One Claim Going OTOC

Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com

By now you've likely heard of this claimant fraud case as reported in the San Diego County News Yolandi Kohrumel, 35, went to work for Staples about 10 years ago. After three months on the job she claimed a box fell on her big toe and broke it. She received treatment and benefits. But the big toe is connected to the foot bone, which is connected to the leg bone, which is connected to the hip bone, which is connected to the back bone.... An EAMS search on her claim reveals wrist, back, lower extremities, nervous system and "other body systems" claimed. The party service list is filled with very familiar names to those who do workers' compensation litigation in Southern California. Eventually Kohrumel even got approval for 24 hour care, provided for, of course, by relatives - her husband at first and then her father. You get the picture. Claim out of control. Which means either something is REALLY wrong with this lady, or it's fraud. The claims administrator, ESIS, followed the law and did what it could to dispute elements of the claim that didn't add up - such as the 24 hour care provided by her South African husband who did not have a work permit (so dad stepped in to "provide care"). Surgeries, pain pills, lots of doctors, crutches, wheelchairs, lots of TTD payments. She even convinced the claims administrator that she needed a bigger place to live for her wheelchair access and the administrator went for it. Well, that became Kohrumel's undoing because the...

[Click here to see the rest of this post]

Related articles

• OK's True Cost Control Feature (workers-compensation.blogspot.com)
• Cost Shifting vs. Cost Fixing (workers-compensation.blogspot.com)
• Despite backlogs, VA disability claims processors get bonuses (workers-compensation.blogspot.com)
• Claims Adjuster, TPA Could Face Criminal Charges for Worker Fatality (workers-compensation.blogspot.com)
• Brain injuries a big problem for NFL in California (workers-compensation.blogspot.com)
• ICD-10 will impact workers comp, non-HIPAA entities, too (workers-compensation.blogspot.com)
• BP ordered to pay $130 million to oil spill claims administrator (workers-compensation.blogspot.com)
• NH Supreme Court outlines intoxication defense and other parameters of workers' comp claims (workers-compensation.blogspot.com)

Found on

An Employer Is Responsible To Compensate For Pain

A NJ Appellate Court, in a dramatic reversal of a compensation judge's dismissal of a case, held that "an employer is responsible to compensate" an injured worker for pain.  The reviewing court held that, "...the judge misapplied some standards bearing upon this case."

The trial judge's conduct, in baring the treating physician from testifying, was also cited as "a discretionary lapse." The trial judge's ruling was reversed and the case remanded for a hearing.

The case involved a long standing injury that required prolonged treatment for a chronic medical condition. The injury occurred in June of 1989 and was the subject of an Order Approving Settlement in January 2004 for 20% of partial total. That award was entered by another trial judge.

Even thought an Order had been entered by the prior trial judge for continued medical treatment and medication, the insurance company unilaterally terminated provision of those benefits without a court order. The claimant's attorney, George Goceljak, was required to file two motions for continued medical treatment and medication benefits. The trial court dismissed the case for lack of prosecution and then subsequently restored the matter for trial and then marked it "not moved" when a minimal one-cycle (3 week) adjournment was requested. Customarily, NJ workers' compensation cases are tried in piecemeal, every 3 to 6 weeks.

The trial judge then mandated that the trial should begin immediately on January 15, 2010, commenting that she was, "...not going to wait" any longer for the the claimant to proceed with his case. She denied a reconsideration of the application of the injured worker to allow the treating physician to testify, and then proceeded in a 5 month stagnated trial ultimately dismissing the case.

The NJ Appellate Division found, "the judge erred is using, out of its context, the simple thought that 'an employer is not required to compensate and employee for pain,' as a basis for denying this petitioner's application. The larger principle...is that, to the extent that a petitioner experiences continuing pain as a result of his work-connected injury, the employer for whom he worked at the time of the injury remains responsible.'"

Noto v. Staples, Inc.,  Docket No. A-0237-10T1, 2011 WL 3273921 (NJ App. Div. 2011) Decided August 2, 2010 

Related articles

• Bad Faith Claims Maybe Going To The Jury (workers-compensation.blogspot.com)
• Employers Face Liability For Cell Phone Accidents (workers-compensation.blogspot.com)
• Florida Rules Illegal Aliens Entitled to Workers Compensation (workers-compensation.blogspot.com)
• Employers Prohibited From Seeking Reimbursement From a Public Entity (workers-compensation.blogspot.com)
• Employers Risks Increase From Cell Phone Use (workers-compensation.blogspot.com)
• Court Orders Workers' Compensation Insurance Carrier to Comply With OSHA Subpoena (workers-compensation.blogspot.com)