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Unfortunately this happens all the time.
Our client was an animal control officer for his county. While putting a dog in a cage he injured his back, immediately having pain all the way down his left leg into his foot. His employer accepted the accident as compensable and began directing medical treatment. Key Risk's hand-picked doctor said that although the MRI showed a herniated disk pressing on a nerve, our client could return to "light duty" work.
Our client -- he wasn't our client yet -- returned to work as recommended by Key Risk's doctor. As soon as he returned to work, Key Risk filed a Form 28T and stopped his checks. Within hours of Key Risk cutting off the weekly compensation checks, the employer called him in for a meeting. The county ended up firing the injured worker for "lack of organization."
Ordinarily getting fired for a lack of organization would be pretty unfair. But what happened here was even worse. It certainly looks like Key Risk and the county worked together to get our client back to work, cut off his checks and fire him.
What makes injured workers really vulnerable in these situations is that it takes the Industrial Commission so long to get a case like this to hearing. Even with the Deputy Commissioner putting this on a fast-track basis, it still took seven months to get a decision -- and then the defendants filed an appeal.
The North Carolina Industrial Commission ultimately found that the defendants' conduct was improper and that the plaintiff was entitled to his full benefits from the date of termination ongoing. Tom Clare and John Landry did a great job of showing how absurd Key Risk's arguments were at the hearing. But the case illustrates why we caution our clients about the danger of returning to work before you are 100%.
Read More About When the injured worker returned to work he was immediately fired...
This case was a big win for us and illustrates the problems which come from combining company doctors and rehabilitation professionals who don’t strictly follow the rules. Our client had fallen and injured his shoulder which ultimately led to surgery. The surgery went pretty well, but our client still had problems and his job required him to be climb ladders and carry heavy objects. Having a bad shoulder really hurt the way he could do his job.
The defendants’ rehab professional violated the Rehabilitation Rules by having a private conversation with the doctor which led to a very low rating. Worse yet, the doctor released our client to return to work without any restrictions at all – even though the doctor had no idea what our client did for a living! When we got the Industrial Commission to order a Functional Capacities Evaluation, the adjuster simply refused to schedule it.
We successfully convinced the Industrial Commission that the workers’ compensation insurance company, CNA, was violating the law. Indeed the Commission ordered the Functional Capacities Evaluation to be completed within 30 days and threatened to hold the adjuster in contempt of court (with possible jail time) because we would not let this issue go.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
How unreasonable can an employer and the employer's insurance company be in denying a claim? This case. involving National Benefits Association and a steelworker, perfectly illustrates “deny and buy."
Our client was lifting steel at work when he felt an immediate onset of pain. This was reported to his supervisor, the job foreman and the company’s safety manager. The employer sent our client to the doctor who ordered only light duty work for the steelworker. The company, though, promptly disregarded the light duty restrictions. Unfortunately, that’s not unusual in our experience. Neither was the fact that the employer then refused to authorize a return visit to the doctor. Since he was in such intense pain, our client had to take himself out of work. The employer then decided to send our client to their hand-picked doctor for a second opinion – but then they refused to authorize the MRI this doctor requested. The combination of all this confusion left the plaintiff out of work and without either medical or financial benefits. Fortunately, he was able to survive financially by taking another job.
He agreed that it was important to take this case to a hearing rather than settling for a nominal sum. At the hearing, we cornered the employer’s witnesses who admitted that they had no real light-duty work available for our client. We were happy to win the claim for ongoing medical treatment. As is often the case, however, we had to appeal a portion of the Opinion and Award because it did not provide for enough weekly benefits for our client. The claim ultimately settled while the appeal was pending.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
Our client, a brick mason, fell and injured his back. After lengthy treatment he was able to walk -- but awkwardly with a cane. He needed modifications to his kitchen, bathroom, and other parts of his house to make it easier for him to get around. Additionally, because he had difficulty keeping the house and yard up to proper standards the Industrial Commission ordered Liberty Mutual to provide a housekeeper and a yardboy.
Additionally, we were able to prove that our client had previously roofed his own house and painted it. So when the house required a new paint job Liberty Mutual had to pay for it.
