Virginia Workers’ Compensation Case Results and Settlements

Overview:

Brad was a Security Officer for an independent company. He loved his job and gave 110% of himself to do the best that he could. In March of 2014, during a winter storm which caused deteriorating driving conditions around Chesterfield, a Chesterfield County police officer was assisting another officer with a multiple car accident, when Brad noticed another car accident on the other side of the median strip with the traffic going the opposite direction. Brad happened to be in the vicinity and, without thinking twice, he stopped to help and offer his assistance to the police officer.  He had been on his way from one of his security jobs to his next.

He left his vehicle and ran across to attempt to direct traffic and help the injured people.  Cars were sliding on the black ice and more car accidents occurred.  He parked his security truck at an angle to protect the officer from oncoming traffic and put the security lights on. He got out of his truck and went around to the back to get his flares.  Before he knew what happened, he was pinned against his truck by another vehicle that had lost control on the ice and hit him straight on. The police officer saw the oncoming vehicle and yelled, “Watch out!” So Brad, at the last second, managed to jump up in the air, which likely saved his life.  This way, it was his legs that took the full impact and not any of his vital organs.   He suffered massive damage to both of his legs and both were later, within hours, amputated at the hospital.

The injuries suffered by him were absolutely life altering and he nearly died at the scene of shock and loss of blood.  Luckily, there was a fire truck nearby who had a tourniquet that they were able to apply to help stop his loss of blood and save his life.  A kind woman, a stranger, who happened to be nearby, came to his side and prayed with him and stayed with him in the icy cold on the side of the road until he was transported to the hospital. He was selflessly providing assistance to help other distressed people when, as a Good Samaritan, he almost lost his life.

On top of losing both of his legs, he lost his career and his livelihood.  He suffered the life altering adjustments to his life, his wife’s, and his daughter’s, and he went through months of painful rehabilitation.  To push things over the edge, the insurance company denied his claim for workers’ compensation benefits from the very beginning.

The insurance company’s defense was that he was outside the scope of his employment at the time of his injuries and that he was only supposed to help police officers upon the properties owned and controlled by the independent security company’s clients that Brad worked for.

Outcome:

Thankfully, Brad had a short term disability policy that paid him some income while he waited over a year for the workers’ compensation process to happen and for a hearing before the Virginia Workers’ Compensation Commission.  He also was receiving Social Security Disability.  However, we were able to avoid a hearing and, instead, agreed to mediation.  We mediated an agreeable settlement in the amount of $245,000 for Brad, plus they waived all rights to his personal injury claim against the driver who hit him – which was another million dollars. (Workers’ compensation insurance has a lien on any personal injury or auto accident lawsuit recovery you may get related to the workers’ compensation claim.) In this case, the workers’ compensation carrier would have been able to get the full one million dollars recovery from the personal injury insurance and Brad would have gotten nothing from the personal injury claim against the driver who hit him. He would only have gotten a weekly workers’ compensation check and his medical bills would have been paid but no lump sum recovery. Even though this money will never compensate Brad for the loss of his legs, it was enough to keep him and his family financially stable as he decided on a new career path.

Overview:

This was a very sad case and a very difficult case to prove. It was hotly contested and we had little chance of winning.

On September 13, 2005, Clyde, from Richmond, VA, was working as a self-employed landscaper and was driving from one job to the next. We concluded that he was late to the next job so he was speeding when he lost control of the car and ran off the road where he hit a tree. This accident caused Clyde to sustain very severe injuries, including a brain injury. In addition, his left arm had to be amputated. Sadly, Clyde was in a coma for several months after the injury and was found to have severe brain damage and he could not remember the accident or what happened. There were no eyewitnesses to testify to what happened and it was a single car accident. The workers’ compensation insurance company denied that the accident was caused by something that had to do with his work and, even if we proved it was a work related accident, he was speeding which is willful misconduct and, therefore, is a permanent bar to workers’ compensation benefits.

