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Poll: Do you feel medical care that was necessary was withheld in relation to your Workers Compensation Injury?
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Yes
75.00%
3 75.00%
No
25.00%
1 25.00%
Total 4 vote(s) 100%
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Potential Third Party Lawsuit (New York WC Claimants- please read)
#1
I became inoperable for my Workers Compensation Injury when the Judge refused to authorize surgery or to address critical Workers Compensation C-4 and MG-2 request forms for surgical treatment out of state in 2012.

There have been numerous instances of fraud on my file by the carriers, and I haven't received income in six years despite approved injuries. The Board has continuously refused to respond.

Does this sound like you? I have retained civil rights attorneys to proceed in a "racketeering and corruption lawsuit (a/k/a RICO)", and "deliberate indifference" lawsuit against all parties. There have only been six RICO lawsuits (based on a Supreme Court decision in April, 2012), and I will be the first Deliberate Indifference lawsuit.

However, my action may be stronger as a class action due to a recent 6th circuit decision which is in direct opposition to a 9th circuit decision rendering property rights to Workers Compensation claimants benefits. This is complicated, but believe it or not, WC benefits were not considered a property right for the last 96 years (since the compensation bargain went into effect in NY in 1917).

The potential for a successful Supreme Court Decision addressing the inadequacy of WC benefits could change life as we know it for WC victims; particularly in New York where bad faith lawsuits are limited, and we are prevented, in most cases, from suing the state.

Therefore I seek other seriously injured workers who feel they were deprived of their due process rights and left disabled when they didn't need to be, particularly if you feel critical medical facts were withheld from IME's or "misstated" by the insurance carriers in order to deny benefits, causation, or treatment.

Also, if you had trouble finding a doctor to treat you......

This is not a solicitation and there is no promise that your case will be included in this action, but if you have been significantly injured, then you may be able to help other victims by helping to set legal precedent so WC as we know it today becomes a thing of the past.
 
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#2
(10-27-2013, 05:07 PM)ChimarenTaylor Wrote: I became inoperable for my Workers Compensation Injury when the Judge refused to authorize surgery or to address critical Workers Compensation C-4 and MG-2 request forms for surgical treatment out of state in 2012.

There have been numerous instances of fraud on my file by the carriers, and I haven't received income in six years despite approved injuries. The Board has continuously refused to respond.

Does this sound like you? I have retained civil rights attorneys to proceed in a "racketeering and corruption lawsuit (a/k/a RICO)", and "deliberate indifference" lawsuit against all parties. There have only been six RICO lawsuits (based on a Supreme Court decision in April, 2012), and I will be the first Deliberate Indifference lawsuit.

However, my action may be stronger as a class action due to a recent 6th circuit decision which is in direct opposition to a 9th circuit decision rendering property rights to Workers Compensation claimants benefits. This is complicated, but believe it or not, WC benefits were not considered a property right for the last 96 years (since the compensation bargain went into effect in NY in 1917).

The potential for a successful Supreme Court Decision addressing the inadequacy of WC benefits could change life as we know it for WC victims; particularly in New York where bad faith lawsuits are limited, and we are prevented, in most cases, from suing the state.

Therefore I seek other seriously injured workers who feel they were deprived of their due process rights and left disabled when they didn't need to be, particularly if you feel critical medical facts were withheld from IME's or "misstated" by the insurance carriers in order to deny benefits, causation, or treatment.

Also, if you had trouble finding a doctor to treat you......

This is not a solicitation and there is no promise that your case will be included in this action, but if you have been significantly injured, then you may be able to help other victims by helping to set legal precedent so WC as we know it today becomes a thing of the past.

I'm not sure if this counts, but when I went to reopen my WC case for back injury I was given the run around. I was first told to call one person to another. This went on for about a month or two. I was then told that since I was represented by a lawyer that my lawyer have to make the request for treatment.

My lawyer contacted them without any success. He petition the state (NJ) to make them respond. Still nothing. I went on so long that I started to pay for medical treatment myself. My personnel doctor then decided to take me out of work for several weeks. I tried to contact my WC claim worker again. I left a message about me needing treatment & since they haven't responded I went to my personal DR. & he was taking me out of work for several weeks.

All of the sudden she called & told me that my case was passed the statue of limitation. When I told her that my lawyer & myself have been trying to contact them for the past year she claim that they had no record of that.

Funny I called my lawyer right after the call and he gave her a called. Like magic they found the request for treatment. I do believe that if I would have received treatment a year earlier, I wouldn't had needed the surgery that I had.
 
