ESCONDIDO — Debris scattered across the northbound lanes on I-15 close to state Route 78 has caused several wrecks and has severely slowed traffic Monday during the evening commute, according to a CHP spokesperson. A truck lost most of its load around 7 in the evening, causing the multi car pile up, which included several cars and a Semi-truck. The CHP said at least one ambulance has been sent to the site of the crash and at least one person suffered minor injuries. Traffic was stopped for about 30 minutes as officers cleared part of the freeway to allow traffic to start flowing again, the CHP said.

The San Miguel fire district, which includes Rancho San Diego, Mount Helix, Bostonia, Crest, Spring Valley, Casa de Oro, La Presa, and unincorporated areas of El Cajon, are facing some significant budget short falls this year. The recently proposed car crash charges by the San Miguel fire district would be for those utilizing the services of the district but do not reside in it, as well as for those who are found to be at fault. The crash tax fees range from $400 to more than $2,000. There would also be a hazardous chemical fee for spilled gasoline and car fires. There is even a charge of upwards of $2,100 if a helicopter is needed. The eastern San Diego district covers 47-square miles The voting on the crash tax takes place on January 14th and if approved would go into effect within 2 months. The district fire chief has stated that due to budget decreases this is the only way the district can continue to provide the same level of services.

August 23, 2009

22-year-old dies in motorcycle accident
A 22-year-old Spring Valley man was killed early Saturday after he lost control of his speeding motorcycle on Interstate 5 in San Diego, authorities said.

Richard Dennis Fox was riding a yellow Yamaha R6 north on I-5 when he suddenly veered across traffic lanes into the Clairemont Drive off ramp, authorities said. He hit the guard rail, was thrown off his motorcyle and landed in a stand of trees at the bottom of a steep enbankment.

The accident was reported at 1:39 a.m. Saturday. Fox died at the scene.

ESCONDIDO: Motorcyclist killed in Harmony Grove Road wreck
the North County Times | Posted: Monday, August 17, 2009 7:55 pm

ESCONDIDO —- A motorcyclist was killed in a collision with a vehicle on Harmony Grove Road on Monday afternoon, the California Highway Patrol said.
The wreck took place just after 5 p.m. on the 9000 block of the road, west of the city limits, the CHP said.
Investigators remained at the scene Monday evening and no information about the motorcyclist or the circumstances of the crash was immediately available, said CHP Officer Ken Perez.
Both lanes of Harmony Grove remained closed near the scene of the collision, Perez said.

Mercury Launches Attack on Middle Class During Tough Economic Times
Santa Monica, CA – The California Attorney General has released the official title and summary of a proposed ballot initiative that will allow insurance companies to raise rates when motorists who stopped driving for a time restart their coverage; when they file a claim, even if an accident is not their fault; or when they are late on a payment. The anti-consumer measure is sponsored by auto insurance giant Mercury Insurance and its billionaire Chairman George Joseph, who over the years has funded numerous attempts to undermine Proposition 103, the voter-approved measure that bans unfair rate increases

Under state law, the Attorney General is responsible for analyzing a proposed ballot initiative and issuing a title and summary that will now appear on petitions presented to Californians by signature-gatherers for their approval. The Attorney General’s full title and summary, which was issued late yesterday, reads:

ALLOWS INSURANCE COMPANIES TO INCREASE OR DECREASE THE COST OF AUTO INSURANCE BASED ON A DRIVER’S COVERAGE HISTORY. INITIATIVE STATUTE. Allows insurance companies to raise the cost of auto insurance based on the absence of prior automobile insurance coverage. Allows insurance companies to lower the cost of auto insurance for drivers who have continuously maintained auto insurance coverage, even if they change insurance companies. Allows insurance companies to consider “claims experience” when calculating the amount of any such reduction or when determining which drivers will be eligible for it. Summary of estimate by Legislative Analyst and Director of Finance of fiscal impact on state and local governments: The measure would have no significant fiscal impact on state and local governments. (09-0021.)
The initiative would penalize people who miss one payment or decide not to drive and let their insurance lapse. It would also allow insurance companies to penalize drivers simply because they file a claim, even if they are not at fault such as when they’re at rear-ended while waiting at a stoplight. Currently, only accidents where the driver is at-fault can be used to increase his or her premium.