He was treated at MCV with rehabilitation services. He began to act out behaviorally due to his agitation and depression. He was very angry and frustrated. He was in hospitals and other inpatient facilities for over a year. Due to the brain injury, he had no memory, could not swallow, was incontinent, and could not walk. He became suicidal when he became aware of what he had lost. His intellectual abilities were comparable to a five (5) year old. He also lost his left arm above the elbow in the auto accident which complicated his treatment.

The law firm hired an expert to say that Clyde had his accident due to the curve in the road based upon the skid marks. Since we had to prove the case, our evidence was very weak but at least we had something to try and force a settlement.

Clyde needed to settle his claim in order to have money to be able to be cognitively retrained.  The cost was $600 a day at the doctor’s discounted rate and he would need to spend 6 months at the inpatient facility. His regular health insurance would not pay for it.

Luckily, after months of discussions and right before the hearing date, the insurance company was concerned enough about losing and having to pay millions of dollars. We were concerned that we would lose and get nothing or, even if we won, the other side would appeal the decision and it would be years before he would receive his benefits due the slow appeal process.

Outcome:

We agreed to settle for $300,000. This was more than enough for him to receive the specialized treatment. His brain had been so damaged that it couldn’t tell his body to swallow or to walk. His inability to articulate his problems and lack of self-control was causing serious damage to his relationships with his family. In this program, Clyde learned to walk, eat, and regain some cognitive functions. He is on Social Security Disability and Medicare, so he has monthly income and health care now.  Though he is far from the man he used to be, he is happy and has a relationship with his two daughters.

Overview:

Larry was a Sales Associate in Richmond, VA. Unfortunately, he injured his back while he was at work when he leaned back in a chair and the chair broke. He then fell, landing on his buttock and low back area. All of a sudden, his life and health was changed by something mundane. His main injury was his back for which he later had fusion surgery. However, he also had problems with both of his shoulders and legs due to this back injury. He was also not able to return to his job due to the pain. The claim was accepted by the workers’ compensation insurance carrier and Larry received the full 500 weeks of temporary total disability benefits (his injury happened in 2004), which is the maximum number of weeks allowable unless the claim is a permanent total claim.

After his 500 weeks ran, he received no more wage income from the workers’ compensation insurance company. Larry was not able to work due the injury and he was in a hard situation with not receiving wage income from workers’ compensation insurance after the benefits ran out on his claim. We filed for permanent total disability benefits (which are lifetime wage benefits) on his behalf because we believed Larry was permanently and totally disabled and we had medical documentation in support of our claim for Larry. The carrier also was denying some medical treatment for him that his doctor had recommended around the same time, so we added this to his claim and filed for a hearing to get that medical treatment approved as well.

Outcome:

The insurance company contested his right to permanent total disability benefits and, so, we prepared to fight for his benefits at a hearing. Luckily, however, both sides were agreeable to a mediation and a settlement was negotiated with the insurance company through mediation prior to the hearing. Larry received a settlement and was able to move on with his life. At the time of settlement, he had received $24,710 in lost wage benefits and $849,914.27 had been pain in medical benefits. He received a lump sum settlement in the amount of $230,000 and also monthly annuity payments for life totaling $1,278.98 per month, $19,463 to fund a Medicare Set-aside account, plus yearly payments in the amount of $5,385 for 9 years.

Overview:

On November 28, 2009, Margie from Silver Spring, MD, suffered a serious injury to her neck while working as a nurse.  She was pulling a patient that weighed 300+ pounds. Nurses often injure themselves while trying to move heavy patients.

After a year of treatment that did not help, Margie still complained of pain in her neck with radiation into her head and right arm. She had an MRI in August, 2010, that showed she had a bulging disc at C5-7. In June, 2011, she was diagnosed with chronic myofasical pain and degenerative arthritis in the neck. She underwent an anterior cervical discectomy and fusion at C5-7 in December, 2011. For Margie, the surgery was a success and the pain subsided for her. She was very fortunate.

