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Workers Comp In The Us The spectre of things to come for NZ?

#1 User is offline   Kiwee 

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Posted 08 December 2003 - 10:56 PM

Seen on site:

Recall Mandate: Gov Davis' Anti-Labor Attack on Workers' Compensation
by Ready to Recall Tuesday September 16, 2003 11:29 AM [ignore Ready to Recall] [read more Ready to Recall]

Death penalty Democrat Gov Gray Davis made sure we should support his recall by signing a reactionary Workers' Compensation bill on 9/12/03, slashing Workers' Comp. benefits.

Death penalty Democrat Gov Gray Davis made sure we should support his recall by signing a reactionary Workers' Compensation bill on 9/12/03, slashing Workers' Comp. benefits.

This bill came about because the retail business Costco and aerospace company Boeing threatened to leave California unless their Workers' Comp premiums were reduced.

There cuts were made swiftly by Democrats and Republicans together, unlike the passage of a budget or the solving of our energy problems, much less solving all of the problems of California, which always take a long time, and in the case of the problems, are never seriously addressed.

According to the World Socialist Website, 9/15/03, at,
"* Fees to doctors and outpatient clinics will be reduced to the Medicare level, and pharmacy charges to the Medi-Cal level. As a result, many providers and pharmacies will refuse to serve workers’ compensation beneficiaries, or will force them to make up price differentials out of their own pockets.

* Workers’ visits to chiropractic and physical therapy clinics, which presently can continue so long as the treatment is beneficial, will be capped at 24. Like most arbitrary caps, this particular “reform” falls hardest on the most seriously injured workers, who sometimes require months, if not years, of therapy to mitigate the pain and disabling effects of work injuries. For those too disabled to return to their former jobs, unlimited access to vocational training programs will be ended, and replaced with a more restrictive voucher system.

* There will be stricter guidelines on how often workers can file for benefits and on what kinds of treatments will be available. Employers will have a full year, rather than 30 days, to contest a worker’s claim. Employers will, moreover, have the right to compel workers to obtain a second opinion on back injuries."

While the capitalist press likes to give one the impression that workers' are abusing the current Workers' Comp system en masse, the facts are:

"According to a recent study by the state Division of Workers Compensation, 40 percent of injured workers received no workers’ compensation benefits at all. Those who do obtain compensation are, for the most part, paid much less than someone injured off the job by negligence, such as in an automobile accident."

As to the alleged fraud:
"The system is indeed riddled with fraud, but not at the hands of workers. Insurance companies, health care providers and drug firms inflate prices, bill unnecessarily, wrongfully deny claims, and milk billions of dollars out of the system. They should be penalized, not the workers who are victimized by their unscrupulous methods."

As to the claim that the cuts were needed to save jobs from leaving the state:
"One might just as well call for government subsidies to burglars to dissuade them from breaking into people’s homes and stealing their goods!"
"The unstated premise behind the claim of “saving jobs” is the complete subordination of human needs and the social good to corporate profit, the outcome of which is a never-ending decline in the standard of living of working families. The implication is that workers have no legitimate interests or needs that are in conflict with, or in any way independent of, the profit requirements of the bosses. In other words: “What’s good for the master is good for the slave!”

An alternate program that strengthens the Workers' Comp program in favor of the needs of the workingclass is stated in the above article as follows:
"* Safeguard workers’ health and safety.

Rigorously enforce all existing standards and laws to protect workers against injury and illness

Strengthen health and safety provisions to reduce on-the-job injuries and minimize worker exposure to toxic substances

Allow employees to refuse to work under unsafe conditions

Vigorously prosecute in civil, and where appropriate, criminal court, all employers found in substantial breach of health and safety regulations

* Eliminate fraud by taking profit out of health care. Establish a government-managed system to provide quality health care for all.

Transform the big insurance firms, health care giants and pharmaceutical monopolies into public utilities, run under the democratic control of the working people

Build new health and rehabilitation facilities, and train new health care workers to meet the needs of injured and disabled workers

Pay injured workers full salaries until they can return to work"

Socialists are evenly split on the recall, this writer, being in the Yes camp, says:
Vote Yes on the Recall!
Vote Socialist for Governor: John Christopher Burton at or
C.T. Weber at or
Vote No on 53 and 54!

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Posted 25 December 2003 - 12:19 AM

Welcome To Allstate Insurance
Allstate Insurance Bad Faith Public Awareness Campaign

Insurance Bad Faith Public Awareness Campaign

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Posted 04 September 2004 - 08:53 PM

Injured Workers 4

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Posted 03 December 2004 - 09:45 PM

Here is a Pennsylvania injured Support site featuring the Pennsylvania worker's compensation system.