“Mercury is using the initiative process to go after middle class Californians by allowing insurance companies to raise rates on struggling families in the middle of an economic crisis,” said Consumer Watchdog’s Executive Director Doug Heller. “Auto insurers shouldn’t be allowed to jack up your premium because you stop driving for a time, miss one payment or file a legitimate insurance claim when you are hit in an accident.”

Hidden in the deceptive initiative is Mercury’s plan to create an unfair “use it and lose it ” system, which would raise driver’s rates if they ever file a claim. This creates a perverse incentive to not file accident claims, even when you are not at fault, in order to avoid a major rate hike. People who pay for coverage should not be penalized for using their policy. It also means accidents are less likely to be reported, a public safety hazard. Most importantly, for Mercury, it means that insurance companies will have to pay fewer claims. That is why Mercury, the only donor to this effort, has already contributed $500,000 to the campaign.

“It’s pretty easy to figure out what’s going on here. An insurance giant and its billionaire chairman are going to spend millions on political consultants and signature gatherers to try to fool Californians. Mercury will say and spend anything to win new ways to charge higher premiums and pay fewer claims,” said Heller.

Because the number of Americans letting auto insurance lapse during this economic crisis is skyrocketing, according to insurance industry data, Mercury’s proposed penalty for restarting insurance coverage will also force many drivers to remain uninsured. This will raise the cost of uninsured motorist coverage for everyone else and leave California roads much less safe.

“Mercury’s proposal is a triple threat. You will pay an insurance penalty if you ever have a lapse in coverage; you will pay a penalty if you ever file any kind of claim; and you will pay higher uninsured motorist premiums. That might be good for Mercury, but it’s no good for the rest of us,” said Heller.

Consumer Watchdog has sent Mercury’s George Joseph a letter about his dangerous attack on California families. The letter can be read here: http://www.consumerwatchdog.org/resources/LetterToGJoseph.pdf

Personal Injury Settlement – Exposing the “Multiplier Method” Scam

No doubt you have heard of the so-called “Multiplier Method” of determining settlement value in accident cases. Simply put, the medical bills are multiplied by 3 to calculate the amount of the settlement. In fact, the ‘multiplier method’ is nothing more than a scam perpetrated by the insurance companies to keep settlements low.

Just as every person is unique, every personal injury claim is unique. The belief that there is a simple way to arrive at the “correct” amount of settlement is a fallacy which the insurance companies have encouraged to keep settlements low. A simple example illustrates the point:

ACCIDENT A: rear-end collision, whiplash, $3,000.00 in chiropractic bills, full recovery after three months.

ACCIDENT B: rear-end collision, mid-spine disk injury, non-surgical, $3,000.00 in medical bills, chronic back pain.

According to the “multiplier method,” both victims would receive a $9,000.00 settlement. However, Victim B sustained a back injury which cannot be fixed by surgery; as a result, Victim B will suffer chronic back pain for the rest of her life.

The law says every accident victim has the right to compensation for all pain and suffering, past, present and future. Obviously, the “multiplier method” of settlement cheats Victim B and prevents her from receiving a fair settlement.

In personal injury law, every case is unique, and the lawyer you choose to represent you makes a difference. The insurance company adjustors are professionals; in handling your personal injury claim, the smartest thing you can do is get an aggressive, experienced personal injury professional on your side.

By Alex Johnson
Reporter
msnbc.com
Thurs., April 9, 2009

Insurance industry study warns that 1 in 6 won’t be covered by end of year.

“When you see a multi-car collision on the freeway … if there’s more than three or four cars there, at least one of them is likely to be uninsured,” says Karl Newman, president of the Northwest Insurance Council.

Insurance regulators and safety activists are alarmed at what they describe as a stunning rise in the number of drivers who are cutting back or even dropping their auto insurance to save money during the recession.

“It’s been a shock,” said Chris Pringle, owner of All American Insurance Agency in Little Rock, Ark., who said up to 20 percent of his clients had dropped their policies or missed payments in recent months. “I thought we were somewhat in a recession-proof business, because (auto insurance is) required for everyone to have.”

