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I will assume that most of my readers have been following my series on Independent Staffing Solutions, the Tribal “alternative” to California Workers’ Compensation Insurance, which began to come to view in California at the onset of the 21st Century.   I have written two previous articles containing stories about injured workers who have suffered from a dearth of indemnity benefits and medical treatment, and even one case which resulted in death.  Now, another applicants’ attorney, Jim Gonzales, has shared with www.adjustercom.com, his story about one current client who had the misfortune of working for a company that was “insured” for “workers’ comp” by Independent Staffing Solutions, a Tribal Entity. 

Rafael Manzano worked for a tree trimming company in Santa Cruz, California, called Williams Tree Service.  He started working for Williams Tree in February 2003. 

In January of 2004, Manzano was asked by Williams Tree Service to sign a document stating that he would work for Independent Staffing Solutions.  Then, in February of 2004, he fell out of a tree when he lost his balance and fell backwards to the ground, hitting his lower back on the sidewalk. 

Rafael Manzano did not receive any benefits, and the employer was not providing any medical treatment, so he started treatment with a medical facility that agreed to treat on a lien basis.  Applicants' attorney, Jim Gonzales, finally got involved and began to represent Manzano in November of 2004, nine months after the injury.  It took until the beginning of the year 2005 for attorney Gonzales to figure out that Manzano did not work for Williams Tree Service, but worked for ISS as a Professional Employer Organization (PEO). It can be assumed by this long delay that it was not made clear to Manzano who the “employer” really was at the time of his accident and how he would be taken care of with Total Temporary Disability (TTD) payments and Medical treatment.  It’s also interesting that Williams Tree Service did not make sure ISS took up the claim and further noteworthy that ISS did not step up to the plate.

While Manzano was being treated on a lien basis by a Dr. Nervino, the medical examination and tests showed that Manzano needed surgery for a bad disk.   His lawyer, Jim Gonzales, filed a request for an expedited hearing with the WCAB, but neither Independent Staffing Solutions nor Williams Tree Service showed up for the hearing.  In August of 2005, Gonzales amended the Application to name ISS as the employer.  During this time Rafael Manzano was receiving disability compensation benefits from State Disability Insurance (SDI). 

By December of 2005, Manzano was waiting for authorization for surgery.  Gallagher Bassett in Sacramento was at this time the TPA for ISS, but quickly cancelled their contract with ISS most likely due to their discovery that ISS was not a legitimately bonded and authorized self-insured entity bonded and approved by the California Department of Insurance.  ISS was a tribal entity—and not under the jurisdiction of the State of California.  It could also be conjectured that Gallagher wasn’t getting paid.  

ISS’s lawyer, Sidney Lamb, of the law firm of Laughlin, Falbo, Levy & Moresi, withdrew because he wasn’t getting paid.   This is the understanding of Jim Gonzales.  

AS&G, a Third Party Administrator based in Houston, Texas, picked up ISS’s business sometime in late 2005 or early 2006 after Gallagher Bassett dumped ISS.  Then, AS&G started paying TTD to Manzano in February of 2006.  But by July of 2006, AS&G dumped Independent Staffing Solutions because the payments they were issuing weren’t getting mailed to the claimants. ISS also had not paid AS&G its fees.  Manzano received a TTD check finally in September of 2006 that was dated in April 2006, so it was looking like ISS was writing checks but then holding onto them for months. 

By September, Attorney Jim Gonzales on Manzano’s behalf asked State Disability Insurance (SDI) to pick up disability for Manzano again, and SDI did pick it up again and began to pay him.

Sid Lamb was again at this time representing ISS, which most people now refer to as “The Indians”.  In the expedited hearing demanded by Jim Gonzales it was stipulated that the claimant, Manzano, worked for ISS.  Thus, the stipulation was to not claim dual employment but to name ISS as the employer.  In February, Sid Lamb agreed to go to Mark Howard, M.D., a surgeon who had evaluated Rafael Manzano previously, again for a medical evaluation.  Dr. Howard said that the claimant needed surgery.  But then an adjuster named Maria Gomez, of AS&G in Houston Texas, sent more TTD to Manzano.   So, compensation plus movement towards getting authorization for the surgery seemed to be in progress.