The key to this case was our willingness to hire an expert to go with us to our client's house, meet with him, and make recommendations as to what he needed. This is an example of why spending a $1,000 up front can payoff ten or twenty times that in the value of the case. Plus we had negotiated with Liberty Mutual's attorney upfront that they would accept the expert's recommendations. In a calculated gamble we used an expert which Liberty Mutual themselves often hired. Faced with our client's devestating injury she did the right thing and documented that he needed yardcare, housecleaning, and general attendant care.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
In another failed attempt at "deny and buy" (the insurance industry trick of denying an obviously good claim in the hope of starving an injured worker into a cheap settlement) this restaurant denied the workers comp claim when their dishwasher slipped on a piece of butter, fell on his back, and was taken to the emergency room.
While it isn't recorded in the Opinion and Award the defendant first tried to claim that our client wasn't even on the job. Fortunately we'd immediately made copies of his time card -- so we were able to prove that was, in fact, there. This claim got ugly fast as the defendants poured thousands of dollars into trying every dirty trick in the book. We fought back with a series of tape-recorded interviews, our own investigator, and relentless pressure on a defendant who was willing to do almost anything to avoid payment of the claim.
This case was not easily won, however. The uninsured owner of the restaurant poured money into his defense, using one of the highest profile attorneys in the state to argue the case to the North Carolina Court of Appeals and back.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
We are skeptical of "light duty work" for a whole lot of reasons and this case illustrates several of them. Our client in Lexington had an assembly job with Diebold. She injured her shoulder and the employer began directing her medical care. Notably, however, they refused to file a Form 60 or a Form 63 formally accepting the claim. They sent her to the company doctor who, pretty reliably, returned her to light duty work instead of taking her out of work.
Nearly immediately upon return to work with a 5 pound lifting restriction Diebold moved her to a different job which required her to lift over 40 pounds regularly. Without any other way to pay her bills our client had to try to stick it out. Like many employers and insurance companies, Diebold and Broadspire responded by writing her up for allegedly being less than five minutes late to work. They followed this up with another write-up for a highly disputed instance of tardiness and fired her.
Not surprisingly Broadspire declined to start her on weekly checks.
Like many injured workers this hard-working woman hadn't wanted to hire an attorney. Yet at this point she had no other options. She hired us and we sent her back to an authorized orthopedic surgeon who wrote her out of work. We immediately filed a Motion to Reinstate Benefits, however the Industrial Commission denied this due to Broadspire's failure to formally accept the claim. (Rather than punishing Broadspire for this violation of the law, the Industrial Commission effectively punished our client by requiring her to go to a full hearing without any weekly income at all.)
After the hearing and doctor's depositions the Industrial Commission correctly ruled that Broadspire had illegally failed to accept or deny the claim. The NCIC also held that Diebold had violated the light duty restrictions and therefore plaintiff should not have been at work -- and thus shouldn't have been exposed to the risks of termination. The NCIC proceeded to order weekly benefits paid from the date of termination ongoing as well as all medical treatment necessary to get plaintiff better.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
Our client, a nurse at a private college, was on her way to lunch when she was hit by a speeding student. For nearly two years no attorney would touch her case. The problem was that while the Industrial Commission admits that a workers is still within the course and scope of their employment if they are injured in the company-owned and controlled parking lot, our client had left the parking lot at the time of the auto accident.
We had met with our client to handle the personal injury claim against the student who hit her. No one had been willing to take the workers compensation case before but we decided to consider it. During the course of tallking the facts through with several of our attorneys we developed an argument which proved successful. The rationale behind the "parking lot rule" is that a worker is acting to the benefit of the employer even while walking in/out of the job. The employer should be responsible for injuries in the parking lot if they own and control it or, in other words, have the capacity to keep it a safe place. That rationale should extend to the full extent of an employer's property. The side argument in this case was that the university campus was particularly risky given the concentration of young drivers who are known to be more accident-prone that older drivers.
We discussed the idea with our client and, making no promises of success, agreed to take this case straight to a hearing. The final Opinion and Award is a little anticlimactic because it doesn't detail the lengthy arguments presented for and against awarding our clients benefits. While Hartford Insurance promises an appeal we are confident that we've got a solid argument going in to the Full Commission.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
Our client, a truck driver, had earned nearly $1000 per week as a tractor-trailer driver. His truck flipped and he suffered head injuries and back injuries. He couldn't return to work as a truck driver. As is often the case the insurance adjuster assigned a vocational rehabiliation professional to have him look for work.
We proved the vocational rehabiliation professional from Page Rehabiliation (one of the largest and most aggressive vocational rehab companies) completely disregarded the Industrial Commission rules for job searches. These included her request that our client put in for $8/hr jobs, part-time jobs, look for jobs 30 miles from his home, and continued the job search when it should have been obvious that he wasn't going to find suitable employment.