Karl Newman, president of the Northwest Insurance Council, a trade association based in Seattle, warned that “we may be looking at record numbers of uninsured motorists across the nation.”

“When you see a multi-car collision on the freeway … if there’s more than three or four cars there, at least one of them is likely to be uninsured,” Newman said. Industry figures back up that concern. By next year, 1 of every 6 drivers on U.S. roadways is likely to be uninsured, according to the Insurance Research Council, a nonprofit group financed by the insurance industry. To calculate that figure, the council reviewed accident claims processed by insurers covering half of the nation’s drivers.

All but two states require motorists to carry liability insurance — New Hampshire and Wisconsin are the exceptions — and over recent years, the percentage of drivers without it had fallen steadily, reaching a modern low of 13.8 percent just two years ago, the research council said.

But last year — the first full year of the economic recession that started in December 2007 — the rate spiked to 14.6 percent. It is forecast to reach 16.1 percent by the end of this year, which would work out to more than 33 million licensed drivers across the country without coverage, based on figures compiled by the Federal Highway Administration.

“As a police officer, we see it all the time,” said Steve Ellis, a sheriff’s deputy and driving instructor in King County, Wash. “It’s gambling with your money, and it’s gambling with other people’s lives.”

The phenomenon is directly attributable to the sour economy, said Elizabeth A. Sprinkel, senior vice president of the research council.

The report found that an increase in the unemployment rate of 1 percentage point was directly associated with an increase in the uninsured motorist rate of more than three-quarters of a percentage point. Sprinkel called that finding “an unfortunate consequence of the economic downturn (that) illustrates how virtually everyone is affected by recent economic developments.”

Tommy Manzullo, an agent with A Ace Insurance Agency in Baton Rouge, La., said that when he calls clients to remind them to pay their premiums, he usually gets the same response: They can’t afford even the minimum liability coverage required under state law. Food and rent are more immediate concerns.

But no matter how tight finances get, dropping your auto insurance is one of the worst steps you can take, law enforcement officials and insurance industry representatives say.

The average auto insurance policy cost $72.25 a month in 2007, the last year for which full figures are available, the National Association of Insurance Commissioners said. But dropping it can cost considerably more.

“Uninsured motorists face legal fees, fines (and)penalties, including a suspended license,” said Elaine Zeinner, a spokeswoman for AAA.

That’s not to mention tens or even hundreds of thousands of dollars in hospital and repair bills if you’re in an accident. And in states without “no-fault” insurance laws, you could also be on the hook for the bills of other drivers or passengers, who could sue and, if successful, tap your bank accounts and garnishee your wages.

“You could lose your house because someone is going to be suing you for medical bills and damage to the vehicle,” said Travis Bennett, an agent with AIC Insurance in Redmond, Ore. ‘In the long run, it’s going to hurt.’

It can also be a bad idea to cut back on the coverage you have, agents and regulators said. “Going underinsured is a financial nightmare,” said Bob Davis, an agent with State Farm Insurance in Evansville, Ind., who said he had been busy in recent months changing customers’ policies.

“They’re lowering liability charges and actually getting rid of comprehensive coverage,” Davis said. “Yes, they are saving $13 to $14 a month, but what they find in the long run (is) it’s going to hurt.”

Even with the legal minimum policy in most states, paying for repairs out of pocket is out of reach for most drivers, said Brian Hazelrigg, an agent with State Farm Insurance in Columbia, Mo.

“I would make sure they understand what happens if we drive out of this parking lot and have an accident,” Hazelrigg said. “What are they sacrificing from losing that coverage?”

The National Association of Insurance Commissioners, which represents insurance regulators in all 50 states, said most Americans were woefully uninformed about what was covered by their auto policies.

A quarter of Americans rarely or never review their policies, the association reported in a survey, while three-fifths review their coverage only when they file a claim or renew their policies. As a result, tens of millions of Americans are driving around with policies that don’t reflect major changes in their incomes and family situations, it said.

The survey, which questioned 1,000 U.S. adults in December, reported a margin of sampling error of 3.1 percent.

