Thursday, August 27, 2009

Farmers Group administrative policies have introduced fear, paranoia, frustration, intimidation, anger, despair, and extreme tension

July 21, 2009

An open letter to whom it may concern:

My name is Charles Abernathy. I am a ventilator-dependent quadriplegic. I am writing this while laying in bed, speaking to my computer by means of voice-activated software, and receiving mechanical ventilation at one breath every six seconds. Prior to today, I have asked Farmers Group twice to reconsider their actions.

According to papers filed with different state governments, Zürich Financial Services owns Farmers Group Inc. Counsel for the insurance carrier, Farmers Insurance of California/Truck Insurance Exchange, Simi Valley, asserts (Abernathy V. Whittwood Baptist Church):

"Perhaps it is best for the both of us to just have Judge P. review everything and issue a determination on whether my client [insurance carrier] or the applicant [Charles] controls the course of medical treatment/nursing" (e-mail, June 11, 2009.)

In reality, whoever controls the course of medical treatment/nursing of Charles Abernathy, a citizen of Oregon and a ventilator-dependent paralyzed quadriplegic as a result of a California work-related C2/C3 spinal cord injury in 1981, controls every aspect of his life. Whoever controls the healthcare of Charles is able to decide:

When, where, and what Charles eats; When Charles goes to sleep and when he wakes up;
Whether or not he goes to church; Who invades his body and with what;
Whether or not he sleeps with his wife; What his form of entertainment will be;
Who will come into his home to provide care or visit; Whether he lives or dies!

The catastrophic injured are dependent upon others to provide them with care. This implies giving consent for the invasive actions and nature of the medical situation. By the above statement, the insurance carrier is claiming control of the personal rights of Charles Abernathy under California workers compensation laws. Personal rights are the rights of a person over their own body. Associated rights include the right to protect and safeguard the body or person, a woman's right to her body, and the privacy of personal noncriminal actions.

With a work-related catastrophic injury, Charles has fewer rights than those who are slaves, under involuntary servitude, prisoners, or prisoners of war. Slaves can run away; Charles cannot run away from his physical condition. Involuntary servitude is the compulsion to act against one's will in the form of labor for another; Charles has spent hours having to justify in writing every decision in every aspect of his life and take ambulance trips by order, not request, from the insurance carrier. Prisoners have been convicted of a crime within due process of law; Charles committed no crime, he just got catastrophically injured. Prisoners of war have the right to their own bodies; the insurance carrier wants to control every aspect of Charles' body and life. Charles has no debt to the insurance carrier. Because of his unplanned work-related injury and not his volition or overt agreement the insurance carrier declares the right to dominate or control Charles. However, it took the insurance carrier 2 months to grant approval for replacement of a corroded and obsolete humidifier for his ventilator and it has taken more than three weeks for them to decide which one of four billing forms to use.

In the opinion of Charles, the insurance carrier considers catastrophic injury as an excuse for them to violate several sections of article 1 of the California Constitution. Article 1, section 1 states "enjoying and defending life and liberty, pursuing and obtaining, safety, happiness, and privacy." Section 3 states "the people have the right to petition the government for redress of grievances." Section 4 states "Free exercise and enjoyment of religion without discrimination or preference are guaranteed." Section 6 states "slavery is prohibited. Involuntary servitude is prohibited except to punish crime." Section 7 states "a person may not be deprived of life, liberty, or property without due process of law or denied equal protection of laws." Section 9 states "a bill of attainder, ex post facto Law, or Law impairing the obligation of contracts may not be passed." Section 20 of article 1 of the California Constitution states "noncitizens have the same property rights as citizens."

In 1982, an attorney for the insurance carrier called the future rehabilitation counselor for Charles as a witness against Charles. The attorney also claimed Charles could use public transportation, the bus, within Los Angeles County to go to and from school following rehabilitation. The same attorney later solicited Charles in writing to violate both state and federal labor laws by encouraging him to settle his case and hire illegals. Another 1982 tactic by the insurance carrier was to attempt to force 27-year-old Charles into a nursing home.