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#3
Yes, your case could be relevant, in your state of NJ. I, unfortunately, need to find New Yorkers. However, if you look up RICO and "workers compensation" (in quotes) you should be able to find an attorney who could address this in your state. I urge you to do so. RICO is a brand new legal precedent that circumvents that lack of available legal venues at the State level and allows claimants to sue Federally for intentional withholding of medical benefits, treatment, establishment of injury, or damages due to corrupt practices and violations of due process by a "group" of people from the Board to the carriers to the employers to the doctors to the IME's. As this is actually rampant, there are many ways to prove collusion, and RICO only requires you to show a bad outcome, not even that somebody got paid off, but that individuals conspired to prevent the claimant from getting benefits they were legally entitled to as a type of "property" under the constitution. Believe it or not, up until 2012, WC claimants had no property rights to their lost earnings, medical treatment, or even legal assistance.

This is very important legislation which opens up the door to WC victims all across this country, but those who are eligible need to act. Our window of opportunity may be limited if those who have truly obvious damages don't know that this avenue can be taken. We can help stop the victimization of WC if we talk loudly, spread the word, and stand up.

Thank you for responding. Please follow this post because if I can find you a RICO attorney I will. Also, bad faith may be another avenue in your state, or state created danger under Section 1983.

P.S. Your statute of limitations on RICO is four years from your date of injury (when you became inoperable most likely). Good luck to you!
 
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#4
P.S. It also helps if you have at least two other people from your state with similar issues.... so claimants from NJ, please read and respond.
 
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#5
(11-01-2013, 07:22 PM)ChimarenTaylor Wrote: P.S. It also helps if you have at least two other people from your state with similar issues.... so claimants from NJ, please read and respond.

Does it matter if the WC finally gave me medical treatment & settlement? However it was over a year since my lawyer & I had requested the treatment that they finally gave in. I think they only gave in because I told them that my personal doctor was taking me out of work.

 
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#6
(11-03-2013, 10:04 AM)darrinb Wrote:
(11-01-2013, 07:22 PM)ChimarenTaylor Wrote: P.S. It also helps if you have at least two other people from your state with similar issues.... so claimants from NJ, please read and respond.

Does it matter if the WC finally gave me medical treatment & settlement? However it was over a year since my lawyer & I had requested the treatment that they finally gave in. I think they only gave in because I told them that my personal doctor was taking me out of work.

 
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#7
No, it doesn't matter. What does matter is that there is a continuing pattern of behavior such as denial of therapy, or meds, and/or a failure by the carrier to send all of the medical reports to their independent medical examiner, for example. The unnecessary and improper delay is an issue if the carrier uses the system to get out of paying something that should logically be paid, and does this so often that it becomes obvious.

(11-03-2013, 10:04 AM)darrinb Wrote:
(11-01-2013, 07:22 PM)ChimarenTaylor Wrote: P.S. It also helps if you have at least two other people from your state with similar issues.... so claimants from NJ, please read and respond.

Does it matter if the WC finally gave me medical treatment & settlement? However it was over a year since my lawyer & I had requested the treatment that they finally gave in. I think they only gave in because I told them that my personal doctor was taking me out of work.

 
Reply
#8
(11-13-2013, 03:33 PM)ChimarenTaylor Wrote: No, it doesn't matter. What does matter is that there is a continuing pattern of behavior such as denial of therapy, or meds, and/or a failure by the carrier to send all of the medical reports to their independent medical examiner, for example. The unnecessary and improper delay is an issue if the carrier uses the system to get out of paying something that should logically be paid, and does this so often that it becomes obvious.

(11-03-2013, 10:04 AM)darrinb Wrote:
(11-01-2013, 07:22 PM)ChimarenTaylor Wrote: P.S. It also helps if you have at least two other people from your state with similar issues.... so claimants from NJ, please read and respond.

Does it matter if the WC finally gave me medical treatment & settlement? However it was over a year since my lawyer & I had requested the treatment that they finally gave in. I think they only gave in because I told them that my personal doctor was taking me out of work.

