Workers Compensation Fraud.... Just the sound of those words spark unpure thoughts. But sadly it's a reality in today's California society. And it's causing alot of economic damage.

Let's look at another fact! Who runs the Workers Compensation system? Do you think the state does? Maybe in name they do, but the sad reality is that the insurance industry really runs it through a series of political puppets in our legislature and the California Department of Workers Compensation. The economic and political pressure that these special interests wield is really unbelievable, which is one reason why this state is in such a sad state of affairs.

They also own Arnold Schwarzenegger. He certainly takes enough of this special interest money. So you have to ask yourself, "How can the Workers Compensation system favor the injured worker," which was it's purpose when Progressive Governor Hiram Johnson had the forethought to create a system to help those "injured at work" at the beginning of the industrialization of California some 100 years ago.

The answer is simple. It doesn't! Now that we have that out of the way, the stage has been set and you'll better understand what is to come next.

Look at the legends on those tombstones; Denied; Rejected For No Reason; Denied Because Of Pre-existing Conditions; and they go on and on and on.

Simple basic medical procedures are denied on a wholesale basis simply because the insurance companies refuse to comply with that social contract that they agreed to some 100 years ago. And this is done with the help of their latest cost-cutting scam, Utilization Review. But we'll get into that another time. What we're going to look at here is the lowest of lows; an example of the brute political and economic force that this industry wields with a big stick!

What happens when an injured worker catches the insurance company violating their legal and constitutional rights? And what's worse, what happens when that injured worker takes legal action to enforce those rights? Case after case has shown that the insurance companies don't take this very lightly. As a matter of fact, in many cases, they retaliate against those who turn them in, and who is behind the proverbial 8-Ball? Why the injured worker of course! And I seriously don't think there is any language in the labor code to address that!

What they do is tantamount to judicial terrorism. Using the court system to literally terrorize these citizens for asking for some simple justice. How do you fight an insurance company with pockets as deep as a well and political connections far & wide?

The thought process here is that the injured worker who is already fighting to keep a roof over the head of his family and food in their stomachs, will be totally overwhelmed both financially and emotionally by the shock of a criminal arrest and attempted prosecution. But not in all cases. Some good law abiding injured workers simply won't take no for an answer and will fight these bogus charges to the end because they believe in our legal system, despite the fact that it has been influenced by those business interestes with very deep pockets.

As an example, look at the case of our member Anita Blick. She is a model citizen. Not even a traffic ticket in 54 years! A dispatcher for the police department of one of the wealthiest towns in the United States, Atherton, CA. She shattered her knee running to answer the 911 phone that was never supposed to ring more than 3 times! But it's a funny thing, when an employee has to file an injury report, employers do some very strange things and don't show a pattern of rational thinking.

The Cities group, who is the insurer for most municipalities in San Mateo County, made numerous false statements during her trial as did representatives of the San Mateo County District Attorneys office simply to get a conviction of Mrs. Blick. It has cost her $150,000 plus to defend herself against these false charges. When they were unable to get a conviction using the insurance fraud statutes, they used an ambiguous section of the penal code to get a conviction and forced this law abiding citizen to spend 60 days of a 90 day sentence in solitary confinement in the San Mateo County jail.

But there is a bright side to this story, Just recently the Court of Appeals vacated the conviction on an error of the trial judge who strangely retired right after this case. The judge's instructions to the jury in this 5 week trial were in error. A lot of county resources were used to get this bogus conviction.

If you ever find yourself in this predicament, remember this; fraud is a specific intent crime, and requires proof of a culpable mental state. The District Attorney has the burden to prove this at trial. No proof? No conviction!

Also keep this in mind. Public Defenders really don't care whether you are guilty or innocent. Most of their clients are guilty and under our system of law deserve some kind of defense. And they deal with their clients whether guilty or innocent with that attitude in mind. All they are interested in is disposing of the case. In many instances, they don't convey the legal requiremnt issues to their clients and are just happy that they can convince their clients to plead to a lesser offense whether they are innocent or not.

Why so much pressure by the District Attorneys to get convictions? That question has a simple answer and a big conflict of interest. County District Attorneys are paid by the insurance industry to prosecute injured workers for fraud thru the Fraud Assessment Fund of the California Department of Insurance which is bankrolled by mandatory contributions from the insurance industry.

But there is simply no monetary incentive in it for them to prosecute an insurance company for violating the constitutional and legal rights of an injured worker. Get the picture? I hope so! What's the moral of this story? Simply watch out for your back and know the law, otherwise YOU may be next!