L LEDGERWOOD

LAW GROUP

November 2015 No. 26

Ledgerwood Law Group n 1385 Ridgewood Drive n Suite 106 n Chico, CA 95973 n Toll Free: 888-761-7383 n www.ThomasLedgerwood.com n 1

Safe Harbor

Continued on page 2

A monthly newsletter published by the Ledgerwood Law Group dedicated to the rights of injured workers,

Social Security Disability claimants, food, travel, gardening, fishing, camping and life on the open road.

Continued on page 3

Frances Stevens suffered a significant fall at work. Thereafter, she endured multiple spinal

and orthopedic procedures involving two fusions in her feet. She was in constant, agoniz-

ing pain. She could not sleep at night. She was unable to stand or walk without burning

pain. Her doctors diagnosed her with Complex Regional

Pain Syndrome. There was no cure found for her injuries.

She became deeply depressed. She ended up wheelchair-

bound and ultimately found to be 100% disabled in her

underlying workers’ compensation claim. She was

awarded future medical treatment rights.

If you are thinking this lady was entitled to decent

pain control under the California Workers’ Compensation

System, you would be wrong.

The workers’ compensation insurer, the State Com-

pensation Insurance Fund, shot her doctor’s RFA (Re-

quest for Authorization) for pain medication and in-home

services through UR (Utilization Review). Like many in-

jured workers in this state, UR nit-picked the doctor’s

recommendations and supporting documentation and de-

nied all treatment requests based on their hyper-conservative interpretation of MTUS treat-

ment protocols. Her attorney appealed this decision to IMR (“Independent Medical

Review”).

Continued on page 2

The Sad Case ofFrances Stevens v. WCAB

Thanksgiving to me is about family and

being grateful that we have all survived yet

another year together. It is also about great

food and being crammed into a little kitchen

with a contributing cast of characters, all

vying to finish off their favorite dishes.

Not many men can brag that they have

the best mother-in-law in the universe. I

can. We have been happily cooking together

for over two decades now. Charmaine is the

Obi-Wan Kenobi of the holiday kitchen.

No one is getting any younger in my ex-

tended family; I know that someday the

turkey torch will be passed on to me. So, I

have been taking really good notes as of

late. Last year, I spent Thanksgiving morn-

ing with Charmaine to divine the mystery

of perfect roasted turkey. In this article I

share, as your attorney and fellow appren-

tice turkey roaster, my thoughtful observa-

tions of the day and the culmination of

generations of Wolf family technique:

It is 5:30 pm and I am standing over a

an incredibly prepared turkey in this

crowded kitchen. I have a set of freshly

sharpened, carbon steel, bone-handled

knives that has done service on the Wolf

family side at holidays for well over a hun-

dred years. Slicing into this hot, steamy bird

is pure wonderment.

Scrambling around on the summit of Mount Lassen must be what it would be like walk-

ing in a crater on the moon. Most people really do not appreciate the fact that there are a

series of huge, volcanic calderas to explore spanning a quarter mile across the top of the

mountain. It is a fascinating, otherworldly, high altitude plateau to experience and it is

right in our backyard. When you get there you will feel like you are Sir Edmund Hillary

on the top of Everest.

perfect

Visions from the Peak of Mount Lassen

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2 n Ledgerwood Law Group n www.ThomasLedgerwood.com

The Sad Case continued from page 1

Roasting Perfect Turkey Continued from page 1

Same Circus, Different Clowns

Seven months later, at the IMR level, a se-

cret doctor from Maximus (a federal, rub-

ber-stamping juggernaut used now here in

California in place of judges at the WCAB

to decide medical treatment issues) re-

viewed the UR decision. This doctor, who

never examined or treated her, upheld the

UR decision cutting her off all pain control

medication, in addition to denying the re-

quest for in-home care services. Under our

new system, Frances was not allowed to

plead her case to a Workers’ Compensation

judge on the issue of medical necessity, or

meaningfully contest the denials of her

medical treatment in the appellate courts of

this state. She could not cross-examine the

Maximus physician to determine the lim-

ited, statutorily provided grounds for re-

view. Her fate is that of all injured workers

who appeal adverse UR decisions in the

workers’ compensation system. Their

chances of getting UR-denied treatment ap-

proved now runs between 10 % and 15%,

statewide.

How can this happen in California, not to

mention America, you say?

In the First District Court of Appeal’s Oc-

tober decision in Stevens v. WCAB, it was

held that the system that deprived Mrs.

Stevens of her needed pain control was in

fact constitutional! They held that the leg-

islature had exclusive (“pleanry”) power to

turkey. I have at least ten people who need

surgery that their treating doctor is recom-

mending, but due to the red tape, they are

not getting it in the comp system. It is as bad

as I have seen it in about two decades rep-

resenting injured workers.