In January 1993, after experiencing 2 nursing registries and moving to Oregon, Charles negotiated with Farmers Insurance of Oregon to begin self-care management including a pay package with benefits for his caregivers. For the next 14 1/2 years, Charles managed and administered his four paid caregiver positions. Without any follow-up, audit, or management assistance in over 14 years, Charles made some administrative errors. However, Farmers Insurance of Oregon treated Charles with both dignity and respect by honoring verbal promises to an injured individual.

On July 3, 2007, Farmers Group Inc. purchased Bristol West Holdings for $813.5 million. At the end of July, the case management for Charles was transferred from Oregon back to California. In August, he received his first billing claim denial in 14 1/2 years. The denial was for a $1,000 dental bill. Even though peer-reviewed, published research shows poor dental care is one of the leading causes for Ventilator-Assisted Pneumonia, the leading cause of death for ventilator-assisted individuals.

The insurance carrier has attempted to force Charles to replace his current caregiver management with another nursing registry. After Charles refused, his caregivers were subjected to slander, pay package cuts, humiliation, loss of privacy, and lies. The attorney for the insurance carrier has referred to the caregivers in e-mails as "alleged" fulfilling "supposed roles" or even "purported" positions. Without any warning the insurance carrier refused to honor the verbal agreement between Charles and Farmers Insurance of Oregon providing pay benefits to his caregivers. Currently, private medical information in a format of daily caregiver nurses notes must be submitted to an accounting firm to prove care was provided! In addition, Farmers Group Inc. is requiring Charles to provide the account numbers and the banking institution names of his caregivers/employees. Recently, at the very minute the attorney for Farmers Group and for Charles were scheduled to meet a judge, the claims representative called the home of Charles and talked to the caregiver saying the judge had already authorized the call. The judge had done no such thing. The caregiver, who lost approximately $5,000 in 2008 from the loss of the agreed pay package, gave the claims representative an opinion of the insurance carrier during the conversation.

Charles has no doctor/patient privacy. All medical reports must be sent to Farmers Group. If Charles does not want them to know something, he has to tell the medical provider not to include it in the report. California Labor Code requires Charles to submit to being seen by two different doctors. In June, 2009 Charles took two trips to Portland from Salem, approximately 50 miles one way, by nonemergency ambulance at a cost of approximately $3,000 per round-trip charged to Farmers Group by the ambulance company alone. Both trips were ordered by Farmers Group with no input from Charles as to date or time. Both trips also involved five separate companies, two attorneys, and a claims representative. The doctor for the second trip didn't even know Charles was coming by stretcher and did the examination in his lobby.

A judge has been overseeing this case for the past eight months. The only determination, though Charles has not seen the paperwork, is that Charles is competent. This determination was made without even seeing or talking to Charles. The question was asked because of his disability and his desire to continue to manage his own care. The judge and opposing counsel have never seen him. Charles has not yet had the opportunity to confront his accusers, the insurance carrier and their counsels.

Since August, 2007, Farmers Group administrative policies have introduced fear, paranoia, frustration, intimidation, anger, despair, and extreme tension into the home of Charles. According to Standard & Poor's, on April 16, 2009, Farmers Group Inc. purchased the AIG U.S. personal auto group for $1.9 billion. The day before, April 15, Charles had to write the United States Internal Revenue Service explaining he could not pay his total tax bill because the insurance carrier providing reimbursement for expenses was in arrears to him. He explained their current practices were placing him in a position of choosing between paying for his medical treatment or paying his federal taxes. It started a year ago when the primary care nurse for Charles who was also his nurse practitioner care provider, gave his contractual 60 day notice of departure. One of the reasons for his departure was the "craziness within your life, Charlie, because of Farmers." Charles immediately notified his attorney and Farmers Group of the impending departure. Farmers Group failed to provide a replacement physician or medical provider, so Charles entered into a contractual agreement with the trust and hope Farmers Group would honor its commitment to provide medical treatment.

Farmers Group reminds Charles of their agenda both in e-mails every two weeks and in correspondence when they mention "minimum." This term has never been defined to Charles, so he did some local research. Minimum care in Oregon is a bare mattress in a warm room in a skilled nursing facility with a "companion" for $250,000 a year. Included in this package is no food, no laundry, no medical procedures whatsoever, no supplies, and no equipment. Any concept of minimum in relationship to the complex medical population should be reconsidered.

