5 Times to Just Settle That Workers Compensation Claim File

pic5There are times while engaged in a workers compensation file that you are better off just settling the file out, redeeming all costs for medical, wages, and future medical exposure. Some files will not necessarily call for a full settlement, maybe it is better to settle either wages or medical, or both, but it has to be done when the scenario calls for it. Some examples are below.Note: These are general examples, and all actual claim situtations should be reviewed by your legal counsel.

 

 

 

  1. The injured worker has been terminated by the employer

The cause of a good percentage of litigated files comes when the employer terminates employment with the claimant during the course of their injury and subsequent rehabilitation. The claimant feels they were terminated unfairly due to their injury, and this will send them directly to a plaintiff attorney. This will open up significant exposure for ongoing wage loss, and it will extend the life of a claim. (WCxKit)

 

 

On most occasions you are better off waiting to drop the axe on termination until the claimant has either reached their end of healing, or the end of the case. This way, if you want to settle the file, you can include the voluntary resignation of the claimant from the employment.Note: consult with legal counsel before settlement, having them review voluntary resignation to make sure it meets requirements of state law as “voluntary” and that it complies with all other requirements.

 

 

  1. The injured worker has no job to return to within their permanent medical restrictions

This scenario happens a lot when a major surgery or amputation is involved. The job the worker once did can no longer be done by that worker. You have the option of moving the employee to another department or position, but often with smaller companies the option is just not there.

 

 

This is a good time to settle the wage portion of a claim. If you know for sure the worker can no longer do the job they once did, and you do not want to spend the cost of vocational retraining or vocational job placement, then you should settle out the wage portion of their claim. Again it is best to wait until their medical situation stabilizes before you approach this topic. You do not want to pursue this too early, as the claimant may try to stretch out their medical recovery, further securing their wage loss benefits and adding to the cost of the claim’s wage loss.

 

 

Depending on the job, some claimants will know they have little to no hope of returning back to work at their old position. But not every injured worker is easy to deal with. Changing jobs or losing your job is a major roadblock in a claim, and it can be costly to settle out the wage portion of these claims. But in the long run, it is worth it. Vocational training and placement is not a guarantee, and you do not want to incur those costs and then also have to settle the wage portions out when you cannot find the injured worker a job.

 

 

  1. The injured worker still works for their employer, but their case is denied coverage under workers compensation

In this case you do not have to settle the wages and medical to include a voluntary resignation, unless you want to add it in. If the adjuster denied the case as being compensable, but the worker filed their claim under their disability coverage, and then filed for hearing after returning to work once released from medical care, this is a case to settle after all the exposure for wage loss and medical bills are gathered.

 

 

This case gives you the total exposure, since the lost wages are known, and the medical cost to full duty is known. This is known as a “closed period” settlement.

 

 

Typically the adjuster will have to negotiate a lien with the medical carrier, and a compromise will be made on the wage loss the worker incurred. Unless you have a fantastic denial and can take your defense all the way to trial, it is best to make the compromise and settle for a portion of the exposure. This is probably the most common litigation example in the world of workers compensation.

 

 

  1. The worker’s case was disputed by the comp board, and then they were laid off due to workforce reductions. The injured worker was paid unemployment, and their medical carrier paid the medical cost to full duty

Here we have an example of taking a wage loss offset, and negotiating a medical lien. This is a fairly simple case to settle. Most states will allow a claimant to get unemployment pay when they are laid off. Even when they are off on a medical leave. This is a “collateral source benefit” because the employee may be making more when not working than when working.

 

 

However, if this person files for litigation, the insurance company can offset what the full-wage loss would have been, so, in essence, they get a credit for the wage loss, and only have to deal with the medical lien from the carrier. These medical carriers are usually easy to negotiate with, and most liens can be settled for easily up to 50 percent of their cost.

 

 

Medical carriers will also get a better fee reduction than workers compensation insurance carriers, so not only does the workers compensation carrier get a credit for the unemployment pay the worker received, they also get cheaper medical cost for all the medical expenses the injured worker incurred during their treatment and recovery. These are also usually closed-period settlements, and can be redeemed for a relatively low legal cost.

 

 

 

  1. The injured worker files for an occupational injury claim, naming several employers as the defendants

Occupational injury claims are usually filed by seasoned workers who have spent their lives working for several employers.  When their shoulder or back finally gives out and they need surgical repair, if they seek out an opinion at a plaintiff attorney’s office. The counsel will usually file a hearing for an occupational injury claim, and they will list all of the claimant’s past employers, since they will assert that each period of employment lead to the accelerated degeneration of the worker’s body, which lead to the ultimate injury they incurred.

