Workers’ Comp Case Studies
One day, a nice young couple came into our office. The gentleman, a laborer at a factory, had sustained a low back injury while working. Not only did the employer refuse to pay for the medical treatment and wage loss related to our client’s back injury, but they fired him from his job.
Our client and his wife were heartbroken, and they did not know where to turn. Attorney Tony Georgelis filed a Claim Petition on the client’s behalf five minutes after they left the office.
By asking a Workers’ Compensation Judge’s secretary to schedule the first hearing on the Petition in place of another hearing that had been cancelled, Attorney Georgelis was able to get his client before the Judge within 10 days.
At the hearing, the Judge was so disgusted by the employer’s and its insurance company’s behavior and failure to follow the mandates of the Workers’ Compensation Act, she ordered that they immediately begin paying our client’s wage loss benefits and his medical bills related to the work injury.
If Attorney Georgelis had relied upon the typical timeframes associated with filing a Petition and having it heard before a Judge, our client might have lost his home and his car. He also was able to have the surgery immediately that he so desperately needed to relieve his pain and get him back on the path to recovery.
Look Who’s Plotting To End Your Benefits
One of the things many workers’ compensation claimants do not realize is that, even though they are receiving wage loss and medical benefits, it does not mean that their employer and its insurance company are not plotting to end their benefits.
In one instance, our client was already receiving workers’ compensation benefits when she came in to see us. Attorney Georgelis, who took on the case, conducted a number of tasks to make sure that everything was happening as it should.
What he learned was very disturbing—the insurance company was taking advantage of our client by sending a rehabilitation nurse, or medical case manager as they are sometimes called, to meet with the client’s doctor after the client would have an appointment and leave the office.
Of course, all of this was unknown to our client, and she was livid when she found out. Immediately, Attorney Georgelis put a stop to this. He also retrieved our client’s medical records from the physician’s office and saw notations where the doctor had all but admitted the rehabilitation nurse was trying to bully him into releasing our client back to work—when she clearly was not ready to return.
Low and behold, shortly thereafter, the insurance company filed a Petition seeking to reduce our client’s benefits. Attorney Georgelis rigorously defended the Petition before a Workers’ Compensation Judge and made sure to introduce into evidence the records reflecting what the rehabilitation nurse had done.
The Judge denied the insurance company’s Petition, ordered that our client’s benefits stay intact and scolded the defense attorney for allowing tactics like the rehabilitation nurse had engaged in to occur.
In The Cross-Examination Hairs
One of our clients was receiving workers’ compensation benefits for a knee injury he had sustained on the job. The employer, in an attempt to reduce or end our client’s benefits, filed a Petition with a Workers’ Compensation Judge.
In support of its position, the insurance company took the deposition of a physician who had performed what is called an “independent medical evaluation” on our client. This was the only time the doctor had seen our client, and he spent a total of 20 minutes with him on the day of the exam.
Prior to the deposition, Attorney Georgelis conducted a thorough investigation into the background of the doctor hired by the insurance company and discovered a lot of very interesting details about the doctor’s so-called “practice” of medicine.
As a result of the information he had gathered, on cross examination at the deposition, Attorney Georgelis forced the doctor to admit that he really did not practice that much medicine, but rather was a “hired gun” for the insurance companies to testify against injured workers. The doctor conceded that he made close to $750,000.00 during the preceding year from insurance companies which had paid for his services to examine these workers.
He went on to admit that, in the case Attorney Georgelis was handling, our client’s treating doctor was in a significantly better position to render medical opinions about our client’s condition than he was, because the treating doctor had spent so much more time with our client and followed him much more closely than he had.
Ultimately, in the Workers’ Compensation Judge’s decision denying the employer’s Petition to take away our client’s benefits, the Judge specifically stated that the insurance company’s doctor lacked credibility because of the facts that Attorney Georgelis elicited from him on cross-examination during his deposition.
As a result of the Judge’s decision, our client continued to receive all of his workers’ compensation benefits, and, several months later, Attorney Georgelis was able to negotiate a six-figure settlement of his claim.
Past Due, Plus Interest
When our client met with Attorney Georgelis for the first time, he had been receiving workers’ compensation wage loss benefits for close to three years.
Sadly, he had been exposed to certain fumes at the workplace on a routine basis which caused him to develop a chronic lung condition. Based upon his medical status, Attorney Georgelis knew that the client would be disabled and incur significant medical expenses for many years to come.
As part of his routine case analysis, Attorney Georgelis ordered our client’s records on file with the Bureau of Workers’ Compensation. Shockingly, the only document on file was a wage statement, purporting to reflect our client’s average weekly wage and weekly compensation rate.
Attorney Georgelis immediately filed a Petition to preserve our client’s claim under the statute of limitations. At the same time, he subpoenaed our client’s wage records and ascertained that that the employer (the employer was self-insured) was underpaying him by $34.00 a week.
Prior to the Judge making a ruling on the Petition, Attorney Georgelis was able to persuade the employer to file the appropriate paperwork with the Bureau accepting the exact nature of our client’s work injury and to pay our client all of his past due benefits, plus interest.
Without Attorney Georgelis having taken the time to analyze every aspect of our client’s case, the employer’s omissions would have been missed, and our client’s claim would have been jeopardized by a statute of limitations defense.
You’re Just Getting Old
Our client had injured his back while loading bundles of magazines on to skids.
His employer sent him to a medical outlet facility instead of letting him choose from the panel list of medical providers every employer is legally obligated to provide.
Immediately after meeting with the client, Attorney Georgelis called the human resources manager at the employer and persuaded her to fax over to him the panel list. Attorney Georgelis observed that there was no neurosurgical or orthopedic specialist on the list, so he advised our client that he could treat with whomever he wanted in this field.
Our client made an appointment with an orthopedic surgeon who ordered an MRI. The MRI did not reveal any disc injury but did show some arthritis in our client’s spine. Upon learning of the results of the MRI, the insurance company for the employer immediately denied our client’s claim on the basis that the arthritis was an age-related condition and not a result of the incident at work.
Attorney Georgelis, however, met with our client’s physician to clarify his diagnosis and learned that the surgeon’s opinion was that the traumatic incident at work had aggravated our client’s pre-existing arthritic condition, making him symptomatic and causing his disability and need for medical treatment. The surgeon also indicated that it was not unusual for our client to have a moderate degree of arthritis in his spine because he was in his 50s. By all accounts, the arthritis had not caused him any trouble until the day he was injured loading the skids.
Well, the insurance company fought them until the end, but Attorney Georgelis was able to prove to a Workers’ Compensation Judge that our client’s condition was a compensable work injury. The client received all of his back pay, with interest, and ongoing wage loss benefits, and all of his past and ongoing medical bills were paid.