When a San Jose woman was about to get her disability benefits cut off and appealed to the California Department of Insurance, she was told to try Indiana, where the policy had been written. "They said, 'If the [insurer] offers you any money, its best to take whatever they offer because it doesn't look like you have a very good case,'" the woman said. (A doctor hired by the insurance company claimed that she was not disabled.) But Indiana regulators had a different take and got the insurer to keep paying out benefits. The question, of course, is why she needed to have regulators in another state look into the matter. The Daily Journal's Evan George reports that the state Insurance Department resists taking even simple steps to help claimants fight denials. When George asked a department spokesman about the San Jose woman, the response was, ""She came for help, we directed her to the right place." Not a great answer.

In most cases, when a worker who has paid for disability benefits files a claim, the insurer will review it and pay. But some cases - markedly those where the insured reports suffering from complex symptoms like chronic pain or long-term injuries of the back, neck and spine - are denied, even if treating physicians and the Social Security Administration find them disabled, the Daily Journal has found. The result is that workers who believed they had a safety net find themselves fighting for benefits at the same time they are dealing with health problems and medical bills.

Some insurers no doubt try to weasel out of paying claims - and it's the state's job to flesh out those cases. But it's not easy, and insurance companies are not always to blame. From L.A. Daily:

A Sunland interior designer plead guilty to two counts of fraud this week after he had claimed disability to the tune of more than $147,000 and an insurance company worker happened to catch the man on television -- working. Ronald E. Hunt, 56 continued working as a designer even as he claimed to be unable to work. But an employee with an insurance company paying his disability claim spotted him on an HGTV home improvement show and told the California Department of Insurance.

Actually, these sorts of cases are not unusual, especially when it comes to back and neck injuries that can be hard to pinpoint. As to how many folks with legitimate cases get shafted, well, who knows? And that's part of the problem. Of course, that shouldn't let CA officials off the hook. From the Daily Journal:

California officials say they do not always have the power to intervene in individual cases, but insist that they don't turn everyone away. How often does the department get involved? It's impossible to know because the Department of Insurance doesn't keep track, a spokesman said. Although the agency said it does track how many complaints it receives about disability insurers: roughly 500 each year. [Insurance Commissioner Steve] Poizner's office has initiated no major investigations or enforcement actions and has levied only one fine against these insurers since he took office in 2007. The department denied a public records request from the Daily Journal to review consumer complaints and Poizner declined an interview.

This guy is running for governor?

*Insurance Department spokesman Darrel Ng wanted to clarify the process by which complaints are received. First off, he says, not all policies covering Californians are primarily regulated in California. From his email:

If you work for a large company that's headquartered in, say, Boston and they offer you health insurance, your policy is governed by the master policy of that company and the state it's issued in. In this case, it would be a Mass. Insurance Company. The best place to file a complaint with would be with the Mass. Department of Insurance. We receive hundreds of thousands of calls every year to our consumer hotline (800-927-HELP) and strive to serve every person who calls. Sometimes that action includes Insurance Commissioner Steve Poizner calling an insurance company CEO to get results. Sometimes that means referring people to the correct regulator.

The county's unemployment rate in October was 12.8 percent, up slightly from a revised 12.6 percent the month before. A year earlier the rate was 8.5 percent. The state's rate was 12.5 percent. All told, it's still bad, but it could have been worse. The separate payroll survey shows that 36,600 jobs were added in L.A. County from a month earlier. Almost 20,000 of those were in government (14,400 in local government), which somebody over at City Hall should be trying to explain. Were these additions required contractually or what? Why are so many folks being hired when local government is basically broke? Job losses came in manufacturing, construction and leisure and hospitality, three industries that have really taken it on the chin this year. Entertainment continues its usual zigzag pattern, this time adding 3,000 payroll spots. Here's the EDD release.

Stocks open lower: A worse-than-expected forecast from Dell isn't helping. Dow is down a few points in early trading.

Job numbers: As we posted earlier, the state's unemployment rate in October rose to 12.5 percent from 12.2 the previous month. But in the separate payroll survey, California gained 25,700 jobs. (BLS)

More knocks on Goldman: This time it's coming from the bank's own shareholders, who want the size of the bonus pool reduced so that, well, they can make more money. From the WSJ:

Their complaints in private conversations with the company and at analyst meetings show how anger over its big-money culture is spilling into the ranks of investors who typically shy away from debates over Wall Street pay. One frustration: Despite record net income and compensation at Goldman as markets rebound and the firm outmuscles weakened rivals for business, analysts expect its 2009 earnings per share to be 22% lower than in 2007 and roughly equal to its 2006 earnings, according to Thomson Financial.

