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Lawmaker Considering Ways to Disrupt Business Model Related to Capping

  • State: California
  • Topic: Top
  • - Popular with: Legal
The criminal charges in a $300 million capping scheme announced Monday allegedly stem from a busines…

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John Don Jun 7, 2017 a 12:06 pm PDT

If I have a disputed CT and want to settle out the voucher - the carrier cannot accept the claim. If we settle for $5,000.00 - then we don't meet the requirements AB221. The effort to stop the fraudulent CT's would make it difficult to settle disputed CT's w/o having the carrier pay for a QME. Sometimes it's best to settle out w/o further litigation.

Nathan Yannone Jun 7, 2017 a 1:06 pm PDT

Assemblymember Gray says no one has identified a legitimate claim that would have been disallowed under the provisions in AB 221. This is simply not true.

On 2/22/17, Boehm & Associates at the request of Assemblymember Gray’s Legislative Director Mr. Capper, provided the Assemblymember with numerous examples of legitimate and real, cumulative trauma claims that settled with a compromise and release for less than $25,000. These were real cases that the Assemblymember continues to deny are legitimate. In fact, there are many reasons why AB 221 would have prohibited legitimate claims. For example, legitimate hernia repair and carpal tunnel cases, which are plentiful, typically result in low value settlements. This is due in part because the worker generally is able to return to work, or is left with a low level of permanent disability after treatment is provided.

The bottom line is that AB 221 leaves injured workers with less necessary medical treatment since no medical provider will treat a patient when there is the prospect that neither the employee nor the employer will bear any liability for the treatment. AB 221 will inevitably result in an enormous cost shift for medical treatment as injured workers will foreseeably seek their medical care through other avenues, such as Medi-Cal, Medicare, the Department of Veterans Affairs, county facilities and indigence programs.

Moving forward, it is our sincere hope that Assemblymember Gray will do more to engage and listen to those in opposition to AB 221. Assemblymember Gray should cease making inaccurate statements and perhaps learn to communicate better with his legislative staff regarding what he has received in opposition to various bills. We trust that the Assemblymember will take the time to explain why he believes the numerous examples of claims provided to him by Boehm & Associates, are not legitimate or real. By engaging in this effort, it is our hope that a bill with less unintended consequences can be drafted in the future. Boehm & Associates stands ready to provide the California Assembly Insurance Committee, or other interested parties in the merits of AB 221, with additional examples of legitimate claims as well as the claims already submitted to Assemblymember Gray’s office referenced above.

Pete Almeida Jun 7, 2017 a 10:06 pm PDT

So, the 221 says the employer isn't liable for medical costs or medical liens unless either: 1. The employer accepts the injury, 2. The wcab finds injury or 3. A AME OR QME finds injury.

As a result , the long term waiter/waitress who claims carpal tunnel (who works for a restaurant that doesn't want the ex-mod to go up so they deny the claim)and goes to a credible treater who finds injury, gives prompt/appropriate treatment and leaves the employee with no residuals (which means the case value is low) the carrier can't settle without incurring the cost of an AME/PQME without risking that the medical portion of the settlement and the final settlement value of the liens being non-chargeable.

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