Complaint Review: ZURICH AMERICAN INSURANCE - Glendale California

I have a inguinal hernia and need a doctor. So I was told that the provider has to be on their list to pay 100%. THis was not told to me until after I was told I can go see anyone. Now I am refered to a doctor NOT on their list by the E.R.

I get a letter stating that providers must be on their PPO List which CANNOT be accessed thru their website because their system does not recognize their own policy.

So I contact the doctor I was refered to and he is not on their list.

The list they gave me was to be discovered not updated and verified FOR THREE YEARS. All the doctors I call for the last 6 hours are either moved to another location, or have never heard of their PPO before.

I thought it was just a coincidence that the First doctor was named "Tom Collins" a bar drink and that his address was "420 High Street". Anyways I need a doctor that is in their network and have not found any on their list so far that is still practicing where they say they are or have never heard of their insurance group or PPO Corvel.

This is a joke and I am ver y ill if I cannot find a doctor in the next hour I will have to go see an attorney to GET MEDICAL CARE FROM THESE FRAUDS.

Everywhere in Indiana is corrupt and run by the Mexican Cartel=Free Masons in every judges bench and state agency.

ZURICH: FRAUDULENT DINIAL OF W.C. CLAIM. 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 at location. 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' 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 doctors 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, (a) obtaining a statement from my supervisor describing accident, (b) I found a completed copy of a State Disability Form from the April doctor visit, which stated 'Heavy Lifting On The Job', & 'occurring March 24th, 2005'. (c) 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. My W.C. claim denial was under-investigated and fraudulent. Having been on no prescribed pain, anti-inflammatory, 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 occur. ZURICH: FAILS 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 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 excruciating 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 practitioner 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 at Zurich) 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 plain 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, medical record misinterpretations, 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. This CT imaging is essential in a Medical-Legal exam such as mine. Q.M.E., Dr. Richard E. Nussbaum in his final Q.M.E. report (without CT scan results) concluded that my injury was 'at best, an exacerbation of a pre-existing condition', & that I was NOT Temporarily Totally Disabled. 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 (via CT scan results) discover 'dual pars fractures, indicating the Isthmic Spondylolisthesis was not Degenerative and likely work-related. All the while, I was unable to retain counsel due to one prior back surgery, the unpursued denied claim by Zurich (weeks before the second, more serious injury), and Gov. Schwarzenegger's 2003/2004 Workers' Comp. Reform bill 'SB-899', effectively declawing most W.C. attorneys, by minimizing litigation for insurance companies. Note: Arnold took $500,000. in insurance company donations that campaign. It worked out just great for the Workers' Comp. insurers of Calif., yet invited financial and emotional devastation for the injured worker and family. 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 was not present as recently as six week prior to injury, and only first diagnosed by Q.M.E., Dr. Richard E. Nussbaum three months after my work injury. PERMANENT MEDICAL CONDITIONS: (NON-EXISTANT PRIOR TO INJURY) I now have only 50% strength in both legs, one paralyzed right foot, balance problems, and continuing bowel & bladder complications. I cannot stand for more than 15 minutes without sitting, and cannot walk for more than 20 minutes, before the lower lumbar pain becomes too intense. I suffer from short term memory loss, inability to focus as I contracted a case of pneumonia (eight months after injury) which turned into Acute Respiratory Distress Syndrome, leaving me in a medically induced coma (w/ full intubation and feeding tube) for five days (given 50% chance of survival), due to the high dosages and long term use of opiate pain medications, in combination with the hospital's pain meds. (directly related to Zurich's initial Delay in Treatment, and Q.M.E., Dr. Nussbaum's misdiagnosis which resulted in Zurich American's denial of my claim, and lost pro per W.C. case. Zurich skates free as I continue to retain counsel, as I have for over three years. Now on Social Security Disability, we live week to week, still not able to cover bills, and are in our sixth foreclosure in 3 years, not to mention the stress, anxiety, and severe depression for such a long period of time (between my self and my wife, let alone our three children. Posttraumatic stress disorder cannot be ruled out, considering the devastation Zurich American Insurance caused. Keyword search Q.M.E., Dr. Richard E. Nussbaum for more on my Corruption site..