications and such? It\’s all laid out but the insurance company won\’t follow there own rules which in turn hurts the injured worker.
It\’s this way, the insurance company has more back with there excuses, loop holes then an injured worker can keep up with. The insurance companies make and change the rules all the time leaving the injured worker out to dry.
I am impressed nameless. You are not claiming to state facts, just presenting your opinions. I agree that SOME insurance companies jerk claimants around (which I have said since almost the beginning) but you are still missing the point that some insureds jerk around the work comp carriers. That is a FACT since there are many surveillance tapes of claimants who are injured yet are working at other businesses and still collecting work comp. That was my only point. I asked for your sources of information to back up your \”facts\” simply to verify their validity. You chose to ignore my (and others\’) request for sources. I had no choice but to believe you made them up. I am sorry that you feel the Work Comp carriers are out to get people. I don\’t believe they should be doing so (as that is certainly not fair); I also don\’t think people should claim they are injured and take money while they feel well enough to work at another job doing the same thing (as that is also unfair).
And I agree with you about fault. But work comp is no fault insurance. So, no matter what the reason, the insurance company needs to pay. But, why should they pay for a non-existent injury? (And I am not referring to this case)