Birmingham Personal Injury Lawyer - Compensation

Won Your Workers Compensation Case? Not so Fast

Jon Lewis — Tue, 24 Nov 2009 13:02:11 GMT

What are the insurance companies doing now? They are using "Utilization Review" in order to cut off workers compensation benefits. How does that work?

Well, the Alabama Workers Compensation Act allows for "Utilization Review". That means that the workers compensation insurance carrier can submit your medical records to a third party physician to review and determine if they are related to the injury. If that third party physician says, "No", the workers compensation carrier cuts off the injured employee's benefits.

How does this work in practice? Take my client for example. She had surgery approximately ten (10) years ago. Her workers compensation case was settled, and her medical was left open for future treatment. Typically, that is what happens in workers compensation cases. The person receives medical treatment for the related injuries for the rest of her life.

For ten (10) years, my client has been receiving prescriptions and medical treatment for her injuries. Out of the blue, the insurance carrier sends her records to a foreign doctor in El Paso, Texas who opines that her injuries and medical treatment are not related. So, the insurance carrier, under the "utilization review" provision, cuts off her medical treatment.

Why did they wait ten (10) years? How can this doctor supersede my client's local doctor's opinion when he hasn't even examined her. Shouldn't the "Authorized treating" physician have the final say? The insurance carrier approved her "Authorized Treating" Physician.

This is ridiculous and unfair, but that is how the insurance industry works. Insurance covers everything but the loss. All they want is their money and to hell with everything else - morals, humanity, sympathy, kindness, and generosity. It is all about the bottom line. People talk about "greedy trial attorneys" when they should be talking about "greedy insurance companies".

Originally posted at InjuryBoard by Jon Lewis

Alabama Workers Compensation - Disadvantaged Employees

Jon Lewis — Wed, 30 Sep 2009 13:28:21 GMT

We are in the process of representing an individual who was seriously injured on the job. He has had two back surgeries, and he is 72 years of age. He has been deemed 100% disabled, and we are trying to resolve his case. There is no question about whether or not his employer is responsible for compensating him under the Alabama Workers Compensation Act, so what is the issue?

Well, in Alabama, the employer (really, the employer's insurance company) can try to settle the case or force you to go to court to prove your case. If the insurance company settles your case, they typically pay the settlement in a lump sum amount. If you try the case to a verdict and win, the insurance company can choose to pay the employee weekly or in a lump sum. Usually, they will choose the weekly option because they will benefit if the employee dies before the payout is complete.

What about our situation? What would our client be entitled to in a lump sum? Approximately $170,000.00. What has the insurance company offered? $85,000.00. Why? Money. It is all about the bottom line for the insurance company, and they understand that we, as the employee's attorney, have no leverage to force them to do otherwise.

Why would our client accept a lump sum for less than $170,000? Several reasons. First, he can get a lump sum and know what he has. Second, if he were to die, he knows that his wife will receive something; whereas, if he died during the weekly payments, the payments stop immediately. Third, he doesn't have to try his case to a judge (you cannot get a jury in a workers comp case) and risk the judge thinking he's less than 100% disabled which would dramatically reduce his compensation. Finally, he can incorporate language for Social Security Disability which minimizes the effect on any set off Social Security would get if he received weekly payments.

Why wouldn't the insurance company pay the full value of the lump sum? They have no incentive. They have nothing to lose. If they don't pay it, what happens? They hire an attorney to defend the case. If the attorney wins or gets less than 100% disability, they don't have to pay as much. If they lose the case, they only have to pay the weekly benefits, and if our client were to die, they win. The only way the insurance company loses is if our client lives beyond his life expectancy, and the insurance company has to keep paying his weekly benefits. That is how the insurance company evaluates the claim: what is the likelihood that our client will live beyond his life expectancy. In their mind, our client is just another number, not a human being who is going to have a difficult time supporting his family because of his injury.

There should be some consequence to the insurance company and employer if they force the employee to try the case to a verdict, and the employee wins - at least in a 100% disability case. These types of cases are serious, and the individuals who have been injured have very little recourse and will have a difficult time the rest of their lives. This is their only chance at compensation, and the insurance companies hold their feet to the fire. It is time the employees could fight back and not be forced into settlement situations.

What do you think?

Originally posted at InjuryBoard by Jon Lewis

Injuered at work? Now what?

Danny Lehane — Tue, 28 Jul 2009 14:06:17 GMT

When an individual is injured or suffers an illness arising out of and in the course his/her employment, that individual has certain rights provided to her/him under the Alabama Workers’ Compensation Act (also referred to as “the Act”). The Act provides for medical care, surgery, and rehabilitation as well as Temporary Total Disability (TTD) benefits. TTD benefits are compensation based on a percentage of the injured worker’s wage. The TTD benefits provide compensation for an individual that is determined to be unable to return to work to earn wages.