Allegedly, this new system was designed to

save money and time. I question if it effi-

ciently does either. Billions are spent on

fighting treatment requests. A huge new

layer of pork is being liberally spread over

UR/IMR vendors across our nation, who

happily find new and interesting ways to

say no. Furthermore, the decision-making

delays experienced by Mrs. Stevens were

not unique; this happens all too often to the

very people that need timely medical treat-

ment the most.

For all my clients that were hoping to get

some relief from the spiteful way the work-

ers’ compensation system begrudgingly

doles out medical treatment, this is not good

news. The court’s decision is frustratingly

persuasive and well reasoned. Sadly, it ig-

nores reality. The fox has been totally in

charge of the chicken coop for some time

now.

This is what we are up against, folks. How-

ever, as Yogi Berra was so fond of saying,

“It ain’t over ‘til it’s over.” Other circuit

courts will be weighing in on the issues and

there most certainly will be an appeal to the

Supreme Court. We will keep you posted,

Tom & Crew

mold the workers’ compensation system

outside the state constitution in any fashion

they wished. They also held that Stevens

was not deprived of her due process and ap-

pellate rights, as the UR/IMR system is

“fundamentally fair” and afforded her suf-

ficient opportunity to present evidence and

be heard.

For all of us in the trenches, here is why this

“Ivory Tower”, “let them eat cake” reason-

ing just doesn’t cut it: The new system was

designed, bought, and paid for by big em-

ployers and an insurance industry whose

primary focus is to save money. It is not

about getting needed medical treatment to

injured workers anymore. So, the opinion

of a treating doctor (also chosen and vetted

by the insurance industry) doesn’t matter

now. A secret doctor gets to call the shots

and I can’t even ask him/her/it why.

The treatment algorithms the primary physi-

cians must follow now are so complex, that

most treating doctors don’t spend the time

justifying their requests. They are simply

not compensated to advocate their treatment

decisions. Conversely, the insurance indus-

try is allowed to literally spend billions on

the UR/IMR process to deny their treating

doctors’ requests. It is a fundamental flaw

in the system. It places injured workers at a

distinct disadvantage. I have seen people

with bone-on-bone injuries, deeply in need

of pain control, simply cut off - some cold

As always, our holiday bird is perfectly

roasted. It has wonderful, crispy skin, juicy,

moist breast meat and “fall off the bone”

tender wings & drumsticks. It is accompa-

nied by a savory stuffing that was tenderly

cooked inside the bird, and soul- satisfying,

velvety smooth gravy made directly from

hot drippings and brown bits in the roasting

pan that Charmaine is preparing right now.

The Bird. Charmaine finds the biggest,

un-frozen bird she can and notes that

fresh birds, “… just taste better.” Based

on family lore, her choice is a hen as op-

posed to a Tom, because, “they have more

marbled fat in their flesh.” She always

finds a bird that is in excess of 20lbs; this

monster was a 22 pounder and this article

is based on a bird of this size—adjust

your cooking accordingly.

The Stuffing. Nothing like a simple, tasty

stuffing. Charmaine dices three onions and

six healthy stalks of celery, sautéing them

until translucent in one cube of butter. She

next tosses 1.5 tablespoons of Bell’s season-

ing into the pan and gives it a good stir. She

pours this mixture over the contents of a

package of prepared bread cubes, then

moistens the bread cubes with two cups of

chicken broth. She next packs the dressing

in the breast and neck cavities.

Roasting and Basting. We lost the old

turkey chain we used to put under this bird

this year, so it was a two person job lifting

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Ledgerwood Law Group n www.ThomasLedgerwood.com n 3

Mount Lassencontinued from page 1

Cobalt blue doesn’t come close to describ-

ing the sky at the top. There is a maze of

lava walls, nooks and crannies that will oc-

cupy an afternoon of exploring. You will be

treated to sweeping God-like vistas in all di-

rections: Mount Shasta, Lake Almanor,

Drakesbad, and the Devastated Area at the

base of the mountain. It is a definite bucket

list item for all those healthy enough to

make the journey.

It was Saturday, Labor Day weekend, our

last hiking blowout of summer 2015. I had

been patiently waiting for this day for 14

years. It was one of those milestones a fa-

ther gets to experience as he watches his son

grow up. It did not seem that long ago that

I was looking at his smiling face via a level

three ultrasound in his mom’s belly. Today,

he was kicking my 59-year-old buttock all

the way to the peak of the 10,463 foot

mountain. I bet he thought we were just

hiking. I’m thinking we were working on a

fond memory, like the hundreds I have of

my dad when he was alive.