Oprah fallout: So how will KABC and the other big ABC stations replace the talk show queen? One idea would be to have "The View," another strong ratings generator, lead into the local news. Another possibility, reports Variety, is that the ABC stations would try to grab "Ellen," whose deal with NBC stations is also up in 2011.

Burkle buying into Barney's: The Bev Hills billionaire, through his Yucaipa investment arm, has picked up a large part of the company's debt - at about 60 cents on the dollar. Istithmar, a unit of Dubai's state-owned Dubai World, paid $942.3 million for the company in 2007, but the retailer took on a bunch of debt in the process. From the WSJ:

One person familiar with the matter said he and his investment fund "have had a great relationship with Dubai for a long time." Mr. Burkle has previously invested in businesses alongside an entity connected to Dubai's ruler, Sheikh Mohammed bin Rashid al-Maktoum. Mr. Burkle also has fashion experience, holding stakes in Sean Combs' Sean John clothing lines, specialty retailer Scoop and designer label Zac Posen.

More immigration audits: Federal officials have told 1,000 companies that they will be reviewed to see if illegal immigrants are being hired - just as happened at L.A.-based American Apparel a few months back. The companies weren't identified, though the language of the order suggests that retailers and manufacturers are not being targeted. (NYT)

Doctor groups merge: Burbank-based Lakeside HealthCare was acquired by Heritage Provider Network Inc. of Northridge, a deal that will impact more than 600,000 patients in the SFV. Lakeside apparently was on the verge of filing for bankruptcy. (LAT)

Vivendi-GE haggling: The two companies are at least $1 billion apart in their valuation of the French group's stake in NBC Universal. This could become a stumbling block in Vivendi's exit and the arrival of Comcast as majority owner of NBCU. From the FT:

GE's negotiating position is understood to be that current media sector multiples would imply a price of $4bn-$5bn. Independent analysts' estimates vary, but Bernstein Research has valued NBC Universal at $27bn, suggesting Vivendi could expect $5.4bn for its holding.

Bloodbath at Business Week: About a third of the workforce was cut, including 60-70 in editorial. The business magazine has been taken over by Bloomberg. ((NY Post)

Gas check: Prices keep edging downward. An average gallon in the L.A. area is $2.96, a couple of cents below last week, according to the Auto Club survey. Demand normally drops off this time of year.

The October rate for California was 12.5 percent, up from 12.2 percent in September and 8 percent in October 2008. County numbers will be out later this morning.

It's still just a parking lot at 11th and Figueroa, but developer Moinian Group had received entitlement to build 53- and 37-story towers housing 860 condominiums, plus 250,000 square feet of retail space. Basically, it was going to compliment L.A. Live. Now it faces foreclosure proceedings, according to the Downtown News. The property owner failed to make several payments and owes Wachovia about $45.6 million. These filings have become fairly common, and they set the stage for a huge rejiggering of downtown property.

Final air date is not for a while - Sept. 25, 2011, according to CNN. She'll talk more about it during a live show tomorrow.

Here's more from the NYT:

After her broadcast talk show winds down, Ms. Winfrey will concentrate exclusively on her coming cable channel, OWN: The Oprah Winfrey Network. The channel is a joint venture between her production company and Discovery Communications. Getting the channel off the ground has proved challenging amid management turnover and an uncertain advertising climate. OWN will have its premiere on cable in January 2011, according to a person with knowledge of Ms. Winfrey's decision who insisted on anonymity. That timeline will theoretically give Ms. Winfrey about nine months to promote her cable channel on her existing show.

L.A. Councilman Paul Koretz is still the new kid on the block, having taken over the Jack Weiss 5th district seat a few months ago, but he exudes a lot of freshman enthusiasm - and optimism - in his early days at City Hall. Speaking today to Emma Schafer's Current Affairs Forum, Koretz seemed pleased with the latest package of concessions worked out between the city and the unions (he painted himself as a kind of conciliator in making it happen). I'm not aware of his role, though he might not want to take that much credit: the city is still in the hole, big time. For all the challenges of being an L.A. Councilmember, he said it's a pleasure compared with the dysfunctional state assembly, where he had been a legislator. He intends to play a watchdog role in ways the city can save money. On his to-do list: Thumb through all those audits by former Controller Laura Chick that have been collecting dust.

The Board of Regents signed off on the 32 percent increase in student fees, which brings the basic UC education fees to about $10,300 a year. That's triple what it was a decade ago - and it doesn't cover room, board, etc. Protesters were chanting their displeasure on the UCLA campus. (LAT, NYT)