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Politics : Politics for Pros- moderated -- Ignore unavailable to you. Want to Upgrade?

To: Ilaine who wrote (64862)	8/27/2004 9:32:03 PM
From: Sully-	Read Replies (2) \| Respond to of 793914

OT - Can't argue that CB. Perhaps an expert lawyer would have made the difference. It's all water under the bridge now. At the time I was most interested in just getting my physical problems appropriately resolved so I could return to as normal a life as possible. I was somewhat full of myself since I knew the system well. I never had a single audit finding overturned. Every single fraud case I was involved in went my way based on the facts & evidence I had thoroughly documented. I approached each formal complaint & appeal the same way (determine precisely what I needed to do to comply with laws & regs, then thoroughly document everything with credible evidence - And don't hide any inconvenient facts). The main difference was that in the Dept of ED, my job was to protect the misuse of Federal funds that were rather easy to gain access to. With Workers Comp, they had become wary in dolling out tens of millions to false claims filed by many claimants year after year. They changed their system from being too lenient to being highly suspicious of all claimants despite no changes to the laws or regs. They instituted a bonus system for their employees. Claims reps & staff who quickly dispatched comp claims, made nice bonuses. In essence, they created a system of over zealous employees who benefited from terminating claims, something I was unaware of when I took them on. I ran into a meat grinder system that could care less for facts, laws or regulations. If your emergency room visit didn't clearly establish all evidence of the extent of your injuries, you were basically SOL. From that point on, you faced roadblocks, denials & obstacles that all led to termination of your claim..... regardless of the facts.