Injured Worker, Lee GriffithI supervised home supportive living services for the disabled. I fell down a flight of stairs at work and suffered a traumatic brain injury. The insurance company’s UR has denied home support services for me using the wrong guidelines. This is no luxury.  I’ll die if left alone.

Lee Griffith
UR Denied - 2013-2014

 


About Me:  My name is Leland "Lee" Griffith. I’m 49 years old and I live in Sacramento.

About My Family:  I am married, and we have three children, ages 9, 12 and 14.

My Job and What Happened: I worked for North Star Services, a home care services company that supports people living with disabilities. I worked for North Star for 6 years, and became a supervisor. I made sure that our caregivers were prompt, professional and personable. I grew up in a foster care home, and am very sensitive to people deserving respectful treatment. In August of 2009, I was at work and I fell down a flight of stairs. I suffered a traumatic brain injury, a fractured shoulder and hip injuries. My vision, speech, balance, motor control and brain functions were all severely damaged. I have dizziness, and I vomit frequently. Bright lights, noise and commotion cause me great stress and discomfort. The insurance company agreed that I am 100% disabled.

What this has meant to my life: I am totally homebound. I have two bad shoulders, blurred vision, can’t sense temperature, and can barely walk, even with crutches. I get headaches and nausea, and am often in pain. It’s not safe for me to exit my home without attendant care. I can’t do much of anything by myself. I spend nearly all my time in one room, in a wheelchair or recliner. I eat, sleep, use a urinal device and dress in that same chair. I can’t focus, speak very well or remember what happened from one day to the next. I use a laser pointer or fl ashlight to point caregivers to things I need. The insurance company thinks I should be alone for hours at a time.

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How Utilization Review (UR) Delays and Denials Affect Me:  I have had home health aides since my injury. Now, the insurer denies I need them all day, or every day. I need help with eating, drinking and going to the bathroom. The insurer’s UR has denied their own network treating doctor’s request for continued home care. The UR company applied the wrong guidelines, terming me “partially or intermittently homebound”. But I am completely and permanently homebound. They ignored that fact, and used the wrong guidelines to deny essential home care - the same care I used to make sure was provided to people like me! The insurance company just wants to save money, no matter how I’m harmed.

 


How Workers’ Comp was supposed to help me: Workers’ Compensation was supposed to help me: Workers’ Compensation insurance is supposed to provide medical care necessary to cure or relieve the effects of my work injury. But the insurance company denied my home health care, falsely claiming I am only partially or intermittently homebound. I’m going downhill rapidly. I feel I don’t have too long to live. Without home health care, I’d fall and have no way to get up. I wouldn’t be able to get through a single day! How can UR ignore the facts, and their own doctor’s report, and deny essential home care so I can live out the days I have left in safety?


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For more information, contact Steve Hopcraft, 916/457-5546; steve@hopcraft.com; www.caaa.org