The Real Fraud|Same Old
"Ye of Little Faith," by Margaret Downing, November 13
The Real Fraud
I read with great interest your article on Texas Mutual Insurance and Ms. Nichols' comments that the "system" doesn't need legal or judicial advice. As a practicing physician who has participated in the workers' compensation system both as a treating physician and a designated doctor, it is not surprising to me that Ms. Nichols is blaming the victim.
I was not surprised when she mentioned that the carrier has to protect themselves against insurance fraud. She is quick to point out that those culprits who file a claim may fail to report an injury that happened years before. In my experience I have found that injuries which are remedied are often forgotten. But if the shoe is on the other foot, and someone from TMI alters records, it now becomes an "honest error."
The idea of "lifetime care" is a farce. While it is true that the patient has the "right" to "lifetime care," just try receiving it. In order for patients to receive care there are a series of hurdles they must go through. First, the physician must request preauthorization (approval) from the insurance carrier. If this is denied, the physician has the right to request an appeal. If this is denied, the physician will then have to go through other steps, all of which can take several months to be resolved.
Years ago the former TWCC (Texas Workers' Compensation Committee) had an oversight committee that consisted of physicians, nurses, carrier and public representatives. Their job was to make recommendations to the TWCC for rules to fix the system and make it amenable to everyone. The executive director at that time basically told the committee thanks, but no thanks, and instituted rules that were clearly anti-claimant. The goal of TMI has always been to eliminate attorneys from the system, except for those who represent insurance carriers.
Name withheld by request
In reference to your November 13, 2008, lead article. The workers of Texas are being abused by Texas Mutual:
Dear Representative [Burt] Solomons,
Unfortunately for me, when you passed your workman's comp. bill and put it mostly in control of Texas Mutual and their surrogate Concentra, you essentially destroyed my business. My practice is not a fly-by-night enterprise of corporations; it is a good, honest medical clinic where employers sent their injured workers in the surrounding area. Concentra has panels of doctors, and of course, they don't need me in their network, thereby eliminating their closest competition for the most part.
I hope you realize that Texas Mutual abuses injured workers. They refuse claims right and left. They outlast and out-lawyer the poor working man, most of whom are uneducated or don't speak the language. Lawyers for the most part are not interested in representing them. Really, it is no money, no lawyer, no justice or care for honest, injured workers.
Look in the Dallas Observer article. It is correct and mostly because of you and insurance money. It is wrong to let this happen. You should be ashamed.
Zech Dameron III, MD
Buzz, by Patrick Williams, November 13
The DISD saga continues! Anyone who has worked with payroll for more than a few days knows that Social Security numbers cannot be made up. In fact, a copy of the card or equivalent is necessary for the first paycheck. If a nonworking number is used, the TWC report will catch the error, and the employer is notified. So, to assume that no red flags were raised over a period of several years is simply not believable. Where were the professional administrators who oversee the payroll process? And, more important, who will be held responsible? History tells us that there will be no repercussions with this situation. With the $1 million credit card debacle, a few people were let go, one went to jail and hundreds were given a free pass without being required to pay back their thefts. The budget shortfall, uncertified teachers, total lack of oversight, the list goes on and on.
I wonder if the volunteer CEOs will be able to provide solutions to problems that do not exist in the wildest imagination of ordinary business persons. DISD employees have, if nothing else, a knack of making the simplest task become illegal, immoral or beyond understanding. Which, of course, is a direct reflection of the management.
Jim Salsbury, Garland
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