DO YOU KNOW WHAT A 3RD PARTY RECOVERY IS?

DO YOU KNOW WHAT A 3RD PARTY RECOVERY IS? I mean with regard to Worker's Compensation?

I did not. Because my Compensation Claim was from an automobile accident, I had a civil case that was handled before the medical diagnosis was actually discovered. There was a three and a half day mistrial, time that was a blur for me because of pain, hours spent going to Doctors, waiting for Doctors, even then having to deal with Doctors seeing me only to act as an advocate for AIG, submitting required papers more than once, twice - even three times.

When I settled for a sum, I knew that the amount that was stated was not what I would receive. First, there had been a trial - and attorneys. That was 40% off the top. There we also expenses for the attorneys, and the trial. More money out of the pot.

I'll get down to the actual numbers in a bit. It's late and I have already been blogging too much today. The main point is this.... From a $400,000.00 settlement my amount of money that I ended up with was approximately $189,000.00.

That was wonderful - not enough to offset what happened to my life, but certainly it helped to find ways to adapt to all the changes I had to find to function and keep working.

The big news was the day I learned that every single cent of the $189,000.00 that I got as my portion of the settlement was going to be paid back - but not to the company that paid it to me. No, they paid it out fair and square. It would be going to ... yep, you guessed it. You must be much quicker than me! AIG. AIG gets all my settlement money. In little bits of every thing that they have to pay me, they take away some of the money, because "I OWED THEM" ALL $189,000.00.

Now I realize they have paid for my surgeries. They have paid my Doctors, and paid for my medications **(when my Adjustor will allow me to have them).

I just do not understand that because I had my body drastically injured, and someone was responsible for that - and no one, not one person, not one corporation should be entitled to what I had gotten for what I went through, just because they were insuring my company for workers' compensation.

HIDDEN COST OF HEALTH CARE BY AIG CHEATS ME, MY DOCTORS AND THE PUBLIC

AS A Worker's Compensation Claimant, I have been dealing with the difficulties of major medical problems for just under twenty years. Five spine surgeries, jaw surgery, many, many doctors, many diagnoses', lifetime disabilities, a great number of lawyers, multiple therapists, and hours and hours of dealing with papers to satisfythe Employer/Carrier(AIG) in order to have them pay for the expenses that that are related to the claim that came from the accident determined to be Worker's Compensation.

AIG has advertised that "THEY ARE THE LARGEST WORKERS' COMPENSATION PROVIDER IN THE WORLD" YOU CAN SEE THEIR ADVERTISING ON TV. I HAVE, MANY TIMES.

IN EARLY 2007, my Adjustor, an employee of AIG, began what I believe was an all-out effort to force me to agree to a settlement. From May, 2007 to December, 2008, my Primary Care Physicians were paid a total of $651.34. Those Physicians had billed AIG a total amount of $1,554.00. The difference was discounted by AIG, so the Doctors did not receive even a reasonable percentage of their fee. Their payment was not sent before several weeks after I was seen for my appointments.

DURING that same time period, AIG made payments to other Doctors and Administrators/Providers, in Florida and North Carolina in the amount of at least, $13,200.21. TWO of these Physicians actually met with me, through appointments, spent some time with me. They were paid a total of $3,050.00. They were paid at or before the time of my appointments. Both were to discredit my medical needs, one had been given advance information inaccurately as shown by his first question to me. In their reports, it was obvious that they had an established opinion prior to the appointment.

THE REASON for each of these Doctors reports, reviews or opinions was to have their statements, paid for by AIG, whether they met with me or not, was to "prove" that I "no longer needed any care and should"settle out".
The point of going through this process is to reinforce my understanding that they will keep making me go through these extensive efforts to get any medical care or medications, and to"settle" would benefit me because it would be MY choice, not that of AIG.


LET ME REPEAT! AIG paid my Primary Care Physicians $651.34 in over 1 1/2 years. During that same time period, AIG paid out at least, $13,200.21 to Physicians whom I have never seen, but gave reports about the state of my health, my future medical and medicine needs and made conclusions that convinced at least my Adjustor, if not persons of greater power at AIG.

