claymont......this is a horror story in action.......I've tried to get the attention of Hausfeld, LLC, which is the most famous social injustice pro bono type law firm around.......they've won something like 4 billion dollars in awards under class action suits........I am screwed because of AB 899 and my final award will be calculated by formulas, etc. There's no judge or jury award on workers comp cases in California and I believe 11 other states that have enacted similar changes to their WC laws........Get this......ready....
In the state of California, workers comp insurers are "held totally harmless from any and all bad faith claims" and the maximum penalty that can be levied is limited to $10,000 maximum. So denying treatment and surgeries for as long as possible allows the insurers to keep millions of dollars invested and at the worst case, the firm could be fined $10,000 and the insurers could still disobey the court's instructions......pay the fine......but still deny treatment.
We have laws enacted long ago to protect against child labor and we also have laws passed that require employers to provide workers comp insurance protection for injured workers. The employer hires the insurance firm and it's the insurance firms that are abusing the law. And nothing can be done since the insures can't be sued for acting in bad faith.......they are indemnified in CA & 11 other states.
My employer hasn't done anything wrong and can't do anything to help. The workers comp insurance firm is Sedgwick.......People....do a Google search "Romano vs.Kroeger-Sedgwick".........Mr. Romano was a CA grocery worker that died from complications from undergoing shoulder surgery resulting from a workers comp injury. Do the google search and read how Sedgwick killed Mr. Romano and the District Attorney Office wants to file criminal charges against Sedgwick and the case adjuster specifically.
Okay....back to your query......7/10/2009....a Friday......I'm on the job site at a large food processor for the installation of two new large boilers. I install and service chemical treatment systems for commercial/industrial/hospital heat & cooling sytems & waste water treatment. So I'm on site making sure the piping and fittings, valves and sample ports are installed properly and I also have to do the boiler start-up etc. I took a shortcut to my truck and someone called my name which caused me to turn around but not stop walking. The 6" piping was stacked right next to me and my field box caught the top pipe which cause the stacked pipes to avalanche to the ground......the pipes hit my foot and ankle and lurched me sideways and I landed on my left shoulder.....well, it was a really.bad fall that lead to rotator cuff surgery in Sept. 2009.......and I returned to work January 10, 2010.
Anyone that is over 55 yrs old that's had rotator cuff surgery knows you lose appreciable arm strength after surgery. I sure did and so basically I had to do my work essentially relying on my right arm and it's physically hard work......cleaning cooling towers, descaling heating & cooling systems, installing & maintaining equipment & water systems in the field, etc. Cooling towers often require climbing 25 ft ladders and pulling up 55 lb. pails of dry chemical to the cat walk of the towers, moving & positioning 55 gallon drums of liquid chemical that weigh 450-500 lbs, This happened pretty much all the time with large systems and so I ruined my right arm. It was judged to be work related because it's directly attributable to diminished use of my left arm after the surgical repair to perform my duties.
Well, you see what happens..........I go on disability leave June 17, 2011 and am still on disability but of course without any pay. All disability pay ended after 36 months.......104 weeks private insurance coverage.....max allowed under the new law AB 899 enacted January 1, 2004........before that it was for life if the injured worker never returned to work. So at that point, you apply for state disability which of course I did.......I had to since I was still having surgeries....and you get 52 weeks.....max allowed under the law.......and so at that point you would normally apply and receive Federal Disability which I did.
Get this......I was eligible for Federal Disabilty when my injury started but you cannot get Federal until after you have first exhausted your state disability benefits (52 weeks).....and you cannot get that until you have exhausted your 104 weeks of private workers comp insurance your employer is obligated to carry.....which I also did.......but when I applied for my Federal Disability, it was denied because as soon as you reach social entitlement (which is age 65), all eligibility for Federal Disability is forfeited (ineligible) and you must apply for early social security even though I want to return to work and continue working until age 70 for to get max benefits........Nope......take social security now or starve. The net difference in net to me is $785/mth shortfall because I had to take it early despite that I am still on the payroll records of my employer designated "on disability leave".
Why all the surgeries? Because of the denials for treatment in between surgery and the long wait which results in muscle and tendon atrophy which is irreversible and so the surgeon has less healthy tissue to work with. I have medical bolts and steel sutures in my shoulder,.....it keeps ripping apart......now it going to involve sewing in a special leather like fabric that's reinforced with steel strands and hope it holds, and while inside my shoulder, also sew up the new tears, repair my labrum and perform debridement of the new bone marrow edema surrounding my acromioclavicular joint.
The workers comp situation in California and these other 11 states is literally scandalous.......do that Google search.........maybe I should post the letter I got from my lawyer when my surgeon was deposed for hours earlier this month........she wrote" your surgeon argued passionately in your behalf" and "questioned why workers comp insurers would authorize surgery and then deny post surgery treatment?" The workers comp game is fixed in CA in total favor of the insurance companies. AB-899 should be ruled unconstitutional........no insurer should ever ne indemnified against acting in bad faith......and only a class action can get this fixed and I am hoping Hausfeld, LLC will consider taking up the cause.
Matt B.
How did this accident happen? I totally understand if you don't want to reply or tell me to mind my own business. 