“Now, more than ever, consumers need to be mindful of the impact their insurance decisions can have on their financial future,” said Terri Vaughan, chief executive of the association.

© 2009 msnbc.com

Embattled insurance giant American International Group Inc. is selling 21st Century Insurance Group to Farmers Group Inc., a subsidiary of Zurich Financial Services Group, in a $2 billion deal.

Los Angeles-based Farmer’s will pay $1.5 billion in cash, plus $400 million in capital notes backed by Zurich for Woodland Hills, Calif.-based 21st Century. Farmer’s also will assume 21st Century’s $100 million in outstanding debt. The transaction is expected to close in the third quarter.

Farmers Insurance Group, a unit of Farmers Group, is the largest employer in Olathe, with about 3,000 agents and employees combined, a spokeswoman for Vince Donofrio, vice president of Farmers Insurance Group’s HelpPoint Operations in Olathe, said Friday. It’s too soon to know how the acquisition will affect Farmers Insurance’s Kansas City-area operations, she said.

To increase the capital at Farmers, Zurich is expected to raise $1.1 billion in a stock offering to institutional investors.

“Both 21st Century and Farmers are strong companies, providing policyholders with exceptional levels of service and personalized coverage,” Anthony DeSantis, CEO of 21st Century, said in a statement. “This is an excellent fit and we look forward to a smooth integration that will be seamless to our customers.”

AIG (NYSE: AIG) is based in New York City.

A World of Hurt: For Injured Workers, a Costly Legal Swamp (March 31, 2009)

Nicole Bengiveno/The New York Times
Dr. Edward Toriello feels that workers’ doctors are often biased. “I think it’s human nature to help your patient. I think a lot of doctors say: ‘I don’t need the aggravation. It doesn’t hurt to keep him out of work.’”

The worker, a driver for a plumbing company, told the doctor he had fallen, banging up his back, shoulder and ribs. He was seeking expanded workers’ compensation benefits because he no longer felt he could do his job.
Dr. Samuels, an independent medical examiner in the state workers’ compensation system, seemed to agree. As he moved about a scuffed Brooklyn office last April, he called out test results indicative of an injured man. His words were captured on videotape.

Yet the report Dr. Samuels later submitted to the New York State Workers’ Compensation Board cleared the driver for work and told a far different story: no back spasms, no tender neck. In fact, no recent injury at all.

“If you did a truly pure report,” he said later in an interview, “you’d be out on your ears and the insurers wouldn’t pay for it. You have to give them what they want, or you’re in Florida. That’s the game, baby.”

Independent medical exams are among the most disputed components of New York’s troubled workers’ compensation system. Under that system, workers with bona fide injuries are entitled to medical care and replacement wages, usually paid for by their employer’s insurer.

The independent exams are designed to flush out workers who exaggerate injuries or get unnecessary care, and there is no question that some of that goes on. As a check on what a worker’s doctor determines, insurers are allowed to order an ostensibly neutral exam by a doctor they select and pay for. They do so regularly, with more than 100,000 exams conducted each year.

But a New York Times review of case files and medical records and interviews with participants indicate that the exam reports are routinely tilted to benefit insurers by minimizing or dismissing injuries.

“You go in and sit there for a few minutes — and out comes a six-page detailed exam that he never did,” said Dr. Stephen M. Levin, co-director of the occupational and environmental medicine unit at Mount Sinai Medical Center, who has been picked as the interim medical director at the compensation board. “There are some noble things you can do in medicine without treating. This ain’t one of them.”

New York uses independent medical examiners far more extensively than many states do, and critics say the practice adds to the mistrust in the system. The examiners’ opinions can empower an insurer to slash benefits, withhold medical treatment or stall a case. Workers say that psychologically, there is something particularly damaging about being dishonestly evaluated by a medical professional.

“I was in so much pain and felt so hopeless for so long,” said Carol Houlder, a substance abuse counselor who waited a year for surgery on her injured ankle to be approved. “Doctors see you’re in pain and say you’re not. How do they call themselves doctors?”

Many independent examiners are older, semiretired physicians who no longer treat patients, and claimants and lawyers have asserted that the memories and judgments of some of the doctors have at times been impaired by their age and frailties. The examiners do not need special training, only to have a state license and to be authorized in a specialty.