 

 

In this case, each employer will contribute an amount towards a global settlement. The exposure of each employer will depend on the duration of employment, types of jobs the claimant performed, and the associated risk involved in relation to the injury. The hardest part about these claims is figuring out how much each adjuster should have to contribute. Once the adjuster takes all the past employers and the exposure into consideration, they will nominate a general amount for the represented employer’s exposure, and once all parties agree on all the amounts the case can be settled. It can take some time for all carriers and adjusters to agree, but they eventually get there and the case can be resolved.(WCxKit)

 

 

Workers compensation claims are settled all the time, usually for one of the reasons outlined above. As you can see, you have a number of opportunities where a settlement is the best option, and you should discuss with your adjuster if this is the road you should explore, instead of incurring other costs to bring an injured worker back to work at your place of employment. This differs from my normal opinion of bringing every able employee back to work.


Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.

 

 

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

 

Jury Awards $212 Million for Botox Brain Injury

A Virginia jury has awarded $212 million to a man who alleged that side effects of Botox led to him to suffering brain damage. 
 
 
According to Bloomberg News, the lawsuit was filed by 67 year-old Douglas Ray, who alleged that he was disabled by permanent brain damage after receiving Botox injections to treat writer’s cramp in his right hand. The complaint accused Allergan Inc., the manufacturer, of failing to warn about the risk of brain damage from Botox triggering an autoimmune reaction. (WCxKit)
 
 
In late April, a jury in the U.S. District Court for the Eastern District of Virginia in Richmond awarded Ray $12 million in compensatory damages and $200 million in punitive damages. However, Virginia tort reform laws will reportedly cap the punitive damages award at $350,000.
 
 
Botox, which includes limited quantities of the bacteria associated with the development of botulism poisoning, is approved for both cosmetic use to reduce the appearance of wrinkles in the skin and to treat medical conditions such as strabismus (crossed eyes), hyperhidrosis (excess sweating), cervical dystonia (involuntary contractions of the neck muscles) and blepharospasms (involuntary blinking of the eye). However, it also commonly used off-label at high doses to treat stiff and jerky movements associated with cerebral palsy in children.
 
 
A number of Botox problems have been reported among users, where the medication can spread from the area of the injection to other parts of the body. This can result in symptoms of botulism poisoning, such as paralysis, difficulty swallowing, respiratory distress and other issues. These Botox side effects have most commonly been seen among children with cerebral palsy, where the typical Botox dose is substantially larger.
 
 
In October 2010, Allergan pled guilty to charges of illegally marketing Botox and agreed to pay $600 million to settle the charges. (open-ended)
 
 
According to allegations raised in the lawsuit over Botox marketing, the company went as far as training doctors how to bill for unapproved uses and created a Botox Reimbursement Hotline to help doctors get reimbursed for using Botox in ways that have not been sanctioned by the FDA.
 
 
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Do You Know The ONE Thing An Employer Can Do to Drive Their Injured Employees Straight to An Attorney

The easiest way  to chase your injured employee to an attorney is to ignore the employee once an injury occurs.  Of course the attorney who is interested in maximizing his income, builds-up the employee’s claim by whatever methods are available in the jurisdiction of the injury.  The best way to prevent unnecessary attorney representation is through on-going contact with the injured employee.

The employee  is human and like all humans craves attention, especially when hurt.  In addition to being concerned about the injury, the injured employee is concerned about future employment, future income, ability to take care of the family. 

The employee  needs reassurance throughout the claim, not just when it is reported.  Most companies do a fairly good job of reassuring the employee everything will be taken care of when the workers’ compensation claim is first reported.    But, the first report of injury is not the only time the employer needs to be in contact with the employee.

On-going contact  with an injured employee actually starts before the injury ever occurs.   As apart of the new hire package, the employee should be told what to do in the case of a workers’ compensation injury.  The new hire package specifies who the employee reports the work comp claim to, the importance of reporting the claim immediately, the medical treatment providers available (in those jurisdictions allowing the employer to select the medical provider) and the return-to-work program or modified duty program available to them.  This sets the stage for active involvement by the employer with the employee throughout the recovery from the work comp injury.

During the initial  report of the claim, the employer emphasizes the need for the employee to keep the employer informed about his/her medical treatment and work status.  The employee then sees the employer cares about his/her well being, wants a return-to-work as soon as the injured worker is physically able and thus, is much more likely to return to work in a appropriate time frame than to malinger at home off work. 