As your advocate, this is my advice if

you choose this hike next year: For starters,

this is not a short pants hike. You are climb-

ing a local volcano with really sharp rocks.

Stout long pants are a must. Also, it can be

colder than “the ####s on a brass monkey,”

as Dad was so fond of saying. You will most

likely come across small snow fields on top,

even in late summer. So plan on layering

your clothing and bringing a really warm

jacket. Quality hiking boots are essential.

Slather yourself up with sunblock, or you

will be looking into a scorched, red face in

the mirror as I did on Labor Day.

The best part of the hike is spending an

afternoon at the top exploring; it really is a

special pristine alpine experience. Plan on

savoring it. There are critters and plants up

there you will never see in the valley. Pack

a great picnic lunch and make a day of it.

We brought two liters of water with a “shep-

herd’s lunch” of aged cheddar, parmesan

cheese, two juicy Fuji apples, a crusty loaf

of Dutch Crunch bread and a chocolate To-

blerone for dessert. Yum.

This is not a hike that you plan on the

last minute and just decide to drive to

Lassen Park (as I have sadly done way too

many times in the past). Be at the summit

parking lot for the beginning of your so-

journ by at least 10:00 am – 8:00 am would

be better. It will take about two hours to

climb to the peak. If there are clouds at the

top, or there are thunder storms threating,

cancel the hike to the peak and have an al-

ternate hike to the boiling mud pots at

Bumpass Hell a few miles below the sum-

mit parking lot.

A good book to read before you start

exploring Lassen Park is Shasta & LassenCamping & Hiking by Tom Stienstra, Moon

Outdoors. Tom gives this hike a “10” for

scenic beauty and for good reason. Exer-

tionally, he gives it a “4,” that is “very chal-

lenging and suitable for physically-fit hikers

who are seeking a workout.” Enough said.

If it was not for the steepness and the steps,

the trail to the peak would be wheelchair ac-

cessible. It is the finest path I have ever

hiked on. It is consistently four feet wide

and the switchbacks are well designed with

hand-carved, local dry laid stone walls. You

will see people with five year olds make the

trip. However, this is a high altitude hike;

plan on a little huffing and puffing. As in all

things in life, take your time and enjoy the

ride.

Happy Trials,

Tom & Son

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This publication is intended to educate the general public about Worker’s Compensation, Social Security Disability and other issues. It is for information purposes only and is not intended

to be legal advice. Prior to acting on any information contained here, you should seek and retain competent counsel. ©LLG All Rights Reserved. n 4

me when I was a total roasting rookie, you

will wait until two hours before dinner time,

stuff your bird, crank up your oven and toss

it in and have another glass of wine. Don’t

go there! If you don’t plan your day accord-

ingly, you might as well just order pizza.

After about two hours you will smell

the heavenly aroma of roast turkey wafting

through the house. Don’t open the oven!

Wait about four hours, and then start basting

with the accumulated juices about once an

hour thereafter. Forget about a thermome-

ter; your turkey is perfectly done when you

it out of the old “Savory” roasting pan.

Make sure you have a turkey chain under

the bird when you start your journey, as the

bird will be so tender that it will be ex-

tremely difficult to take out without it when

it is all said and done. Charmaine pours two

cubes of melted butter over the bird and

likes to “pepper the hell out of it.” She does

not use the cover of her roaster, preferring

to put tin foil over the bird. This allows a

longer roasting time.

The absolute secret to perfect turkey,

by the way, is the roasting time. The sacred

formula is 20 minutes per pound @ 325 de-

grees. They call this technique “low and

slow” for a reason. The food scientists will

tell you that slow-roasting breaks down the

collagen in the bird, making everything

ultra tender. Incinerating a bird in 1.5

hours at 450° will not do it – you will dry

out your breast meat and the bird will be

tough and stringy. Charmaine popped this

baby in the oven at 10:00 am sharp and

pulled it out around 5:00 pm. If you are like

Roasting Perfect Turkey Continued from page 2

wiggle the drumstick joint and it easily sep-

arates from the bird. Trust me – the “low

and slow” technique will keep your breast

meat nice and juicy.

Take the tin foil off during the last 20

minutes or so to let it brown. Your goal is

not the perfectly brown bird you see on the

cover of November’s Sunset magazine.

Your goal is tender, moist breast meat, so

don’t go too crazy on browning the bird. A

turkey needs to “rest” for at least 20 min-

utes. If you accomplish this, you know you

have made it to turkey nirvana.

Happy Thanksgiving,

Tom and Charmaine

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