“Basically if you haven’t murdered anyone and you have a medical license, you get certified,” said Dr. Alan Zimmerman, 75, a Queens orthopedic surgeon who does the exams. “It’s clearly a nice way to semiretire.”

Some examiners see dozens of injured workers a day. Often the appointments are booked by brokers who help insurance companies find doctors. Some brokers are not registered with the state, as required, but there has been little enforcement of the rules.

Insurers, examiners and brokers, however, defend the exams as necessary and largely untarnished by bias. Dr. Brian L. Grant, chairman of Medical Consultants Network, a company based in Seattle that arranges independent exams across the country, said, “We never get pressure from an insurer.”Many workers contest independent medical examiner opinions and often prevail. Judges can, and do, dismiss the exam findings. In fact, some lawyers and judges laugh when certain examiners’ names come up at hearings.

A New York Times examination of New York State’s workers’ compensation system uncovered a universe of delays, suspicion and questionable rulings.

Dr. Kenneth E. Seslowe, an orthopedic surgeon who mainly does independent medical exams, is mocked at hearing offices by attorneys as Dr. Says-No, because they feel he consistently finds no disability. Asked about this, Dr. Seslowe said, “I really don’t have time for this.”
But even when the opinions are discounted, resolution can take months, years, even decades, and many workers, tired of the ordeal of five, six, seven exams, eventually give up.

Some examiners, of course, do furnish honest, well-reasoned opinions. And sorting out the yawning breach between what a worker’s doctors and an independent medical examiner conclude is complicated by the fact that some injuries and their impact on a person’s ability to work — especially soft-tissue injuries like those to the back and neck — are hard to document with indisputable tests.

Zachary S. Weiss, the chairman of the workers’ compensation board, said that he found the disparities in medical opinions shocking and that use of independent examiners was “off the charts.” But Mr. Weiss, who was appointed in late 2007, said he was unsure what would rectify the problems.

After nearly a dozen years without a medical director, the board has finally filled that job temporarily. It has introduced new, more detailed forms, which many doctors find maddening. It is also working on fresh guidelines that it hopes will better calibrate an injured worker’s care and work limits.

Dr. Robert E. Bonner, the medical director of the Hartford, an insurance company, said it was clear that the landscape had polarized. “Physicians regrettably have moved away from being neutral observers,” he said. “They’ve moved toward one camp or the other.”

Doctor vs. Doctor

When New York companies complain about the high cost of doing business in the state, they often cite fraudulent workers’ compensation claims as a key factor.

Though experts say talk of worker fraud is frequently overstated, it is widely acknowledged that some doctors collaborate with workers or their lawyers to magnify injuries or provide treatment for years without making someone better. Law firms representing workers often have cozy relationships with doctors to whom they refer patients, and vice versa.

A few years ago, Dr. Rafeak Muhammad, a Queens ophthalmologist, was barred from taking workers’ compensation patients after acknowledging that he had treated several long after it was necessary. He declared them unable to work when in fact they could.

David Donaldson, senior vice president at the domestic claims subsidiary of A.I.G., one of the state’s largest workers’ compensation insurers, said, “Our position on I.M.E.’s is we’re looking for someone who is going to give us a coldly objective view of the injury.”

Critics, however, contend that independent medical examiners who reliably dispute workers’ doctors are hired more often by insurers. Some workers cynically refer to them as “insurers’ medical examiners.”

Shu-Ying Xu, 66, a home health aide, said she met with an independent examiner in October 2006 so he could review the back, neck and leg injuries she suffered when she tried to prevent a patient from falling.

She said the exam took two minutes and was so quick that the doctor, Wayne Kerness, an orthopedic surgeon, did not ask her anything.

As a result, she said, when the doctor filed his report he said she spoke English. She does not.

He said she took no medications. She said she took nine.

He said her disability was mild and she could resume work.

She said that she was in debilitating pain and that the Social Security Administration had already concluded that by its standards, she was totally disabled.

“She can’t even hold a gallon of milk,” said Peter Chang, her son. He had come along to the exam to translate. Since no questions were asked, he said he had nothing to do.