An injured worker is required to report the injury as soon as possible and no later than in writing within five (5) days. Obviously there are exceptions (such as a catastrophic injury within a plant that is witnessed and where management makes the 911 call). However, if the injured worker is able it is best to be sure to give notice of the injury and request that a First Report of Injury is completed. Typically a worker is sent to the employer’s company doctor. If the injuries are severe the worker is sent to an ER.

An injured worker has the right to request a panel in which to choose a different treating physician if he or she is not satisfied with the current treating doctor. However, it should be noted that the request for a panel is a one-time event and the request should be used only as a last resort. If a worker elects to use his/her own physician without approval of the employer (or work comp insurance carrier) that worker may find that the treatments are not paid for by the work comp carrier or his/her health insurance carrier. Injured workers are reminded to be very careful when electing to use their own physician as the results may be harsh on several fronts.

Originally posted at InjuryBoard by Danny Lehane

AIG - Workers Compensation - The Bailout

Jon Lewis — Thu, 08 Jan 2009 13:24:55 GMT

Well, I have just seen first hand what the bailout has done for AIG: made them even more heartless and cold than ever before. We represent a family who lives in Mexico. Their son was employed by a company in Atlanta, and he was killed on the job. The company is insured by AIG, and it is a clear liability case. What is AIG's response?

First, they made this man's parents travel across Mexico, obtain a special permit to enter our country, and come to Atlanta to give a deposition with a translator. They do not speak English. These individuals live in a two bedroom, aluminum house with 8 family members. We cannot imagine the life they live.

They cried at their deposition over the loss of their son. This was VERY emotional for them. They went back to Mexico, and the defense attorney and I discussed the possibiliity of settling the case.

I learned today that AIG is not interested in settling this case because they want to make it hard on this family. They know how difficult it is for them to travel back to this country, and they know it's difficult to get them back into this country. It's a foregone conclusion that the case will be won, but AIG doesn't care. They want to hold on to their money until the last possible date.

So, not only does AIG know the case is a loser from their standpoint, but they want to make it difficult on a very poor family in Mexico who just lost their son while he was working hard for AIG's insured. Furthermore, AIG knows that they have nothing to lose by doing this because the worst that can happen is they pay what they should pay anyway. The Judge cannot rule that they owe more than what the workers compensation statute says they owe so what do they care.

I ask you the following questions:

1. Is this right?
2. Is this humane?
3. Should AIG be punished for taking this stance?
4. Should AIG's insured have to endure further litigation because AIG wants to hold onto its money?
5. Should my client's family be made to suffer further?
6. Should they have to spend more money to come back to this country?
7. How should our system handle these situations?

The next time you hear about trial attorneys and tort reform, think about this case. It is insurance companies that drag out litigation and increase costs. It is insurance companies that turn down fair settlement offers and make their insured's go through the litigation process. It is insurance companies that make us take doctor depositions. AND, it is insurance companies that blame everything on the trial lawyers of America.

Isn't it time someone started holding these insurance companies accountable? AIG received billions of dollars of our tax money, and yet, this is how they treat human beings while they go to their spas and on their English hunting trips. It is time for these companies and the individuals operating them who have fleeced America to start paying the price.

Originally posted at InjuryBoard by Jon Lewis

Put Your Money Where Your Mouth Is

Jon Lewis — Sat, 09 Aug 2008 13:10:08 GMT

In today's Birmingham News, there were two letters to the editor. One is entitled, "Follow basic driving rules", and the other is, "Be courteous when driving". Each article discusses driving and safety. Examples: driving the speed limit, don't tailgate, keep your lights on in the rain, don't use your cell phone, and use your turn signals.

What are these individuals really saying? Don't drive negligently. What does that mean? It means that when you drive on the public roadways, you have a duty to others to abide by the rules of the road and to pay attention and not cause "accidents" (it's in quotes because had the person who caused the "accident" been paying attention, the "accident" wouldn't have happened). When you breach that duty, you are responsible for the damages you cause.

Because so many people fail to drive responsibly, we carry insurance on our cars. That way, when we cause these collisions (more proper term than "accidents"), we can afford to compensate the victim who was driving responsibly.

Unfortunately, people like the ones who wrote the letters to the editor don't put their money where their mouth is. When these people sit on juries, they seem to forget these "Basic Driving Rules." That is the way citizens can enforce these driving rules. When jurors render low verdicts, they don't send a message to the public that when you fail to pay attention while you are driving, you will pay a price. Money talks, and people will start to listen if jurors will realize they have the power to affect change.

When people realize that they will be responsible for SIGNIFICANT damages if they cause accidents, they will drive more carefully. When they realize that their insurance rates will increase, they will drive more carefully. As it stands, however, jury verdicts are low. These same people who preach driving safety, do not act accordingly. Next time you sit on a jury in a car "accident" case, put your money where your mouth is, and tell the person, "You need to drive more carefully."

Originally posted at InjuryBoard by Jon Lewis