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Posted 03 December 2004 - 09:48 PM

they had these interesting links too :) - Worker Compensation message board - The Bureau of Workers' Compensation home page. - This site will give you all biographic information of all elected officials within your districts state and federal officials. It also gives their mailing addresses as well as their e-mail addys. - This attorney group has graciously provided the entire Pa Worker Compensation Statute on their site. It is easily obtainable. Please take a look. - This is the national site of our organization. It is filled with mounds of information. Please check it out, you will find it very valueble. - Want to do some research on legal case opinions go to this site, you will sure be able to find what you need.

http://www.members.a...ak101/index.htm - Mike is an injured worker in Pa, he has so graciously provided information about the current Pa WC system. Please take time and check out his site. - This is an attorney group you may want to check out. You can e-mail the group at [email protected] Thank you Richard Teitell, Esquire for responding to our board.

http://www.princelaw...act/default.htm - This link will provide the entire current Pa Worker Compensation Law with the revisions included, this is a must read if you are injured in this state. - This link provides a wealth of current news throughout the U.S. involving worker compensation issues. Thank you, Jim for providing us with this informative article.

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Posted 19 January 2005 - 01:40 PM

Cause of "toothache" was 4-inch nail in man's skull

By Erin Gartner

The Associated Press


LITTLETON, Colo. — A dentist found the source of the toothache Patrick Lawler was complaining about on the roof of his mouth: a 4-inch nail the construction worker had unknowingly embedded in his skull six days earlier.

A nail gun backfired on Lawler, 23, on Jan. 6 while he was working in Breckenridge, a ski-resort town in the central Colorado mountains. The tool sent a nail into a piece of wood nearby, but Lawler didn't realize a second nail had shot through his mouth, said his sister, Lisa Metcalse.

After the accident, Lawler had what he thought was a minor toothache and blurry vision. On Wednesday, after painkillers and ice didn't ease the pain, he went to a dental office where his wife, Katerina, works.

"We all are friends, so I thought the [dentists] were joking ... then the doctor came out and said, 'There's really a nail,' " Katerina Lawler said. "Patrick just broke down. I mean, he had been eating ice cream to help the swelling."

A dental office X-ray shows the nail, which was embedded when a nail gun backfired while Lawler was working.
He was taken to a suburban Denver hospital, where he underwent a four-hour surgery. The nail had plunged 1-1/2 inches into his brain, barely missing his right eye, Metcalse said.

Lawler told KUSA-TV in Denver that the nail gun had recoiled and hit him in the mouth. "For six days we were icing it and taking Advil, thinking I got hit real hard, like a punch. Way off!"

Dr. Sean Markey, a neurosurgeon, told KUSA: "This is the second one we've seen in this hospital where the person was injured by the nail gun and didn't actually realize the nail had been imbedded in their skull.

"But it's a pretty rare injury."

Lawler was recovering yesterday in the hospital, where he was expected to spend several more days. Despite his lack of medical insurance and hospital bills of between $80,000 and $100,000, Katerina Lawler said her husband is in good spirits.

"The doctors said, 'If you're going to have a nail in the brain, that's the way you want it to be,' " she said. "He's the luckiest guy, ever."

A dental office X-ray shows the nail, which was embedded when a nail gun backfired while Lawler was working.

Attached File(s)


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Posted 19 January 2005 - 01:42 PM

Ths case highlights the benefit of the acc type system - dont be fooled into thinking privatisation is going to improve things, its just the legislation, acc minister, acc board and all former and current CEO's and executive management that need improving and the public informed how things have gone so wrong. use your vote wisely this year.

years ago in NZ using a nail gun used to be a privelidge earnt after proper training and proper certification, you used to get warning before the gun is fired, now days, you lose your hearing because unqualified labourers have replaced trained and experienced tradesmen, visit a building site, many times it is seen labourers call out (often very quietly) "Firing" as they pull the triger, no time to protect the ears. if anyone dare speak up, life is made tough, nz is where being popular means more than being qualified and safe.imho.

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Posted 19 January 2005 - 01:54 PM

Opposition Parties Barking Up Wrong Health Tree
Tuesday, 18 January 2005, 4:17 pm
Press Release: Association of Salaried Medical Specialists


Opposition Parties Barking Up Wrong Health Tree

''Opposition parties ACT and National are barking up the wrong health tree with their proposal to contract out public hospital work to the private sector,'' said Mr Ian Powell, Executive Director of the Association of Salaried Medical Specialists, today.