THAT ADJUSTOR, and her Supervisor, installed a restraining system for my medicines when I called to have my Blood Pressure medication refilled. I knew I had open refills, as I had in the past, I called the AIG Pharmacy preferred provider, PMSI (the only source I am to use for my medicine) to get the prescription renewed, where the Doctor had left the 3 refills. When I did not receive it within several days, I called PMSI to ask when it would arrive. I was told that there was a new restriction.

THE NEW RESTRICTION, the Adjustor had to approve anything that was done regarding my account, including dispensing a refill. I finished what I had of my prescription. I made 5 attempts to have the BP medication refilled, without success. Over the next three months I had to pay for my own BP medications through my own private insurance. My health was put into jeopardy and continues to be so. The company that provides the medicine is a willing conspirator, to allow a non-authorized, non-medical individual to act OVER a PHARMACIST, a PHYSICIAN, and a JUDGE, and the LAW, to the detrement of the injured party to maintain their Corporate connection with AIG. I do not know how far up this policy goes within the Corporation, I only know that it has lasted at least from the summer of 2007 and it is now April, 2009.

AT PRESENT, I AM WAITING for refills on prescriptions that my Primary Physician has prescribed for me before, sent to the approved PharmacyPMSI) for the Carrier (AIG). I called on 4-16-2009 to that approved Pharmacy and I was told that there was still no approval given to send out my medications. It is now 24 days past first contact with my Adjustor for one of my Blood Pressure medications, 22 days past first contact with the Supervisor of that Adjustor (per the Pharmacy contact) and they still have not given approval to send my medication. I called 10 days ago for 6 additional refills of medications and there has been no approval to dispense those medications, three of which are Blood Pressure medications. I will have to contactPrimary Physician to write new prescriptions to fill at my own expense because I cannot be without necessary medicines.

I have gotten my prescriptions in a more timely manner, when it suits the Adjustor, though the restriction for her approval is still in place. Her response, when asked for a suggestion to a way to resolve this difficulty - to find a way to handle this ongoing procedure with a 48 hour turn-around time, under oath, was -

"the mail order..it's like an automatic thing as long as there's refills on there. You know, for me, as a - - R... W...., employee of AIG, if I have it on mail order and as long as there's refills available, then they'll send it out."

Asked again: "But even on a refill, they have to call you even though they have a refill on the script?"

Response: "No. Only on narcotic stuff,**that's the only time that they really have to call me. So if there's a refill... they do it because she's had so much stuff that's came up.. ** [I do not take any narcotic medication prescribed under AIG-S.Fodi]

Asked again: "So it just depends - - because we have to find a solution for this. You know, she was without medication for a day or two.

Response: The solution is to settle the claim.


THERE IS NO LAW that prevents any Employer/Carrier (such as AIG) from delaying decisions on payment, delays on approvals or benefits due to a Claimant. Even a Judicial finding in favor of a Claimant only means that the Carrier MUST do the right things, not WHEN!

I am a prejudiced advocate for law changes to protect the rights of the individual against the highly weighted and partial current legal process toward the huge, unregulated Insurance Industry that has long lobbied and won Congressional favors.
I am prejudiced because I have lived through the result of those laws. I have also been employed by an Insurance Company and a Financial Wall Street Firm and as a successful Insurance Agent and Stockbroker - while dealing with Worker's Compensation. My success was in spite of Worker's Compensation and AIG, not because of them!

Sandra Fodi

Note: I picked up my medications today from my local Pharmacy through my own prescription program. No one told me I had to have approval of a subordinate, uneducated and vindictive go-between before I could have what my Doctor prescribed for my health. If my Adjustor at Worker's Comp had finally approved release of the refills it would still be days before they would be here. She has lied before saying she will authorize a prescription, without doing it. AIG needs to be held accountable.