- Report: #419951
Report - Rebuttal - Arbitrate
Complaint Review: ZURICH AMERICAN INSURANCE
ZURICH AMERICAN INSURANCE801 N Brand Blvd Glendale, California U.S.A.
Zurich American Insurance, Q.M.E., Dr. Richard E. Nussbaum, Victor Vidales (claims Mgr.) ZURICH AMERICAN INS.-(1) Insurer Fraud, (2) Denied Tx. for Spinal Injury (Now Perm. Nerve Damage)! Glendale California
*Consumer Comment: Change your company Immediatly, these guys are a joke
*Author of original report: This is to add critical info (minus typo's) in first submission. Please switch.
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My name's Scott, and have worked in the construction end of Film & Television for some 15 years. I've had one prior lumbar surgery in 1999 for a herniated disc.
On March 24th, 2005, I threw my back out co-lifting ten or more 250 to 300lb. decorative Queen Palm trees during a "wrap" of a pilot shoot. Two weeks later, my back was not improving, so I'd seen an orthopedist (Pain Management Specialist) who scheduled and performed epidural spinal block injections in my lumbar spine in the first week of May. It was around this time where I interviewed with a Zurich "claims investigator" named Dennis Hawthorn, providing him with witness contact information (telephone number of my superior who'd delegated the job), and signing medical records (release) forms of all docors I'd seen over the years.
On June 20th (three months later, following Zurich American's "90 Day Delay notice", Zurich had denied my claim on three points,
1. No supporting medical records.
2. Claim not filed in a timely manner, &
3. No witness found to corroborate injury.
One year later, I'd bumped into the same construction coordinator I'd worked for on the date of injury, who informed me he had never been contacted by anyone (claims investigator, claims manager, or anyone from Zurich American) regarding my lifting exacerbation nearly one year earlier.
This led to my own investigation, obtaining a statement from my supervisor, describing accident, I found copies of medical records from the April doctor visit, which stated "Heavy Lifting On The Job", & "occurring March 24th, 2005". I then contacted my employer's Workers' Comp. department regarding the date of reported injury, about which they informed me I indeed "had filed the injury report within the legal time frame.
Having been on no prescribed pain, anti-inflamatory, or muscle relaxants, during the entire event, I returned to work (w/o restriction) on June 28th, 2005, leaving myself little time to pursue the Zurich denial legally as my health insurance coverage was to lapse on July 30th, and I needed to make as many specialists appointments (cardiology, orthopedic, dental, etc., as quickly as possible. I have all documentation.
But ten days after returning to work, a new and very different (non-lifting) severe spinal injury would occurr.
ZURICH: FAILURE TO PROVIDE (ANY) PROMPT CARE FOR SPINAL FRACTURES.
I was working (lifting, carrying, climbing without any limitations) for my first week of construction on an HBO show, "Deadwood".
Into my second week (July 6th, 2005) my crew had a deadline of building, and setting a "raked" roof-piece over a two story bay window.
While setting the ledger-board against the building, my co-worker held the board in place, as I screwed some thirty 4" deck screws over the course of about five minutes with my right hand with screw-gun, with my only support being at my knees (both knees on outer bay-window wall, facing the building, with my left hand stretched out grasping the left return wall of the bay window.
This was at the end of the day, and my back was very tight, but I attributed the tightness to muscle strain for being in an unusual position for those five minutes. By 10:P.M., the tightness was significantly worse as I went to bed. I was awakened by excrutiating pain at 4:00 A.M., and awake until 6:00 to call my foreman, advising him that I could barely walk, and that I was unlikely to be able to work for at least a week, and to look for a replacement
My foreman suggested I "hobble" into work and fill out an injury report, and Workers' Comp. papers with the "on-set medic", then go to my doctor, which I did. My general practicioner wrote me a "referral" to my pain management orthopedist.
I reported the injury to my employer Cast & Crew Entertainment Payroll, whose W.C. carrier Zurich American, (claims adjuster, Victor Vidales) contacted me the same day, informing me that Zurich would authorize an appointment with the orthopedist.
The following four business days, I was calling both the orthopedist's office, asking if an appointment had bee authorized by Zurich, and concurrently contacting Victor (claims) to find out why no authorization had been given.
Victor (claims a Zurich) had never returned any of my phone calls.
Five business days following my injury, I received by mail a "Ninety Day Notice of Delay" from Zurich American Insurance. Meaning they would not even authorize a plain X-Ray.
Oct. 18, 2005 (three months later) a state appointed Qualified Medical Evaluator (who also provides the service of "Expert Medical Witness" for insurance companies in personal injury jury trials) discovers that my spine has shifted out of alignment 25% from his "exam-day X-rays. He explains the condition is absent in my eleven month old MRI I'd brought to the exam.
This (among numerous blunders, misrepresentations, misfacts, labor code violations, and contradictions) Q.M.E., Dr. Richard E. Nussbaum FAILS to order a CT scan, which can best determine the type of spondylolisthesis, and often the cause, essential in a Medical-Legal exam such as mine. Q.M.E., Dr. Richard E. Nussbaum concluded that my injury is "at best, an exacerbation of a pre-existing condition".
Jump two years, after Zurich's refusal of prompt medical attention, and twenty-one months after Q.M.E., Dr. Nussbaum's misdiagnosis, eighteen months of collapsing legs, followed by a paralyzed right ankle, and bowel & bladder issues, neurosurgeons at LAC+USC Medical Center discover "dual pars fractures, strongly suggesting the "Isthmic Spondylolisthesis" was injury or work-related. All the while, I was unable to retain counsel due to one prior back surgery, an unpersued denied claim by Zurich (weeks before the second, more serious injury), and Gov. Schwarzeneggar's 2003/2004 Workers' Comp. Reform bill "SB-899", effectively declawing most W.C. attorneys, by minimizing litigation for insurance companies. Arnold took $500,000. in insurance company donations that campaign. It worked out just great for the injured workers of Calif.
POST JUNE, 2007 EMERGENCY DOUBLE SPINAL FUSION SURGERY:
Due to Zurich American's initial refusal to provide prompt medical attention after my July 6th, 2005 work injury (supported by numerous documents & spinal shift not present as recently as six week prior to injury.
PERMANENT MEDICAL CONDITIONS: (NON-EXISTANT PRIOR TO INJURY)
I have only 50% strength in both wobbily legs, one paralyzed right foot, balance problems, and continuing bowel & bladder complications, and cannot stand for more than 15minutes without siting, and cannot walk for more than 20 minutes.
Full details at my web site (((link redacted)))
Santa Clarita, California
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This report was posted on Ripoff Report on 02/04/2009 01:06 AM and is a permanent record located here: http://www.ripoffreport.com/r/ZURICH-AMERICAN-INSURANCE/Glendale-California-91203/Zurich-American-Insurance-QME-Dr-Richard-E-Nussbaum-Victor-Vidales-claims-Mgr-Z-419951. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.
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