“The main reason why too many people are waiting for public hospital treatment is workforce shortages, including doctors and nurses. But the private sector faces a similar difficulty and it does not have a large reserve army of unemployed doctors available to do much extra work. At best it could provide limited short-term assistance around the margins.”

“The most effective solution rests with more effective workforce planning and recruitment strategies. Public hospitals are now better placed to overcome this challenge with the recent successful negotiation of more competitive national collective agreements for senior doctors and nurses.”

“In general contracting out to private hospitals is more expensive, involves more bureaucracy and creates unnecessary fragmentation. We should not forget that contracting out was attempted in the 1990s and failed abysmally.””
Text DONATE to 883 to send $3 to Tsunami relief
“ACT’s health spokesperson Heather Roy is to be commended for asking challenging, but largely unanswered, questions about delays in receiving treatment and senior doctors would share her concern. But her solution is the wrong one,” concluded Mr Powell.

Ian Powell

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Posted 30 January 2005 - 06:27 PM

from SEIU Local 6

While Service Employees International Union Local 6 affirms the value of the The Bon Macy's "Charge for a Change" campaign to promote breast cancer awareness, we note the incredible irony that the store is failing to address the health-care needs of its own janitors.

After four rounds of contract negotiations with SEIU Local 6 janitors, The Bon is sending a message that the health of its janitors is not worth $2.41 per hour. That is the amount the store is balking at paying for full family health-care, including dental and short-term disability, even though over a dozen janitorial firms have already agreed to pay this rate.

"I've been cleaning nasty Bon toilets at 5:00am every work day for over 17 years," said Elaine Johnson, a Bon janitor at South Center who is a member of the union's negotiating team. "It's bad enough that the store only pays me $9.80 per hour, but their refusal to pay for my medical coverage makes me sick!"

Janitorial firms in the Seattle area who do pay for the family insurance for their janitors and their families include American Building Maintenance, Metropolitan Building, Dependable Building Maintenance, Diamond Janitorial, Dunn Janitorial, Pacific Building, Seattle Building Maintenance, and others.

All of these unionized contractors also pay wages for janitors at a much higher rate than The Bon does.

"The Bon tries to project a compassionate, responsible image to the community," said Sergio Salinas, President of SEIU Local 6, "Yet the reality of their internal practices harshly contradicts their public relations."

"The Bon can afford to purchase full-page color ads in the Sunday Seattle Times to promote breast cancer awareness like it did on October 3, yet it can't pay janitors' health costs of $2.41 per hour? For crying out loud!" added Sarah Luthens, lead negotiator for the union janitors.

As of this writing, the next round of contract negotiations has not been scheduled. A federal mediator, Andy Hall, has been called in for assistance.


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Posted 01 February 2005 - 07:58 PM


I know a lot of you have to deal with hospitals, which are becoming increasingly mean-spirited. Here is an example:

Tax-Exempt Hospitals' Practices Challenged
46 Lawsuits Allege That Uninsured Pay the Most

By Ceci Connolly
Washington Post Staff Writer
Saturday, January 29, 2005; Page A01

TUPELO, Miss. -- When Tim Gardner was born at the hospital here 53 years ago, it was just "one little building on the hill" in a town best known as Elvis Presley's birthplace.

>From those humble beginnings, North Mississippi Medical Center has grown into the largest non-metropolitan hospital in the country, a booming enterprise with a complex of glass and marble buildings and 40 satellite clinics stretching into Alabama and Tennessee. The company, incorporated in Delaware, has nearly $300 million in the bank and "exceptional profitability," according to one Wall Street rating agency.

And it pays no taxes. As one of 4,800 nonprofit U.S. hospitals, North Mississippi Medical Center is exempt from federal, state and local taxes in return for providing care to "charity patients."

But when Gardner, who is uninsured and suffers from heart trouble, asked for more time to pay off a $4,500 bill, the response came in the form of a summons. The hospital sued him for the balance plus $1,100 in legal fees.

Now Gardner and hundreds like him are at the center of a nationwide battle over whether nonprofit hospitals -- often flush with cash, opulent buildings and high-paid executives -- are fulfilling their mission as charitable institutions. Since last spring, a phalanx of trial lawyers who made millions suing asbestos makers and tobacco companies have been targeting tax-exempt hospitals, accusing them of gouging the poor.