The employer’s  work comp coordinator tracks the medical progress of the employee until he/she returns to work.  When the employee is going to be off work for an extended period of time, the employer contacts the employee on a monthly basis to see what progress is being made and to confirm the employee’s job is available for return-to-work.

Following a  report of the injury,  the adjuster contacts the employee within 24 hours of the claim being reported to the adjuster’s office.   During this initial contact with the employee, the adjuster obtains all pertinent details about the claim to complete the investigation.  With proper people skills the adjuster builds rapport with the employee during this initial contact by taking an active interest in the claim and by obtaining all the information needed to move the claim forward. 

The adjuster  also advises the employee to call and report any change in the worker’s medical or work status. However, the adjuster does not rely on the employee to report everything happening on the work comp claim.   The adjuster as part of a file action plan, in addition to regular contact with the medical provider, plans to contact the employee every 30 days (or less if the situation calls for it) to maintain rapport with the claimant and to ensure a timely forward movement of the work comp claim.  (workersxzcompxzkit)

By maintaining  on-going contact with the employee, the adjuster is established as the expert on the work comp claim and as the person who will assist the employee with all questions and concerns in regarding the work comp claim.   The adjuster is established as the go-to person, creating a positive environment for processing the claim and gives the employee confidence the work injury is important to both the employer and the adjuster.  With the confidence built by the adjuster through on-going contact, the likelihood of the employee feeling the need to hire an attorney is greatly diminished and the overall cost of the claim is more effectively controlled.

“FRAUD PREVENTION” PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Private investigator with 25 years experience.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.

©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com

Why THE EMPLOYER Must Talk to a Doctor BEFORE Settling a Claim

Medical Issues

Both the work  comp adjuster and your work comp coordinator need to have a solid understanding of common medical problems faced by employees recovering from on workplace injuries.  When either the adjuster or your work comp coordinator does not understand the nature of an employee’s medical issues they need to either research the medical issue by contacting the treating physician or your insurance company’s/TPA’s medical director BEFORE SETTLING THE CLAIM. 

A discussion  explains the medical issue and how it will affect the employee long term.  A complete understanding of the medical issue(s) facing the employee is necessary for a proper evaluation of the value of the claim. The internet may also be used (judiciously) for research.

Often a stumbling  block to the successful settlement of a work comp claim is the lack of understanding by the employee of the medical issue(s) currently being experienced.  The nurse case manager on the file should always be present at the employee’s conference with the treating physician when the future prognosis and future treatment and care are discussed.   The nurse case manager can assist the employee in obtaining answers to all questions about the medical condition.   This helps to alleviate the employee’s fear about the future, making it easier for the adjuster to settle the claim.

Disputed Issues

Disputes are  unavoidable in the handling of work comp claims.  Disputes arise from almost all aspects of the claim including whether or not the medical issue is work related, the amount of the temporary total disability benefits, the medical benefits provided, the disability rating and the value of future medical benefits.  While disputes cannot be totally eliminated, the adjuster can reduce the number of disputed issues and reduce the contentiousness of the disputes. 

As part of the  Best Practices established by your Risk Management Department, you require the adjuster to make immediate contact on each new claim reported, plus you have required the adjuster to maintain regular contact with the employee throughout the course of the claim. 

The employee  is primarily concerned about all aspects of the claim being handled promptly and fairly.   The rapport built up by your adjuster with the employee through regular contact eliminates many disputes.  If the employee contacts the adjuster whenever there is a problem or a question rather than an attorney, the end result of the claim will be much better. If the employee does not hear from the adjuster in months, the employee will have no confidence in being treated fairly by the adjuster to resolved problems.

When the employee  is represented by an attorney and a dispute does arise over what will be paid, the adjuster must have a thorough understanding of the work comp laws in their state. http://reduceyourworkerscomp.com//laws_and_regulations.php   

Most jurisdictions have previously resolved every imaginable type of dispute over wage benefits.  What is and what is not covered can usually be found in either the written statutes or case law.  The knowledgeable adjuster can point out to the employee’s attorney the governing law or ruling defining and determining what is owed/not owed.  (workersxzcompxzkit)

The area of disputes  most often in contention is medical benefits.  When the employee’s doctor selected by the employee’s attorney wants to continue treatment beyond what is necessary, or the employee wants to try the latest unproven experimental treatment, it is essential for your IME doctor to be highly proficient in his/her specialty.  Your IME doctor must be able to testify if necessary as to why the medical treatment sought by the employee/employee’s attorney is not justifiable.

TO DOWNLOAD OR LISTEN TO FREE AUDIO PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Anthony Van Gorp, private investigator with 25 years experience.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or broker about workers’ comp issues.

©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

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