This case is an example of why adjusters love vocational rehabilitation. Indeed many of them use a short-hand verb. "To voke" an injured worker is to try to drive the plaintiff into giving up by having him look for terrible jobs. In fairness, some vocational rehab professionals refuse to cooperate with such goals, and nearly all get angry at the term "to voke." Fortunately our client was willing to stay the course, and we had this rehab provider removed from the claim.
Footnote: We also learned a lesson in this case. The Industrial Commission is no longer satisfied with just tearing up defendants' witnesses. We needed to hire our own experts to put on the necessary evidence. In this case we produced sufficient evidence after the claim that defendants settled on terms quite favorable to our client.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
This case illustrates a rare, but difficult situation. Our truck driver client had two separate accidents and didn't report either of them until a month or so after the second. Which accident lead to the need for surgery? Often it doesn't matter but in this case the employer had changed insurance companies in the interim. Neither wanted to take responsibility for it.
The biggest weakness in the case was our client's delay in reporting the claim. In fact he didn't do so until he found out he needed surgery. The next biggest problem was that he didn't get his information lined up beforehand. He described the facts of the accident but had it occuring in the wrong month. This gave the company's safety manager a cheap and easy excuse to deny the claim.
We took statements from a coworker and put the employer's safety manager on the stand immediately. We forced her to admit that the injured worker had indeed reported the claim to the company although to the wrong supervisor. However it is the Industrial Commission which defines the rules for reporting the claim -- not an adjuster or safety manager. We also forced her to admit that while our client put the initial accident in the wrong month she could very easily have confirmed the correct date by all of the other facts which he did have straight.
As a side note, several months after this one of the insurance company's witnesses referred a friend of hers to us for another denied claim. After having been involved in dozens of hearings she said this was the one time that the plaintiff's attorney was in complete control of the hearing from start to finish and her attorneys didn't stand a chance.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
Our client was an insulation installer on his way to a job site. He was the passenger in a company truck which got in an accident and rolled over. In a classic example of insurance company delay tactics the adjuster refused to accept or deny the claim. When we filed a written request to the Industrial Commission to force a decision in this obvious case, the insurance defense attorney blatantly lied to the Commission claiming that benefits were being paid on a Form 63.
This story fell apart at the hearing and the insurance company took the creative approach of arguing that while the truck rollling over and, yes, the plaintiff had to be taken to the emergency room for treatment there was not enough evidence for them to determine if the treatment offered at the emergency room was related to the accident. It would be funny if it hadn't taken our client nearly a year to get the benefits he should have had from the start.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
Our client had gunwounds to his hand, shoulder, and thigh. As a result of these he struggles to do his own yardwork and housecleaning. Given that he had been able to do all of this before he was shot in a robbery outside his Charlotte restaurant we believed that GAB Robbins and Royal Insurance should provide assistance with this.
Unfortunately plaintiff's doctor, an excellent surgeon, was not willling to go along with this idea. When he was quizzed about the North Carolina Industrial Commission's requirement of all medical treatment necessary to "effect a cure, provide relief, or lessen the period of disability" he noted that a yardboy would provide relief to anyone -- whether they were on workers compensation or not.
Fortunately, we had already had an expert in the area of attendant care meet with our client at his house. While the surgeon didn't see what was really necessary he did agree to defer to this expert. The North Carolina Industrial Commission agree with us and awarded the requested services.
This is a real example of being prepared. Had we walked into the doctor's office without the expert's statement we would have walked out losing the case. By arranging for this ahead of time we won what GAB Robbin's adjuster thought was an impossible case.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
Our client, an oil change technician, injured his back rotating tires. He had previously injured his back while working in construction but did not require surgery. He settled his first workers' comp claim and changed jobs into something easier.
While this should have been obviously a compensable claim given that he complained of pain immediately while working, the adjuster from Hartford employed an old "deny and buy" trick of denying the claim because she couldn't tell whether or not the current need for surgery was due to the old accident or the new one. Plaintiff's neurosurgeon was perfectly clear about it but Hartford apparently wanted to see if the automotive tech would fold and settle cheap.
Fortunately he didn't and Hartford Insurance ended up paying the claim.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
Our clients were the children of a cafeteria worker who broke her pelvis when she slipped and fell, with a cart landing on top of her. While they had willingly taken care of their mother, who passed away from other causes, they came to us when Cambridge's adjuster refused to even pay their mother's rating for her fracture.
We retroactively obtained evidence of the need for attendant care and also of the permanent partial disability rating, and won both of these fights at the North Carolina Industrial Commission.