"I was paying the best I could," said Gardner, who on his $18,000-a-year cook's salary had managed to pay $1,000. "I'm not trying to run. At the end of that week I was going to pay them some more."

Forty-six suits have been filed in 22 states, including one against Virginia's Inova Health System, alleging the hospitals violate their tax-exempt status by charging uninsured patients the highest rates and employing abusive tactics to collect.

"Their goal is to discourage these uninsured patients from returning," said Richard F. Scruggs, the lead attorney. "If they paid taxes, I couldn't complain. But these hospitals are given freedom from taxation for doing something."

Included in the cases is a California hospital with $1 million in an offshore bank account, another in Louisiana that owns a luxury hotel and health clubs, and a Georgia hospital that flew its executives on private jets to meetings in the Cayman Islands and Florida's Amelia Island. Because private insurers and the government negotiate deep discounts for their clients, the uninsured are usually the only ones charged the list price -- up to six times as much as for insured patients.

The American Hospital Association (AHA), which is a co-defendant in many suits, says hospitals are among the most generous businesses in the nation and it is unfair to blame them for a larger societal problem.

"Mr. Scruggs is seeking to use the courts to reform the health care system," said AHA executive vice president Rick Pollack. "We don't think lawsuits are the answer to the problem of the uninsured."

Scruggs does not disagree, but he is pessimistic that politicians will tackle a system in which 45 million people are without insurance and those with coverage are paying double-digit premium increases.

"Where you have entrenched, vested, financial interests versus no organized national effort on behalf of patients, the effort is not likely to succeed in Congress," said Scruggs, the brother-in-law of Sen. Trent Lott (R-Miss). "Courts have traditionally stepped in to the breach as a safety net when the political branch couldn't act."

The legal fight has been slow going. A federal panel of judges refused Scruggs's request to consolidate the cases, and a handful of courts has rejected the argument that uninsured patients have legal standing to pursue hospitals for possible Internal Revenue Service violations.

Last summer, it looked as though Scruggs was on the verge of scoring an early win. North Mississippi Medical Center was ready to deal and sent to the bargaining table former state attorney general Mike Moore, the man who helped Scruggs extract a multibillion-dollar settlement with Big Tobacco.

In the tentative settlement the former allies crafted, North Mississippi agreed to provide free care for patients earning less than 200 percent of the poverty level (about $18,000) and low-priced care for those with incomes up to 400 percent of poverty. The hospital said it would issue refunds to patients in those categories who were treated in the three previous years and would revise its collection practices, according to court documents.

The deal, Scruggs proclaimed, would be a national model, eliminating $150 million in charges over a 10-year period.

Because the hospital collects less than 4 percent of what it charges indigent patients, North Mississippi estimated the cost at $1 million a year, an amount Fitch Ratings Ltd. deemed "relatively immaterial" for a business that bills $1 billion annually and collects about $650 million.

"After reviewing the proposed settlement, there seemed to be little reason to pursue the lengthy litigation of the issue since the proposed discounts are very reasonable," chief executive John Heer said in a news release at the time.

Before approving the deal, however, U.S. District Judge Michael P. Mills ordered the two sides to tighten conflict-of-interest provisions governing relationships between the hospital and its board members.

Little progress has been made since.

Gerard Wages, the hospital's chief operating officer, said in a telephone interview that since word of the tentative agreement got out, North Mississippi has seen its volume of charity care jump, with patients traveling from outside the region for care and some locals "bypassing other hospitals." Some area businessmen have also told him they or their workers were considering dropping insurance to take advantage of the reduced rates in the settlement, he added.

Wages acknowledged that Scruggs's firm has discussed ways to temper those developments, but no final decision has been made.

For people such as Kathy Millican, 50, nothing has changed. After an emergency hysterectomy, she was flooded with bills totaling more than $11,600, she said. With her husband making $12 an hour hauling rocks, the best Millican and her mother-in-law could do was send in periodic checks for $50 or $100.

Bill collectors began calling at odd hours, suggesting she put it all on a credit card or deliver a bank note. After her second request for charity care, the hospital forgave $700 but added $1,000 in finance charges. Last week, she delivered a large plastic bag bulging with medical bills to Scruggs's office and joined the lawsuit.

"I knew they wanted their money, but I didn't know how I could get blood out of a turnip," she said.

Now Scruggs, whose triumph over the tobacco industry was depicted in the movie "The Insider," is back on war footing. From his offices above Oxford's historic square, he coordinates a legal team that includes some of the best-known trial lawyers in Chicago, San Francisco, New York, Atlanta and Missouri.

