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Employers' Fraud Task Force Produces Top Film On Workers' Comp Claims Handling And The Problem Of Liens In Southern California
By Lonce LaMon - May 2, 2012

Just last Monday of last week, the film premiere showing of “Decreasing Workers’ Comp Costs and Improving Outcomes”, which is a film production of the Employers' Fraud Task Force in association with the law firm of Floyd Skeren & Kelly,  Chronic Pain Associates, and Global Pain Institute, took place at the Team Disney Auditorium at the Disneyland Resort in Anaheim, California.  John Riggs, who is the present Workers’ Compensation Manager of the Disneyland Resort and Chief Advisor to Employers' Fraud Task Force, was the Emcee of the event.  Laura Clifford, the Executive Producer of the film, was also in attendance as a primary hostess.

The film was entertaining and enjoyable to watch.   It not only addressed the issue of fraud in workers’ compensation, which is most egregiously carried out by medical service providers at this time in our history, but it emphasized the importance of good claims handling which requires cooperation between all the parties involved in getting the claimant treated and back to work. Highlighted was an example of a bad claims adjuster with a serious attitude problem, who was actually amusing to the audience in her ineptitude and snootiness as she well acted out the role of the claims adjuster from Hell.

Christine Baker, the Director of the California Division of Industrial Relations, was the keynote speaker.  Christine and Rosa Duran, Administrative Director, are presently conducting a listening tour of California, which Christine says is quite incredible.   She has been saddened by some of the stories of people’s lives that have been totally ruined by the system. 


Christine Baker, Director of the Division of Industrial Relations, pricks up her ears on a listening tour of California.  Here she is at the film premiere with John Maloch, left, and John Riggs, right.

Some of these individuals have been “totally 100% ruined,” Christine stated with empathy.  “They have shown us their x-rays with spinal hardware.  And something is wrong.  Of course, some of these patients had injuries a while ago, and we don’t really know what happened.” 

That reminded me of what everybody who’s active now in workers’ comp is painfully aware of: the existence of spinal surgeons who are out for their own greed, have an interest in partnering with spinal hardware agents who charge exorbitant fees to the workers’ compensation system for the hardware, and absolutely do not have the patients’ best interests in mind.  They use patients as pawns in their game of greed.   Thus, this is a huge present problem in workers’ comp which Christine Baker touched upon and which resonated with probably everybody in the room. 


Laura Clifford, the Founder and Executive Director of the Employers' Fraud Task Force in her ever-present red jacket, is pictured here with Anne Horelly, an attorney who is now a Special Assistant with the California Department of Workers' Compensation. Anne is a subject interviewed in the film. 

“We also know there’s way too much utilization review,” Christine said.  “Everything delays if it goes through the utilization review.  But on the other hand, the film depicted the reports are incomplete.” 

Christine discussed post-termination claims.  They are way up.   “This is a difficult economy.  It’s difficult for the employer.  Their ex-mods are going up.  Employers have to dismiss workers and one told me that 20 of them came back with workers’ comp claims.  That’s a sad story, too. 

“The economy is such that they couldn’t keep the workers.  There are horror stories.  These are tough economic times.  And we’ve got to make sure that the costs stay down.  Stay down for the employer.” 


John Riggs, the Manager of Workers' Compensation at The Disneyland Resort in Anaheim, was the Emcee for this premiere of the film "Decreasing Workers' Comp Costs and Improving Outcomes".  John is also Chief Advisor to Employers' Fraud Task Force. 

She discussed more about the inefficiencies in the system.  “Liens are overwhelming in Southern California.  In no other place in the country are there liens.   Not even in Northern California are there liens…”

Many people were abuzz before and after they watched the film, and at the excellent buffet dinner afterwards, about the lien problem in Southern California.  There was much discussion about how in Northern California, if there is a debate over treatment, the conflict gets handled immediately, the issues are addressed, and/or the case gets set for trial.   Someone stated that it’s a “cultural problem”, a disparity in the cultures of the northern half of the state versus the southern half of the state.   Someone stated that it’s the fault of the Southern California judges—that the judges don’t take actions and some don’t care.   Also it was said that there aren’t enough judges in the Southland. So, out came numerous conjectures from the wide spectrum of personalities at the event. 