We also tried to find a link between our clients' mother's death from COPD and her being bedridden. While it made sense to us that this would have worsened by her lack of exercise her physicians explained that she was in pretty bad shape already at the time of the fall. While we lost on that point we firmly believe it is critical to be (a) willing to lose and (b) never give up trying to win.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
Our client fell and injured her elbow, ultimately requiring surgery. She then contracted a terrible case of Reflex Sympathetic Dystrophy which largely confined her to a wheelchair. We persuaded her physicians to order attendant care for her (having someone help with her activities of daily living) as well a major renovations to her house to make it wheelchair accessible.
The adjuster initially agreed to provide attendant care but couldn't find anyone in this rural area to do it. The adjuster refused to pay family members to provide the care. The North Carolina Industrial Commission ruled in our favor.
Note: in this Opinion and Award the NCIC also required defendants to build a new house for the plaintiff. This was subsequently overturned. Defendants instead spent over $100,000 in modifications.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
The workers' compensation adjuster at Kemper Insurance accepted this claim as compensable and sent this injured laundry worker to the "company doctor" who told her to work light duty. When she did this she was soon fired from the job. Through extremely aggressive courtroom tactics we produced evidence that the North Carolina Industrial Commission described as follows:
"Employer terminated plaintiff as part of a scheme between Mr. Barnes and Mr. Williams and not due to any fault or misconduct on the part of plaintiff. Mr. Barnes and Mr. Williams specifically created a scenario under which they could terminate plaintiff and claim that it was for absenteeism. Mr. Barnes and Mr. Williams continued this scheme through their sworn testimony"
Unfortunately we see this happening in most cases where injured workers go back to their jobs too soon. While this time it was in Greensboro, North Carolina we've seen it occurring throughout the state.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
My client, a collections worker for Oakwood Homes, was asked to participate in a fundraising event for charity. While he was off the clock everyone in his department was doing it and he was pressured to help out. Unfortunately while working on the project he seriously injured his back.
The workers' compensation adjuster from ACE USA denied the claim and basically tried to starve the injured worker into a settlement. He refused and we took this case to hearing even though most similar cases had gone down in defeat. Our willingness to take risks was rewarded with a big win for our client.
The key bit of testimony was that the employer benefitted from the "team-building" aspects of the project, and thus while it was technically for charity the employer profited from it as well.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
The workers' compensation adjuster at Argonaut Insurance Company denied this carpal tunnel syndrome case for a truck driver. The injured worker came to us for help based on the referral from a friend. We retained an ergonomics expert who testified that the vibration coming from the steering wheel and the gear shifter could cause carpal tunnel syndrome. With this piece of evidence we refused to settle at a mediation and took the case to a hearing. Without it we surely would have lost the case. Defendants sought permission to send our client to their hand-picked doctor; however we prepared our client for this visit and sent him with the ergonomics report. Even the insurance company doctor had to concede the point in the face of our ergonomics report. The workers compensation defendants dropped their denial and gave in even to our choice of treating doctors.
Our client underwent successful surgery, collected his permanent partial disability ratings, and is back at work as a truck driver.
Click to read the Industrial Commission decision. User name is "public" and there is no password.
We don't go out of our way to get involved in other North Carolina lawyer's cases. But when we see an injured worker who isn't getting the help he needs in his workers' compensation case we'll intervene. Sometimes this is when the other attorney is passing all of the work off onto paralegals and doesn't have time for the injured worker. Other times it's when the attorney won't return phone calls. In this case the original attorney, a well-known auto accident defense attorney, was trying his hand at representing an injured worker. While he was inexperienced at this type of law Key Risk's lawyer wasn't and was beating the plaintiff badly. The original attorney got in over head at the hearing and basically threw up his hands and went no further.
We were able to get involved in the case, get the medical evidence we needed, succussfully got the insurance company's doctor to change the date of maximum medical improvement so that we could obtain far more in benefits than our client expected, and secured lifetime medical benefits for this injured plumber to boot.
Click to read the Industrial Commission decision. User name is "public" and there is no password.

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"10 Ways to Wreck Your
Workers Compensation Claim"
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"10 Things Your Insurance Adjuster Wont Tell You"
"Deny & Buy" - Confessions of Former Insurance Defense Attorneys
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What Can Go Wrong with a Return to Light Duty Work.
How a Functional Capacities Evaluation Can Wreck a Claim.
An Example of a Workers' Comp Adjuster Manipulating the Recorded Statement.