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DISCLAIMER: Please note that every case is different and these verdicts and settlements, while accurate, do not represent what we may obtain for you in your case.

When is it helpful to LOSE a case

No one likes losing, and we are not exceptions to the rule. But here are two examples of great outcomes for our clients even though it looked bad for them in the beginning.

The first example involved a truck driver we will call Frank. Frank has an accepted workers compensation case with some complicated, and expensive medical treatment potentially down the line. Frank has also applied for Social Security Disability benefits. Frank's SSD claim was turned down twice. That is pretty common. Frank was scheduled to have a SSS hearing before an administrative law judge recently. At the same time Frank had been hoping we would be able to settle his workers compensation claim.

Frank and our attorneys had a couple of problems, which were making things a mess. First, Frank's rehab nurse had set him up with a doctor who only put very modest restrictions on him. There was no way Frank could do every thing his doctor cleared him to do. Second, because of these restrictions - or the lack of them - it was going to be difficult to convince the Social Security judge that Frank had NOT experienced an almost miraculous recovery to the point he was no longer eligible for SSD. Third, because Frank could still potentially get SSD he could not settle his WC claim without setting aside a considerable amount for future medical care. Furthermore it was going to require clearance by SSD even though they had approved no benefits for Frank.  Fourth, Frank's future SSD benefits would be significantly reduced because he was still drawing WC checks. Fifth, the realistic settlement target for WC including weekly checks and medical treatment was so high that the self-insured employer simply could not afford to settle.

So how did it work out? A tip of the hat to our Social Security Disability team for this success. When we appeared in front of the SSD judge Frank conceded that he couldn't prove ongoing disability. In exchange for that the judge went ahead, on the spot, and said he would approve retroactive benefits for a closed period - up to when the doctor gave insufficient restrictions. Because Frank no longer has an ongoing claim for SSD and Medicare then he didn't have to set aside any money out of his WC settlement. Thus Frank was able to settle his WC claim. Having done that Frank was free to go to his own doctors who documented the need for more work restrictions. Now Frank is able to modify his closed SSD award, receive unreduced benefits and Medicare. All because he realized he was going to "lose" part of his SSD case.

The second example involved a restaurant cook we will call Sharon. Sharon's workers compensation claim had been denied without any legitimate basis. While waiting for her WC hearing Sharon was approved for and began receiving full Social Security Disability benefits. We realized that if we won her WC case most of the retroactive weekly checks would go to reimburse SSD. Future SSD benefits would be dramatically reduced to the extent that winning the WC case would result in only a net gain of $250 per month to Sharon. To make things even more complicated we reasonably anticipated that when Sharon won her WC claim the employer would either bring her back to work or aggressively seek to place her in another position. If either of those occurred Sharon would lose her SSD and, more importantly to her, her Medicare.

In Sharon's case it made sense to settle her WC case on a denied basis. This put a large amount of money at her disposal which more than made up for the $250 per month increased income she gave up. Plus it preserved her health insurance through Medicare.

We shouldn't have to remind you that everyone's case is different. There are unique factors in play in each one. So what we can successfully do in one case is not necessarily going to happen in every case. But we hope these two cases illustrate how a thoughtful approach to a complicated problem can work out well.


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OTP - Greensboro
1155 Revolution Mill Drive,
Studio 4
Greensboro, NC 27405
Phone: 336-274-4494
Fax: 336-274-4525
Toll Free: 1-866-OTP-Law1

OTP - Winston-Salem
110 Oakwood Drive, Suite 420
Winston-Salem, NC 27103
Phone: 336-274-4494
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409 Alamance Road, Suite C
Burlington, NC 27215
Phone: 336-226-5925
Fax: 336-226-4492
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854 South Cox Street
Asheboro, NC 27203
Phone: 336-633-4496
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Raleigh, NC 27612
Phone: 919-573-5241
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Fayetteville, NC 28314
Phone: 910-764-3363
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OTP - Charlotte
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Charlotte, NC 28202
Phone: 704-547-1617
Fax: 704-334-2213
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Hickory, NC 28601
Phone: 828-322-1271
Fax: 828-322-1643
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OTP - Wilmington
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Wilmington, NC 28405
Phone: 910-509-7274
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OTP - Greenville, NC
3800 East 10th Street
Suite 101
Greenville, NC 27858
Phone: 252-294-1109
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OTP - Rock Hill, SC
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Rock Hill, South Carolina 29730
Phone: 803-327-0078
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FAQs

Workers' Compensation

The accident wasn't my fault so can I sue my employer?

If I can't sue my employer, can I sue someone else?

What is "Maximum Medical Improvement" and what happens at that point?

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Case Studies

Workers' Compensation

When is it helpful to LOSE a case

The Workers' Comp Adjuster Denied a Perfectly Legitimate Claim.

What Can Go Wrong with a Return to Light Duty Work.

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