The state of California has determined within California Labor Code that Medicare is the standard for medical reimbursements. Charles does not fit the Medicare model for post-acute care as expressed in a 2006 Medicare reform policy paper. Charles has unskilled workers (trained and supervised by an RN, FNP) doing skilled nursing tasks. Medicare does not provide for this scenario, but the Oregon State Board of Nursing does.

California Labor Code, §3209.3 says Charles must have a "licensed by California" physician, but Charles lives 250 miles from the California border.

After 16 years of honoring claims, the insurance carrier has declined payments due to "billing inappropriately", however, they have not stated how appropriate is defined. Case in point, even though they still request the paperwork from, they have refused to pay for, Charles' Oregon bookkeeper, yet they're willing to pay an Oregon accounting firm to review her work.

Recently, they have stopped paying for Charles' California workers compensation attorney, yet they tell the Oregon and California insurance commissioners they have hundreds of millions of dollars in available funds.

California Labor Code has various requirements for the insurance carrier to provide Charles with information concerning his rights and responsibilities, yet they have failed to advise him of these requirements. His knowledge comes from personally reading the code or talking to his attorney.

One of the possible killers of a ventilator-assisted person is stress-induced ulcers causing acid reflux and aspiration (breathing a solid into the lungs.) Two doctors have referred to Charles as "remarkable" receiving excellent care. A testament to this is Charles has never been readmitted overnight to any medical facility for medical complications in over 27 years since his release from the original rehabilitation hospital. However, California Labor Code gives one of the previously mentioned two doctors the power to deny Charles his ability to choose his own medical provider.

After considering all the above, Charles asked the consumer protection division of the Oregon Insurance Commission for help and was told they had no jurisdiction over the situation. Charles then notified by e-mail, but was ignored by, national Senators and Representatives from both Oregon (Merkley and Schrader) and California (Boxer, Feinstein, and Waxman.) Representative Schrader did refer Charles to a state representative whose sympathetic person said they had no jurisdiction. Another sympathetic person was found in the Seattle office of the Medicare regional administrator.

During the week of 16-20 February, 2009, in a confidential meeting of Farmers Group Inc. management personnel at the Sheraton Downtown in Phoenix, Arizona, his case was declared too "expensive" and the target case for the writing of future catastrophic injury coverage policies. It was the type of meeting in which notes are not usually taken. However, according to documents submitted to the Insurance Commissioner of California, the workers compensation case risk per occurrence is covered by Lloyds of London, Endurance Specialty Insurance Ltd., Aspen Insurance UK Ltd., AXA RE, and Flagstone Reinsurance Ltd. with the percentage of risk dependent upon risk layer. Therefore, Charles isn't even covered by Farmers Group Inc. February 16-20, 2009 was the same week they promoted their Hispanic and March of Dimes support. The president of Farmers Group Inc. is on the board of trustees for the March of Dimes. Also, Farmers Group Inc. is the official sponsor of the LA Sparks WNBA team (check out WNBA, Store, LA Sparks website.)

The leadership of Farmers Group Inc. and opposing counsel have seen or heard about a previous e-mail containing most of the above information. With knowledge of his finances (they subpoenaed them) and his physical condition (they have two medical reports from the last seven weeks), the insurance carrier has:

1. Continued to refuse to pay their bills in the case of Charles;
2. Expressed interest in his sources of information. Charles has friends and family and other contacts in 15 states;
3. Complained to his still unpaid attorney about Charles creating problems; and
4. During the first two weeks of July, 2009 upper level management of Farmers Group Inc. threatened other management personnel with job loss for revealing company business discussed in confidential meetings.
5. Become confused as to who his attorney is and who speaks for Charles. Charles' currently unpaid attorney represents Charles.

I, Charles Abernathy, a non-service-connected, medically-retired United States Marine Corps Captain and a currently nationally-certified rehabilitation counselor, certify the above is true in its original sent e-mail form to the best of my knowledge.

Charles Abernathy
4886 Chan Street South
Salem, Oregon 97306

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