After checking his notes, Dr. Kerness said it was an error to have said that Ms. Xu spoke English. Otherwise, he stood by the report. “What can I say?” he said. “People can say whatever they want.”

He added: “I have my share of people I’ve found totally disabled and even recommended treatment that has been overlooked. I think I’m pretty heterogeneous.”
A judge ultimately ruled that Ms. Xu’s benefits should continue.

For decades, independent medical examiners were essentially unregulated. Reports were sometimes altered by brokers and exams often were done at airports, hotels or in the garages of doctors’ homes. In 2000, a doctor examined five patients in a Long Island bar.

In 2001, the state introduced rules. Among them: doctors had to register with the board, work in a medical office and let workers record or videotape their exams. Claimants are permitted to bring along anyone they choose to witness or film the sessions.

While the law has helped, the process remains riddled with flaws. Lawyers and injured workers say many of the examiners still do brief, perfunctory, one-sided exams.

A small study conducted a few years ago at the Central New York Occupational Health Clinical Center in Syracuse found that the clinic’s doctors and independent medical examiners virtually never agreed on whether a worker was disabled. When it can be proven that medical examiners have acted inappropriately, the compensation board revokes their certification — which has happened more often in recent years. But investigations are time consuming and only a dozen or so result in revocations each year.

William Gurin, the board’s fraud inspector general, says his unit’s limited resources are best focused on more fertile areas of fraud, such as employers who underreport their work force to save on insurance premiums.

Similarly, the board struggles to regulate businesses, from storefront exam factories to multistate networks, that help produce independent exams. Decades ago, insurers hired doctors directly. Now the job is increasingly done by third-party brokers called entities.

Entities are paid by insurers — around $500 or $600, say, for an orthopedic exam — and they in turn pay the doctor. Often, doctors submit dictated notes or checklists to clerical staff at the firms, who then draft the reports. Other times the notes go to transcription companies. The people preparing the reports may have no medical training.

Since 2001, the state has required entities to be registered. About 170 have signed up. But a fair amount of independent exam work is performed by companies that have never registered.

It was an unregistered company, Wine Medical Management, that arranged an independent medical exam of Santos Padilla, an injured worker, in 2006. The exam was to be done by Dr. Kerness, but it was canceled, and Mr. Padilla was seen by another doctor.

But somehow the compensation board received a report signed by Dr. Kerness recounting an exam that had never happened.

Dr. Kerness blamed the bogus submission on a clerical error by Wine. He said the company, using a signature stamp, had affixed his name to a report he had not seen.

Wine went out of business last year. A former manager at Wine, Laura Urban, blamed the discrepancy on a transcription company that prepared the reports. Ms. Urban moved to Commander Management, another entity that was doing unregistered work until the board ordered it to cease.

The board is looking into the Padilla episode, and has pledged to crack down on unregistered I.M.E. entities. Only a handful have ever had their certifications revoked, usually not for creating shoddy reports but for failing to pay their doctors.

Robert Grey, a claimant lawyer, said the board should track the opinions of independent medical examiners and compare them to ultimate verdicts, and then exclude doctors who were constantly found not credible.

Currently, the best protection for a worker is to tape an exam. But few do. The board does virtually nothing to promote the practice, and some doctors do not like it. When a woman brought a camera to an appointment upstate, the doctor called the police to toss her out.

Ms. Houlder, 63, who hurt her ankle, videotaped her exam by Dr. M. Pierre Rafiy, a 77-year-old Long Island orthopedic surgeon.

In the videotape, Dr. Rafiy grasps Ms. Houlder’s right ankle and says it is swollen. In the written report, he stated that there was no swelling and no disability and that she could return to work.

When subsequently deposed, he backtracked, saying it had been a secretary’s mistake to say no disability. He did not correct anything else.

Asked about the exam in an interview, Dr. Rafiy said: “I have no way to know if she had real pain. You have to remember, a lot of people don’t want to work. They lie a lot.”

Dr. Samuels, 79, with a radiant smile and a burst of snowy hair, stopped doing surgery years ago. Until recently he commonly filled his days performing insurance exams on workers, sometimes as many as 50 in an afternoon, he said in his small office in Borough Park, Brooklyn.