 
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#9
Hi,

I don't know if this might be any help but I figured I'd post it anyway.
Most pharmacies in New York are under contract with StoneRiver Pharmacy
Solutions. Most workers comp injuried workers bring there prescriptions to
a local pharmacy and are given authorization by the insurance claims adjuster
and don't pay anything out of pocket. That pharmacy then processes the
paperwork for billing through StoneRiver. Most of us IW's never pay attention
to what the price of the drugs is being actually charged back to the insurance
company. Well for 7 months I was given authorization for my Class 2 drug
Percocet and received a notice by mail from Healthsystems showing the voice
that StoneRiver was billing for my prescription from my local pharmacy. I really
never paid attention to this voices because the insurance company was paying
the bills. Then I was suddenly denied authorization for my medication. Called
called doctor and my lawyer but to no avail. So I filled the prescription with
money out of pocket and was charged $90.65. When I got home that night
I wanted to see what the insurance company had paid for the medication and
checked the invoices I had received from prior refills. Then, to my surprise,
the invoices showed that the billing for the same drug was being billed by
StoneRiver for the amount of $389.48. How was this possible, the invoices
don't included the name of the local pharmacy were I filled the prescription
but showed that StoneRiver was the "provider" in Tenn. I live in the Bronx.
How could the provider charge $389.48, when I paid only $90.65 over the
counter? If StoneRiver has 60,000 pharmacies under contract you would
naturally think the price of the drug would be MUCH lower than what I would
pay of $90.65, no they are charging $389.48. Then someone on this forum
was kind enough to post the link to the articles below.

This StoneRiver has settled NOT once, but on 8 prior cases.
Their fraudulent billing practices are now clearly still going on
in New York. I notified the NY Inspector General and never got
a response. This is what I believe a major fraud case which is
possible all parties are involved, there has to be some kind of kick
back scam here. Maybe you would like to share the info with who
is working on your action. Probably of no use, but you never know!

I'm going to a hearing this week, I had a judge grant an IME at
my last hearing for two additional body parts. Then I receive the
Notice of IME with a copy of a letter to the IME doctor where the
claims adjuster tells the doctor to "ONLY" examine everything but
the two body parts which the judge ruled on. Then they change the
IME to the morning of the Hearing I have this week showing complete
comtempt for the judge's ruling and where the insurance company
was supposed to have the IME report filed with the WCB two weeks
ago. It's all a game of unethical practices to deny medical treatment
and needed multiple surgeries and to delay. I have all three letters
to the IME doctor telling him to explain only as they put it "our injuries."
That's their way of telling the IME that this is the only body parts they
want examined and what they will take casuallty for. The great pair is
they don't sign these letters or file them with the WCB. Most IW's have
no idea of the dirty nasty tricks these insurance companies will do to
deny you treatment or medications and to keep your rating as low as
possible. You most have a lawyer but one must also stay right on top of
their case.


Workers’ Compensation Billing Company to Pay $1 Million for Allegedly Overcharging State Entities for Prescription Drug Coverage

AG’s Office Has Recovered More Than $9 Million to Date Through Workers’ Compensation False Claims Act Investigations



BOSTON – After allegedly overcharging the Commonwealth and a number of cities and towns for prescription drugs through the workers’ compensation insurance system, StoneRiver Pharmacy Solutions, Inc. (StoneRiver) has agreed to pay approximately $1 million in restitution, Attorney General Martha Coakley announced today.

To date, the AG’s Office has recovered more than $9 million in relief through similar investigations of pharmacy retail stores including Walmart and Target Corporation, along with major pharmacy chains CVS, Rite-Aid and Walgreens. The AG’s Office has also obtained recoveries from both Shaw’s Supermarkets and Stop & Shop regarding their workers’ compensation municipal prescription businesses. The settlement with StoneRiver is the eighth of its kind.

“Overcharging for prescription drugs harms cities and towns at a time when they are facing great financial pressure to provide much needed services to people,” AG Coakley said. “This case will provide restitution to those communities, and we are determined to prevent overcharges like these from happening in the future.”

The assurance of discontinuance reached with StoneRiver, a workers compensation billing firm that charges cities and towns on behalf of pharmacy retail stores, was filed in Suffolk Superior Court on Wednesday. Under the terms of the agreement, governmental subdivisions, including nearly 80 cities and towns, will receive close to $500,000 from StoneRiver as a refund for the alleged overcharges and violations of the False Claims Act.

StoneRiver will separately make an additional payment of over $500,000 to the Commonwealth. The terms of the agreement require StoneRiver to put procedures in place to guard against future overcharges and implement a pricing protocol compliant with state laws and regulations.

Cities and towns affected the most include Weymouth, which will receive $91,600 in restitution, and Rehoboth with approximately $46,000. Other municipalities affected include Lunenburg, Fairhaven, Lowell, and Haverhill, all receiving refunds in excess of $10,000. On average, the public entities overcharged in this case will receive approximately $6,000 each.

This matter is being handled by Attorney General Coakley's Insurance and Financial Services Division, Assistant Attorneys General Peter Leight and Glenn Kaplan, and mathematician Burt Feinberg
 
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#10
For some reason I am just getting confirmation of your response to this post now. Please contact me at chimaren@roadrunner.com urgently.

I am in the process of filing a RICO action for a landmark lawsuit against New York. You are a candidate because of the situations you describe, and I need to speak with you.
 
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