Birmingham Personal Injury Lawyer - Workplace Injuries

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

How to help your body heal after an accident (part I)

Beth Scherer — Mon, 18 May 2009 12:45:09 GMT

Automobile accidents typically cause people a lot of emotional & physical stress. In my 18 years of chiropractic practice, I have found that when people focus on 4 areas of health, they are able to substantially reduce the stress of the auto accident. Today, I would like to focus on one area: Nutrition.

It is always important to fuel your body with proper food because the healthier you fuel your body, the better it will work for you. You do not give your car lemonade - correct? This is especially true after an automobile accident - when joints and muscles become sore and when a person has to handle the emotional stress of dealing with all the details of fixing the car, getting a rental vehicle, dealing with the insurance company, etc.... Focusing on better nutrition will enable the body to better adapt to both the physical and emotional stress of the accident.

The following are some nutritional guidelines:

1. Increase your water intake - remember that coffee is not water, soda is not water. just drink water. The rule is to take your body weight, divide by 1/2 and that is the amount of ounces of water you should be drinking per day. Aim for that goal even if you cannot reach it. Drining water is crucial to flush toxins out of your system and keep your muscles and joints hydrated. Avoid dehydrating fluids like soft drinks, coffee, ice tea, alcohol, etc....

2. Increase your protein intake - try to eat more protein - fish, chicken, lean meat, nuts, beans, milk, yogurt are some examples.

3. Decrease sugars, breads, and processed foods.

4. Increase fresh fruits and veggies.

5. Take supplements - a good multi vitamin is a start. Omegas are important for healing. If you have joint problems - glucosamine/chondroitin, MSM is a good supplement to take. Just make sure to speak with your primary physician before beginning any regimin to make sure that it does not interact with any medications you are taking.

6. Try to eat 5-6 little meals per day instead of 3 large meals. When a person is under a lot of stress, the digestive system does not work as well. Eating smaller meals will help the body digest better.

Taking these steps is one way to help your body resist stress while optimizing your health.

Originally posted at InjuryBoard by Beth Scherer

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

Injured on the Job?

Jon Lewis — Sat, 14 Jun 2008 18:37:34 GMT

If you are injured on the job, what should you do? First and foremost, report the injury to your employer. You need a record of the injury so they cannot say you weren't injured. It is best to do this in writing, whether you write it or make sure your supervisor writes it. The record needs to show (1) what, specifically, caused your injury; (2) where it occurred; (3) when it occurred; and (4) who the witnesses were if there were any.

In Alabama, if you are injured on the job, you are entitled to workers compensation. What does that include? If you are temporarily disabled for one week, you are entitled to two-thirds of your average weekly wage (if it's $600 per week, you should be receiving $400). You are also entitled to medical treatment. Initially, your employer may tell you what doctor or hospital to go to. However, once the workers compensation insurance carrier gets involved, they will tell you where you must seek treatment.

Many times, the initial authorized treating physician is not the appropriate type of physician for your injury. If that's the case, that physician may refer you to a specialist. But, if that physician does not refer you to a specialist, you can request a panel of four physicians, and the insurance carrier MUST provide you with such a panel. The panel of 4 must include four doctors from different groups. YOU MAY NOT GO TO A DOCTOR WHO IS NOT AUTHORIZED BY THE INSURANCE COMPANY!!

There are several acronyms associated with workers compensation claims: AWW, TTD, MMI, PPD, and PT. AWW stands for Average Weekly Wage. TTD stands for Temporary Total Disability. MMI means Maximum Medical Improvement. PPD means Permanent Partial Disability. PT stands for Permanent Total Disability. Each of these acronyms are important when assessing what type of compensation you may receive.

When the authorized doctor places you at MMI, it means you are as good as you are going to get. Usually, the doctor will assign you an impairment rating. That rating is the place where you start to determine what the compensation should be. The question at that point is: are you back at work making the same wage you were making before the injury? If the answer is yes, you are limited to the impairment rating. If the answer is no, you might be entitled to a disability rating.

What is a disability rating? Say you have a lawyer and a piano player. Each loses their left hand in an on-the-job injury. Each will have the exact same impairment rating - the loss of a left hand pursuant to the American Medical Association guidelines. However, their disability ratings would be vastly different - the lawyer can still practice law, but the piano player can no longer play piano. Consequently, the piano player will need a vocational expert to assess his disability based upon his injury, his education, his age, his work experience, and the potential for employment in the area.

One important thing to note with workers compensation claims is that you are not entitled to pain and suffering or punitive damages. It is a tradeoff. You don't have to prove your employer was negligent to recover. You only have to prove you were injured on the job, even if it was your fault. The area of workers compensation can be complicated so you should always be careful when making decisions regarding your claim without an attorney's advice.

Originally posted at InjuryBoard by Jon Lewis