“You obviously can’t spend a lot of time with that volume pushing up your back,” he said. “You have to assume there are going to be errors. Look, there are a lot of holes in this thing.”
At times, evidence shows, Dr. Samuels’s official reports were quite different from what he appeared to find during an exam.

Consider his 2007 examination of Johanne Aumoithe, a pastry chef who said she had hurt her arm and neck. On a videotape that Ms. Aumoithe recorded on her cellphone, Dr. Samuels comments that she had limited range of motion. His written report concluded the opposite.

Asked about the discrepancy in an interview, Dr. Samuels chuckled and said he could not even recall the people he saw yesterday. The way he worked, he said, was to submit a checklist to a Queens company called All Borough Medical, which transformed it into a narrative.

“I never write a sentence,” he said. “It’s really crazy, but that’s how it’s done.”

He often inserted numbers in the checklist — say, a measure of hand strength — after the person left, rather than as he performed the tests.

Was he sure they were correct? “I’m not sure of anything,” he said. “They’re just a guess in the first place.”

The law requires a doctor to attest to the accuracy of a finished report before signing it, but Dr. Samuels said he rarely read them. He doubted he had read the Aumoithe report. “I just sign them,” he said.

If he seldom read them, how did he know they were correct?

“I don’t,” he said. “That’s the problem. If I read them all, I’d have them coming out of my ears and I’d never have time to talk to my wife. They want speed and volume. That’s the name of the game.”

Dr. Samuels said he generally received about $100 for one of these exams.

The state does not regulate how much a doctor can make for an independent medical exam, though it does limit what a treating physician may charge an injured worker, and generally that is much lower for roughly equivalent work. Some examiners said insurers pay them by the session, say $1,500 to be available from 8 a.m. to 4 p.m. and handle whatever workers are sent to them.

An occupational medicine doctor deposed by Scott Clippinger, a claimant lawyer, said he charged $550 an hour for an independent medical exam. In 2006, Mr. Clippinger complained to the state board that the imbalance in fees “allows the carriers to purchase opinions.” He asked the state why it was not following a clause in state law that says that independent medical exams “shall be paid according to the fee schedule.”

The board’s response was that while the law “does provide that I.M.E. fees shall be paid according to the fee schedule, the fee schedule does not specify a particular fee for an I.M.E.”

Dr. Edward Toriello, a Queens orthopedic surgeon who cares mainly for his own patients, said he is paid nearly twice as much for an independent medical exam than he is for seeing a workers’ compensation patient he treats ($250 versus $140).

Like many who perform the exams, he views the compensation system as bloated with charlatans. Dr. Toriello, who does about 30 such exams a week, estimates that 80 to 85 percent of the time he finds no disability or need for medical treatment in workers whose doctors have found otherwise. He says the disparity is explained by the “comp mentality.”

“I think it’s human nature to help your patient,” he said. “I think a lot of doctors say: ‘I don’t need the aggravation. It doesn’t hurt to keep him out of work.’ ”

Dr. Zimmerman, of Queens, said he believed that 75 percent of people getting workers’ compensation did not deserve it, but also said he was not surprised to hear that insurance lawyers in Queens said his opinions were overwhelmingly disregarded by judges.

“Judges come up with wrong decisions a huge amount of time,” he said. “The lawyers work it so that anyone who scratches their toenail deserves equal treatment as someone who fell out of a 40-story building.”

Sometimes, a review of cases shows, there are stark discrepancies between the testimony independent medical examiners give at trial and their reports.
Twice in 2005, for example, Dr. Francis O’Malley, a Long Island orthopedic surgeon, testified that a disability was more serious than indicated by his reports.

In one case, Dr. O’Malley testified that a man who had hurt his back lifting packages had a “marked” partial disability. The report described the injury as a less severe “moderate” disability.

When confronted with the discrepancy, Dr. O’Malley testified, “I don’t know what’s going on.”

The reports were filed on Dr. O’Malley’s behalf by Hooper Holmes, a national medical services company that operated an I.M.E. entity. The company said that it always submitted exactly what doctors gave it and that it believed Dr. O’Malley, who is 78, was confused. Dr. O’Malley did not return calls for comment.