Outcome:

She moved and no longer works for the employer and reports that she is very happy. At the time of settlement, she had already received $51,526 in lost wage benefits and $63,386.44 was paid in medical benefits. She received lump sum settlement in the amount of $150,000

Overview:

Shannon, from Point Marion, PA, worked for a power company and was trimming a tree when he fell 25-30 feet from a ladder. He sustained a T12 compression/burst fracture and a spinal cord injury which caused him to be a paraplegic from his waist down. He was young and was not being paid very much money from his employer.

Right after the injury, Shannon underwent surgery and ended up being hospitalized for a month. Later, he found out that he would need medical care for the rest of his life due to this injury. He would definitely have to have doctor visits for the rest of his life, as well. He had to undergo spinal stabilization and was put into the hospital many times due to different infections and other problems secondary to the injury.

After the injury, Shannon went back to school in order to get his associate’s degree because he wanted a different job since he couldn’t return to his other one. He attempted to go to school several times.

Thankfully, his case was accepted from the beginning. So, he qualified for and was receiving permanent total disability benefits. However, eventually, in order to compensate Shannon and allow him to move on with his life, the goal for Shannon was for his claim to be settled for an acceptable amount. He wanted to buy his own home and become independent, as well as finish his education. He needed a lump sum to buy the home and yearly income to pay for his future medical needs. He was also on Social Security Disability and Medicare.

Outcome:

At the time of settlement, the insurance company had already paid him $297,176.99 in lost wage benefits and $347,058.23 in medical benefits. We were able to negotiate a settlement for him that awarded him initial lump sum payments totaling $117,000, a $6,000 yearly annuity payment for 20 years, $445.95 per month for 20 years, a $41,799 initial lump sum seed payment to fund a Medicare Set-aside account and annual payments into the Medicare Set-aside account $16,638 for his lifetime.

Overview:

Donald, from Mechanicsville, VA, was a hard working mechanic for Virginia Dominion Power and suffered an injury while doing his work.  One day, he was working on a vehicle and, while lifting a battery out of it, he felt a pop.  He then felt excruciating pain on the left side of his chest. He was in a great deal of pain and, so, he immediately needed sought medical attention to figure out what was going on. It turned out, after a MRI, it showed that he had a full thickness tear of the supraspinatus along with AC joint arthritis.

He was out of work and then, ultimately, he underwent two different shoulder surgeries.  Once he had the surgeries and went through recovery, he was able to return to light duty work in a modified duty capacity but he was not able to return to his old job. He would not be able to get any other job due to his injuries as well.  He also had a Functional Capacity Evaluation that indicated he had a left arm impairment (loss of use) of 15%.  He could now only lift a maximum of three pounds with his left arm.

Outcome:

The insurance company had been paying Donald temporary total benefits while his employer, Dominion, paid him the difference. Donald decided he wanted to settle his case and his plan was to then retire from Dominion with full benefits. We negotiated a settlement for him in the amount of $75,000.00.

Although Donald was working light duty, once the case verbally settled, he stopped going in and used up all of his vacation time as terminal leave. Once the settlement was done and disbursed, he then retired from Virginia Dominion Power and received his full retirement benefits, including health insurance. The Virginia Dominion Power Union worked closely to help him get his full coverage. He made plans to use a little of his settlement money on paying some bills and then to put the rest in savings.

Overview:

Curtis was a Bridge Inspector for a company who dispatched employees to bridge locations to inspect bridges. On the day he was injured, he was working in the City of Winchester, VA, though he lived in South Carolina. The ground that day was muddy and he was in the mud up to his ankles when he tried to move a ladder and he felt a pop his shoulder and neck.

Curtis’s case was mostly an accepted case except that later on in the case as he developed tingling in his wrists and hands, we filed a claim to add those body parts as compensable, in addition to the original accepted neck and shoulder injury.

This case is an example of how an insurance company can manipulate or use a situation to cut off a claimant’s check.

Curtis lived in South Carolina, and the company was based in Northern Virginia. When he was released to light duty work by his workers’ compensation doctor, the employer reached out to him to let him know that they had a light duty position available for him.