From left to right are Suzanne Honor-Vangerov, attorney with Floyd Skeren & Kelly; Anne Horelly, attorney with the DWC; Dr. Tomer Anbar, with Global Pain Institute; and John Riggs, manager of The Disneyland Resort.  All four were featured in the film which premiered last week: "Decreasing Workers' Comp Costs and Improving Outcomes".   

Someone from the audience mentioned there’s a nine to one ratio of liens in the South relative to the North.  A ballpark guess that there are 800,000 liens floating around in the Los Angeles Workers' Compensation system was thrown out there, too. That’s unbelievable.  And that “seems off base,” Christine Baker said. 

She discussed how the industry must get to the root of the cause.  “I’m very much a root cause kind of analytical thinker.  We can find all the external things and blame everybody, but we need to get down to the root cause.” 

She said the notices need to be streamlined.  The language needs to be clearer and non-litigious, non-legalistic.  “We believe this will help reduce the need for running to an attorney.”


Judge David O'Brien, here shown leaving the stage, appeared in the film as one of the experts on the Workers' Compensation system in California.

She also thinks apprenticeships aren’t used enough in California.  And she is trying to expand them.  She has seen offices close in her department and the state system that “had furniture in them but no people.” 

Christine wrapped up her message on a positive note. “With tough times come opportunities.  I put in my 14 hour days as does my team.  We are training our staff with a new vision.  We are preparing for being service oriented.  We are training our new hires to have a different attitude towards service.

Some of the excellent professionals interviewed in the film were Suzanne Honor-Vangerov, a lawyer with Floyd Skeren & Kelly; Dr. Tomer Anbar, of the Global Pain Institute; Anne Horelly, an attorney now with the state Department of Workers’ Compensation; Al MacKenzie, the former Deputy District Attorney in Los Angeles who went after Premier Medical and forced them to withdraw millions of dollars in liens just a few years ago; John Riggs, the Work Comp Manager of The Disneyland Resort; and myriad others. 


Plaques and Mickey Mouse ears were bestowed upon the experts who appeared in the film along with the sponsors who gave their financial support.  Here John Riggs and Laura Clifford look over the award plaques and the Mickey Mouse hats before the opening of the event. 

The film “Decreasing Workers’ Comp Costs and Improving Outcomes” can be purchased for $95 for non-members of the Employers' Fraud Task Force and at some kind of a discount for members.   It’s $300 for a yearly membership to the Employers' Fraud Task Force and the group meets monthly in the City of Commerce for lunch to communicate and educate one another about the reality of fraud and the mission of engaging in competent and appropriate claims handling.

For more information about theTask Force and to purchase the DVD of the new film and other training films, go to www.fraudtaskforce.org, snail mail to Employers’ Fraud Task Force, 5753-G East Santa Ana Canyon Road, #168, Anaheim, CA 92807, or contact Laura Clifford at 714 637-3350 or by cell phone 323 559-0015 or by email at lauraclifford@sbcglobal.net.

About the EMPLOYERS’ FRAUD TASK FORCE:

Preserving the Integrity of Our Workers’ Compensation System

LAURA CLIFFORD
Founder & President

Laura Clifford is the Founder and President of the Employers’ Fraud Task Force. For more than 20 years, Ms. Clifford has united industry leaders on task forces and advisory boards in the development of numerous products and services for workers’ compensation professionals.

The Employers’ Fraud Task Force is a California based organization, Chaired by The Walt Disney Company, committed to combating workers compensation fraud, waste and abuse. The task force was founded in 1998 when visionary industry leaders from some of the Nations most prominent employers came together with concerned law enforcement officials. Together they work to identify the many participants of workers compensation fraud, waste and abuse and deliver anti-fraud tools, solutions and resources to the industry.

The Employers’ Fraud Task Force studies, develops and communicates methods of combating workers comp fraud, waste and abuse. The task force also serves as a general resource and communication forum for the industry and facilitates education and communication among concerned parties such as employers, law enforcement, legislators, insurers and consumer groups.

lonce@adjustercom.com

 
 

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