"This is like moving a mountain," he said during a pause in a blur of conference calls, meetings and even a photo opportunity.

Detractors say the hospital suits are just Scruggs's latest money-and-publicity grab. It is noteworthy, they say, that he has yet to win a round in court. So far, the judges have concluded "it's between those institutions and the revenue service," Mitchell said.

The board chairman boasted that North Mississippi provided $26 million in charity care last year.

But the term "charity care" can be misleading. In most instances, the figure is based on the sticker price for a procedure rather than the much lower amount it accepts from private insurers and Medicare or Medicaid.

"The biggest gimmick they use is charges versus payment," said Rims Barber, a community activist with the Mississippi Human Services Agenda. "They'll bill $1,000 for something, but if Medicare only pays $600 the hospital will write off $400 as charity."

In 2003, the AHA reported that its hospitals provided $25 billion in "uncompensated care costs," which represents charity care and bad debt, adjusted according to a formula to approximate the actual cost of providing the care.

A former Mississippi tax commissioner, at Scruggs's request, calculated that North Mississippi Medical Center's tax exemption was worth about $29 million. IRS filings for fiscal 2003 show that Wages, then the CEO, was paid more than $600,000, in a state where the average salary was $33,000.

Pollack, of the AHA, said nonprofit hospitals need competitive salaries to attract good managers.

All of that galls state Rep. Jamie Franks Jr. (D), who has experienced firsthand North Mississippi's collection procedures. When his wife gave birth to a son last summer, a clerk told him the family could not leave until he paid $1,200. Although he has insurance, Franks had to hand over his debit card and then spent months trying to get reimbursed by his insurers.

"We see people every day wanting to file for bankruptcy, and the main reason is the medical bills from North Mississippi," he said.

Franks is co-sponsoring a bill to bring in a hospital to compete with North Mississippi.

The business practices of nonprofit hospitals are under attack on several fronts. The IRS is said to be investigating management's compensation, and Congress conducted hearings last summer on price-gouging claims. Scruggs and his team, recognizing the federal cases may not work, have begun refiling the suits in state courts.

Gardner, the cook who is a plaintiff in the North Mississippi suit, was surprised to learn that the hospital where he was born pays no taxes, charges uninsured patients higher rates and then picks on people such as him, "a guppy in the overall picture," as he put it.

"Why do they take somebody who is visibly not having an easy time paying but is trying, and kick them when they're down?" he asked. "It's just wrong."

Research editor Lucy Shackelford contributed to this report.




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Posted 11 February 2005 - 10:04 PM

Provident Internal memorandum
To: IDC management Group Glen Felton
From : Jeff McCall
Date : October 2 1995

A task force has recently been established to promote the identification of polices covered by ERISA and to initiate active measures to get new and existing policies covered by ERISA. The advantages of ERISA coverage in litigious situations are enormous: state law is preempted by federal law, there are no jury trials, there is no compensatory or punitive damages, relief is usually limited to the amount of benefit in question, and claims administrators may receive a deferential standard of review. The economic impact on Provident from having policies covered by ERISA could be significant. As an example Glenn Fenton identified 12 claims situations where we settled to $7.8 million in the aggregate. If these 12 cases had been covered by ERISA, our liability would have been between zero and $0.5 million.

In order to take advantage of ERISA protection we need to be diligent and though in determining whether a policy is covered. Accordingly, I have attached a rough draft of questions that should be asked in our claim investigation process. I recommend that it be used for all claims. The key for determining the applicability of ERISA is whether or not the employer 'sponsors' or 'endorses' the plan. If the employer pays the premium, the policy would usually, but not always, be considered to be governed by ERISA. Salary allotment or payroll deductions arrangements, by themselves, do not necessary mean that a policy is subject to ERISA. While out objectives is to pay all valid claims and deny invalid claims, there are gray areas, and ERISA applicability may influence out course of action.

Another requirement needed in order to take advantage of the projection offered by ERISA is to establish a formal appeal process to ERISA situations. When we deny a claim we must include language in out letter that informs the claimant of the right of appeal our decision with in 60 days. I have attached a copy of sample language. The appeal must be in writing and should be reviewed by a panel specifically established to review ERISA appeals. I recommend that the panel composed of Cris Kinback, Bob Parks, Becky Absher, Tom Timpanaro and me.

We will be modifying the salary allotment agreements used at the point of sale to include endorsement language.

I am interested in any comment or feedback you may have on this issue

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