Here is what happened. Curtis received written notice form his employer on 02/22/16 that they were able to accommodate his work restrictions and telling him that he needed to report to their Springfield, VA office. They stated that the job consisted of writing reports and offering general support for the Bridge Inspection Department. The letter indicated that he needed to contact the HR Manager by 02/24/16 to discuss a date for his plan to return to work. The written notice was dated 02/17/16. The letter did not say for him to appear at work on a specific day but only said to call to discuss the job offer and a possible return date. Curtis called and left voice mails with the HR person who wrote the letter on 02/22/16 and also sent an email. He followed that with an email the following day 02/23/16 and he received a response on 02/23/16 after 5pm acknowledging Curtis’s attempts at contact. She also stated that she would get back in touch with him in a few days to answer his questions that he raised in his email to her. However, she did not get back in touch with him.

On 02/26/16, we filed a Motion for Protective Order with the Commission to try to stop the employer from filing an application to terminate his check. However, on the same day, the employer filed an application to terminate his check alleging that he refused selective employment within his work restrictions.

Around this same time, or shortly after, his doctor also specified “no typing” in his work restrictions.

A hearing was scheduled and also a mediation. Curtis was not receiving any monetary income from workers’ compensation during this time. Also, due to the situation, he was also obligated to do mandatory job searches each week.

Outcome:

The case ended up settling at mediation instead of going to hearing. His case settled for a lump sum of $256,000. He was happy to be free of workers’ compensation and plans to open his own business.

Overview: 

Pam, a nurse, was helping to move a patient who weighed approximately 300 pounds. While moving this patient, Pam felt immediate pain in her neck and upper back. She also hurt her right arm while transferring the patient. A common job requirement for nurses, moving heavier patients is a frequent cause of serious injury.

Pam’s injuries were severe, including degeneration of the discs in her back that was so significant that a fusion could not be performed. There was simply not enough disc to which a fusion could adhere. She had complications from the medicine prescribed to her to manage the crippling pain that she experienced. Pam was unable to return to work as a nurse.

Outcome:

Immediately after the accident, our firm filed a claim for temporary total disability benefits for the injuries that she suffered. The claim was approved, and an award was entered. However, the insurance adjuster hired an independent medical examiner who disagreed with the treating physician’s plan for Pam, as a method of denying future medical care.

Because Pam is no longer able to work as a nurse, we negotiated a settlement on her behalf that included $435,000 for future lost wages and $801,625 for future medical benefits. In addition to the amount that she had already received for past lost wages ($289,201.64) and medical benefits ($128,219.38), Pam’s total recovery was $1,654,046.02 in benefits.

This settlement achieved an important goal for Pam: allowing her to live independently, with sufficient income to support herself. Perhaps more critically, it gives her the necessary funds to manage her own medical care without the oversight or interference of the insurance adjuster, so that she can recover and move forward with her life.

Overview:

Susan was tasked with moving a large desk unit. This job led to her suffering a severe low back and left hip injury, leaving her disabled and unable to work as a result. As a career, moving can be particularly risky, as it has one of the highest rates of injuries requiring days away from work. Musculoskeletal disorders — such as back and hip injuries — are particularly common among movers.

Susan’s initial claim was accepted, and she was awarded temporary total disability benefits for a period of 500 weeks. After this initial period of time elapsed, Susan was still unable to work given the severity of her injury. At this point, she reached out to our office, seeking help with her workers’ compensation claim.

Outcome:

Because Susan’s injuries were so significant, we filed a claim for permanent total disability benefits. Through aggressive negotiation, we eventually were able to settle the claim for $1,410,881. Combined with the past benefits that she has received, including $362,782.46 in lost wages and $486,539.04 in medical benefits, Susan recovered a total of $2,260.202.50 in workers’ compensation benefits.

While Susan may not be able to work in her chosen profession again, with her workers’ compensation benefits settlement, she will be able to provide for herself and continue to receive medical treatment. This will give her peace of mind and security as she recovers from her injury.