Several injured workers say Sedgwick Claims Management Services is unfairly taking away their medical benefits -- even one woman's wheelchair.
CHARLESTON, W.Va. -- Carla Strahl injured her back permanently in July 1990, trying to lift an elderly nursing home patient up to her bed at Peterson Hospital.
She soon began collecting benefits, including medications and use of a wheelchair, from the Workers' Compensation Fund.
But in January, Sedgwick Claims Management Services sent a truck to her house to take away her wheelchair, claiming her work injuries in 1990 are not responsible for her current health problems.
On Monday, the day after the Sunday Gazette-Mail published Strahl's story, Sedgwick provided her with another wheelchair.
"On Monday morning, they called and said they would have a wheelchair delivered in a couple hours," Strahl said.
But there's a catch. They're not giving it to her for very long.
"They said they are only giving it to me for 30 days. A woman from the medical supply company said they would come and take it back.
"I said to her, 'Why did they even authorize this then?' I have had a wheelchair since 1991."
Strahl is one of several injured workers who say Sedgwick Claims Management Services is unfairly taking away their medical benefits.
Now 59, Strahl still has difficulty standing and walking. Her permanent back injuries also cause circulation problems in her legs.
Sedgwick also is taking away her medicines, including her painkillers.
"I go day by day," Strahl said. "I just got one of my medicines filled. It cost us more than $100. I don't know what is going to happen.
"I don't even buy Flexeril, a muscle relaxant for spasms in my legs, anymore. If you don't have the money, you have to pick and choose. Today I can't travel very well. I can ride for half an hour and that is it," Strahl said.
Helen Durham of Diamond read Strahl's story and wanted to help.
"My daughter-in-law's mother passed away recently. She had a wheelchair we could give Mrs. Strahl. My husband and I might even bring it up to her," Durham said.
Today, Strahl and other workers who filed disability claims before July 1, 2005, are covered by the "Old Fund," created after Gov. Joe Manchin and the Legislature approved privatization of workers' compensation.
BrickStreet Mutual Insurance, a new private company, handles claims filed after July 1, 2005. But BrickStreet handed management of Old Fund claims over to the Cambridge Integrated Services Group in December 2006.
Sedgwick then won a bid to take that contract over, beginning in December 2007.
CHARLESTON, W.Va. -- Carla Strahl injured her back permanently in July 1990, trying to lift an elderly nursing home patient up to her bed at Peterson Hospital.
She soon began collecting benefits, including medications and use of a wheelchair, from the Workers' Compensation Fund.
But in January, Sedgwick Claims Management Services sent a truck to her house to take away her wheelchair, claiming her work injuries in 1990 are not responsible for her current health problems.
On Monday, the day after the Sunday Gazette-Mail published Strahl's story, Sedgwick provided her with another wheelchair.
"On Monday morning, they called and said they would have a wheelchair delivered in a couple hours," Strahl said.
But there's a catch. They're not giving it to her for very long.
"They said they are only giving it to me for 30 days. A woman from the medical supply company said they would come and take it back.
"I said to her, 'Why did they even authorize this then?' I have had a wheelchair since 1991."
Strahl is one of several injured workers who say Sedgwick Claims Management Services is unfairly taking away their medical benefits.
Now 59, Strahl still has difficulty standing and walking. Her permanent back injuries also cause circulation problems in her legs.
Sedgwick also is taking away her medicines, including her painkillers.
"I go day by day," Strahl said. "I just got one of my medicines filled. It cost us more than $100. I don't know what is going to happen.
"I don't even buy Flexeril, a muscle relaxant for spasms in my legs, anymore. If you don't have the money, you have to pick and choose. Today I can't travel very well. I can ride for half an hour and that is it," Strahl said.
Helen Durham of Diamond read Strahl's story and wanted to help.
"My daughter-in-law's mother passed away recently. She had a wheelchair we could give Mrs. Strahl. My husband and I might even bring it up to her," Durham said.
Today, Strahl and other workers who filed disability claims before July 1, 2005, are covered by the "Old Fund," created after Gov. Joe Manchin and the Legislature approved privatization of workers' compensation.
BrickStreet Mutual Insurance, a new private company, handles claims filed after July 1, 2005. But BrickStreet handed management of Old Fund claims over to the Cambridge Integrated Services Group in December 2006.
Sedgwick then won a bid to take that contract over, beginning in December 2007.
Since then, Sedgwick has cut back benefits and care for injured workers.
Sedgwick has declined to answer inquiries about these claims.
"We work on behalf of the state of West Virginia," said spokesman Frank Huffman. "We do not respond to questions about individual claims."
'Sedgwick will dump us all'
On Friday afternoon, Sedgwick's office in downtown Charleston was open, but no one came to the window in its reception area. The nearby office rooms appeared vacant.
Several other injured West Virginians are upset at how Sedgwick is handling their claims for work injuries.
Rex Carver, who lives in Dry Branch on Cabin Creek, said, "I got hurt running a brush hog, clearing brush off the side of the hill for Marmet Health Care."
Sedwick sent Carver to see Dr. Prasadaras Mukkamala, a Sedgwick medical consultant.
"He sent a letter to Sedgwick saying I wasn't any worse off today, contradicting what a specialist and my regular doctor said."
After his accident, Carver had surgery on both hands and his back. He also had partially torn rotator cuffs in both shoulders.
"Now I need something done for my hips. But Mukkamala denied my benefits," Carver said.
Carver said he won an appeal to the state Office of Judges but has still not received medical care for the ongoing effects of his injuries.
Mukkamala also said he cannot discuss the cases of any individual patients.
Rodney Richardson of Sod was on the way to help a disabled vehicle when a tractor-trailer hit his truck.
"Sedgwick started cutting off my medications on Nov. 12. And I don't think they will pay my doctor anymore.
"I am on Social Security and have a drug policy through that. But it is supposed to be through Workers' Comp. And Workers' Comp should be paying for my doctor.
"I feel the state hired Sedgwick to get rid of everybody under the old Workers' Compensation Fund. Sedgwick will dump us all," Richardson said.
Reach Paul J. Nyden at pjny...@wvgazette.com or 304-348-5164.
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You just made the logical argument for not privitizing any state agency.
Therefore its probably going to happen anyway. You see the govenor has someone else to blame when things go bad. Thats their logic.
State run Medical system compensates for medical services and pays for adminstration to review claims and authorize payment.
Private run system compensates for medical services, and pays for adminstration to review claims and authorize payment. In addition they must make a proffit. any funds defined as proffit reduces the resources available to pay claims.
Problem: state run insurance is in it for the life of the state. Any excess capital is held in reserve to either assure payment for services in the future, or to reduce premiums for the employers.
Private insurance is in it for proffit. Any excess capital goes to the stock holders and not to the injured workers. If a private insurance becomes insolvent the state will bail it out. Who benifits in Private insurance: the ins. executives and stock holders not the physicians or patients. (REMEMBER AIG!!!)
It was legislated to be a NON-ADVERSARIAL procedure where the employee, the employer and comp all worked together to determine the cause of the injury and to educate employers how to avoid similar injuries in the future. Examples: dust masks for underground coal miners, hard hats for construction workers, etc...
Unfortunately comp has evolved into an extreme adversarial process. It has been hijacked by insurance interests that want to maximize proffits while minimizing payment of benefits.
Even the name has changed from Workers Compensation to "Employer's Mutual".
It is sad that an individual riding a lawn mower can be proof of fraud. Remember life continues for injurred employees. They work when they can with the assistance of pain meds (oxicontin). what you may not see is how they suffer for days for performing a simple chore.
Have a greatful day.