If this seems confusing to you readers, it’s because it IS confusing.  The TTD checks ran into May of 2007, but at the same time the surgery was denied by Utilization Review.  Again, Jim Gonzales requested an expedited hearing.  Sid Lamb then got out as counsel to ISS in August of 2007.  He seemed to have gotten uncomfortable.

So, Manzano’s surgery was back to ground zero.  By this time, there was nobody anywhere to get this injured worker his back surgery.

So, Gonzales went back to Williams Tree Service and their lawyer Bruce Baum, and said, “Welcome back!”  Gonzales had already agreed to the non “dual employment” stipulation with ISS and Williams Tree, agreeing that the “real” employer was ISS, but now that the TTD checks were stopped and the not-so-seeming-for-real Utilization Review denied the surgery, Gonzales was back to going after Williams Tree Service.  Thus, Gonzales proceeded against Uninsured Employers Fund and Williams Tree Service.   A Mandatory Settlement Conference was scheduled and took place on December 20, 2007. 

What happened at that MSC was that the judge on the case, Judge Asturias, didn’t know what to do!  His jaw sort of dropped.  Independent Staffing Solutions wasn’t present—they simply didn’t show!—and their attorney wasn’t present either.  And then the Williams Tree Service terminated their lawyers! 

So, the Uninsured Employers Fund picked up the benefits but wanted another AME examination.  “And all during this time there was this horrible cloud over my client,” said Gonzales. 

Now Gonzales deeply regrets his decision he made with UEF to have Kevin Handley, M.D., act as the AME.  Handley in a nut shell reported the claimant had a positive MRI but that it had been so many years since the injury that his back had had sufficient time to heal and that he was capable and well enough now to get back to work.  In the mean time, the testimony of Manzano is that he has constant pain and cannot work.  And he wants the surgery. Now Gonzales does not want to give up on getting the surgery he feels is quite necessary for his client. 

This month, September of 2008, Jim Gonzales will be deposing Mark Howard, M.D., the surgeon who recommended surgery, and reorganizing the case.  Gonzales hopes that somehow justice will be given to his client and the next Judge will favor Mark Howard, M.D.’s findings of a need for back surgery. 

An insightful look at this scenario, going beyond and not even “going there” by getting off track into a debate over which doctor is right about the need for surgery and which one is not, is to focus on the more real issue that owner and operator of ISS, Greg Chmielewski, and his associates, are the perpetrators and culprits who have caused all these delays and run arounds for not only this one claimant, Manzano, but dozens and dozens more besides the ones this writer has reported on in two previous articles. (See the archives.) 

The whole purpose of Workers’ Compensation is to provide speedy and efficient treatment for injured workers at a reasonable and managed cost, which only can happen by prompt action and proactive, swift claim handling.  ISS and Greg Chmielewski, along with his consorts, have wreaked havoc on the California Workers’ Compensation system and upon the lives of many injured on the job.  His actions in coming up with his Tribal “Workers’ Comp” insurance have served no one in a positive way but have only served as a too well paved road to his own avaricious self-interest. 

The State of California clearly needs to set up a road block to this “Tribal Workers’ Compensation Insurance”, which is NOT workers’ compensation insurance at all.  And Chmielewski needs to be held accountable for the damage he has done to so many lives, along with the enormous expense he has put upon the WCAB, the California Workers’ Compensation System, and upon California SDI.

A witness who requested not to be identified in Kewaskum, Wisconsin, wrote an e-mail to this writer on August 1, 2008, stating that Greg Chmielewski pulled into Kewaskum, Wisconsin that day with 2 Penske trucks with trailers, one enclosed and one carrying a Nissan Altima.  “Is he running away from California?” this person in Wisconsin asked. 

I replied that that would be anybody’s best guess.

On Wisconsin...