In the case of William Cassone, the plumbing company driver whose father taped his examination, the exam by Dr. Samuels was arranged by All Borough Medical, an unregistered I.M.E. entity, which got the assignment from another registered entity.

Mr. Cassone had been injured years earlier but was being examined because, as he says on the videotape, he had suffered a second, recent injury.

But Dr. Samuels’s report made no mention of the second injury and deemed Mr. Cassone able to work. When Mr. Cassone got the report, he said, “I was screaming so much I left the house and slept in the car.”

Dr. Samuels later swore in a deposition that the report was accurate. A few weeks later, though, the board received an addendum signed by Dr. Samuels saying he had viewed the videotape and, yes, he had been told of the second injury. Still, he found no evidence of disability.

All Borough declined to comment on the case and its business.

Dr. Samuels said in a recent interview that he had never seen the addendum or the videotape and doubted he had read the original report. He said All Borough must have prepared the addendum without his knowledge.

“This is the first I’ve heard of this,” he said. “Listen, there’s a lot of hanky-panky that goes on.”

Mr. Cassone’s lawyer, Michael Pyrros, told a judge at a hearing that he was concerned there might have been fraud involved in the conduct of Dr. Samuels, the I.M.E. entity and the insurer. When the Cassone case next came before a judge, late last summer, a deal was reached between lawyers to grant Mr. Cassone benefits. Fraud allegations were dropped against the insurer.

Dr. Samuels, who was told to appear at the hearing, did not show up. According to a letter from his lawyer, he was unwell. His behavior was never addressed. Soon after, he retired, his official record unblemished.

——————————————————————————–

Bureau of Justice Statistics Study Offers Some Interesting (and Possibly Unexpected) Findings.

Although our concentration is on attorney’s fees award, we sometimes digress to report on studies relating to the general civil litigation sector. Now is the time to discuss a recent study that has some results that may be surprising in many respects.

The Bureau of Justice Statistics has issued a recent report, “Civil Bench and Jury Trials in State Courts, 2005,” based on a national study of civil litigation trends in the 75 most populous counties from 1992 to 2005 and analysis of civil tort, contract, and real property verdicts/decisions in a national sample of jurisdictions in 2005.

Here are the highlights—some of which buck conventional wisdom or lore:

· In 2005, plaintiffs won 56% of all general civil trials concluded in state courts. In tort cases, plaintiffs were most likely to prevail in lawsuits involving an animal attack (75%), followed by auto accident (64%), asbestos (55%), and intentional torts (52%). Plaintiffs had the lowest win rates in medical malpractice trials (23%), product liability trials not involving asbestos (20%), and false arrest/imprisonment trials (16%).

· Plaintiffs were significantly more likely to win in a bench trial; they won 68% of bench trials and 54% of jury trials.

· Among all plaintiff winners, the median final award was $28,000, with contract cases having higher median awards ($35,000) than tort cases ($24,000). Only about 4% of victorious plaintiffs received awards above $1 million.

· Plaintiffs winning their cases were awarded punitive damages in close to 5% of the cases, with the median punitive damages award being $64,000.

· The total number of civil trials in the nation’s 75 most populous counties declined by 52% from 1992 to 2005. Tort cases decreased the least (40%), while real property (77%) and contract (63%) cases registered the largest dips.

· Overall, median damage awards are on the decline in the most populous counties—except in products liability and medical malpractice cases. From 1992-2005, the inflation-adjusted median damages award decreased by 40%, from $72,000 in the previous large-county study to $43,000 in 2005. This drop was largely caused by a decrease in the median award for auto accidents, which dropped from $41,000 in 1992 to $17,000 in 2005. However, products liability plaintiffs in 2005 received a median award of $749,000, five times higher than in 1992, and medical malpractice plaintiffs received a median award of $682,000 in 2005, nearly 2.5 times as much as the median ($280,000) in 1992.

· Of the cases making it to trial, 61% involved tort claims, with auto accidents being the most frequent matter being tried. The median final award in auto cases was around $15,000.