Worker's Compensation - Skeptical

[jjmanfdl]

Heya fellas, been a while since I've logged on but something has been gaining some interest from me and wanted to get some input from people who have experienced this.

A quick run down, I'll try and be depictive as possible and if I miss something that might be pertinent throw it out there and I'll see if I have the info/answer. For simplicity sake, this persons name will be Bob.

Approximately three years ago Bob was injured at work. Bob was told by his employer that he had to go see DR. A (Yes, he is aware now that he could have gone to any Dr. of his choice). Bob went to go see Dr. A who told him he had a torn meniscus and needed surgery. Bob followed the proper procedures for what was required of his employer and worker's comp. Bob then had a partial meniscectomy performed. Then rated at 5% PPD. He went through rehabilitation, ect ect ect. There were no improvements from the surgery. Dr. A then suggested he needed a second meniscectomy. Bob went through with this a second time. Then rated 10% PPD. Again, no improvements were to come. Dr. A then told Bob he had to go back to work and that nothing could be done. Bob returned to work as required but got a second opinion from an unbiased Dr. B who then removed him from work. Dr. B suggested a complete meniscectomy but there would be a high probability that a complete knee replacement would be needed. Worker's comp along with Dr. A rejected Dr. B's analysis and recommendation. After several months and many other opinions a complete meniscectomy was allowed from worker's comp and Dr. B performed it on Bob. Then rated at 15% PPD As predicted, it did not help and a full knee replacement was needed and this is where the fun started. This is now approximately 18 months after injury.

Worker's comp denied that a knee replacement was needed. Bob decided to get an attorney to help with the headache and financial strain that this had been causing. To sum it up in short, it took 8-9 months going back and forth to get the knee replacement approved. This was then scheduled along with hearings for worker's comp. When the hearing approached the worker's comp attorney was in talks with Bobs attorney where worker's comp attorney conceded on all counts and admitted liability. With that being acknowledged, an agreement was written up and sent to worker's comp attorney to sign, surgery had been canceled since the payee of the surgery would change. Now the worker's comp attorney will not sign the agreement and states that there are other attorneys (WERC and DOC) that want other issues that are entirely separate from worker's comp to be settled prior to the worker's comp settlement to be finished. These are related to the injury but each are supposed to be resolved independently. Even Bobs attorney states that he has no experience in WERC or DOC claims because worker's comp claims are to be finished prior to those claims (It's my interpretation that WERC and DOC claims are dependent on the outcome of worker's comp. Processing them in reverse would have an adverse affect on Bob and what he is entitled to). Now they have to wait for the WERC/DOC/Work Comp attorneys to meet and make a decision (my first inclination on this is they're looking for the most cost effective way for them rather than proper procedure and to bully him)

This is a brief and basic run down of things. There have been a number of other things that have come up. Because the delays and neglect for a speedy resolution, Bob has had to pay monthly insurance premiums out of pocket for the last half year which is more than 4x my rent alone.

Now it's my belief that his attorney isn't being aggressive enough in pursuing the worker's comp issue to get it resolved prior to the other two claims. He get'll get paid either way and more if the three attorneys bully Bob into an agreement.

Any ideas or suggestions on the following?....
Ways to get the ball moving faster on the worker's comp.

Proving that worker's comp is being negligent or purposely making this process as slow as possible (approximately 3 years now).

Ways to get rid of an attorney, this is a contract with a set % rate. Professional misconduct? Or can that easily be defended against by blatant stupidity.

Other things to look for, ask about and to be definitively indicated in any agreement? Just anything in general I guess.

 

[hawthorne]

I have little Worker's Comp experience but I can say a few things regarding this situation.

First of all, Bob should be keeping records of EVERYTHING. If he suspects his attorney is not seeing to his best interests, he needs to have evidence to show that. The attorney is answerable to the state bar association for his conduct, and can even be brought to trial for breach of contract. But only if Bob has been documenting everything and can prove the case. With a new attorney of course.

Second, my basic understanding of Worker's Comp is that it should be resolved first and that if they are still hedging, demand that the issue be resolved or have your attorney file a motion for summary judgement. A judge can decide things for Bob but it may impact negotiations because this is really pressing the issue. In the motion, show evidence that the attorneys are deliberately delaying, if possible. However, be aware, they judge very well can deny the motion when means he will have to wait it out. And yes, it can take up to 3 years or even longer. I had a court case that took 8 years to come to trial. Sometimes it just takes a long time. Sometimes they use every legal trick in the book to delay things. And yeah, they can do that. This isn't a criminal proceeding so there is no right to a speedy trial.

I would suggest to Bob that he get the surgery scheduled again and have worker's compensation pay for it if they are still willing, and have them reduce the expected settlement by the amount of the surgery. Make sure Bob get copies of the bills and all the relevant dollar amounts

 

[jjmanfdl]

Everything is documented including bills and I've been sifting through this majority of the night. I don't think the attorney is being intentionally malicious but rather looking at time invested vs. return which can be perceived that way. That's what I do for work and I'd look at it exactly that way which is nearly impossible to prove unless it's spelled right out.

Surgery and hearing is rescheduled but it's 3 months later than it would have been initially. That's now 3 extra months of insurance premiums that need to be paid and a 3 months longer wait to have a surgery.

Yes, litigations do take time to complete but at some point enough is enough. I've been trying to research bad faith and unfair claim settlements but a lot of those laws/acts are fairly vague on the inclusion of worker's comp.

As for the settlement, numbers are not thrown out as a whole. Medical bills get paid by worker's comp and the only actual numbers that are discussed are the disability value/pay out and wages that are entitled back dated to the injury.

The reason that this is an issue is because the two other claims (hazardous duty pay and duty disability) depend on what the worker's comp settlement is. Hazardous duty claim (lawyer 2) for reimbursement is directly affected by when and what wasn't covered by worker's comp. Duty disability (lawyer 3) payments are different pending when claim is started. If duty disability claim is started prior to worker's comp claim being settled then the income is offset by the income from worker's comp. If duty disability claim is started after worker's comp claim is settled then the income from worker's comp isn't factored into the wages from duty disability. With that being said, duty disability has not been filed for nor has a claim been initiated so why is the attorney meeting with worker's comp and hazardous duty attorney? No beneficial reason on Bobs end that I can see.

Essentially, worker's comp claim needs to be settled so bob can be put back onto hazardous duty pay, on the books, and have insurance covered. Once he is back on the books, then duty disability can be claimed so compensation can be computed based on what capacity he returns to work. Right now it looks like the three are collaborating to devise a way which is most beneficial to them; they know the longer this takes the more financial strain it puts on someone.

/shrug... if that even makes sense... Too tired to think at this point.

 

[Wizman61]

I was in an accident some 14 yrs ago, the other guy's fault. His insurance company started calling me right away to talk me into a settlement. My back was pretty messed up for a while and I needed PT. I went and talked to a lawyer I had dealt with on a small matter before. He agreed to take on my case on a percentage basis, meaning the more he got for me the more he made. He also made the statement to me, after I had gotten all the paperwork and everything he needed to get me a suitable settlement together for him, that there were seminars for lawyers on how to beat Allstate. I should've known right then to get another lawyer.
After 3 years with no indication of a settlement in sight he finally admitted to me that he had dropped the ball and let the statute of limitations run out on suing this guy who had hit me. Then he told me he would pay me $5000 out of his own pocket since he had screwed up. I was looking to get $10,000 initially but figured after 3 yrs $5k would be ok. Two weeks go by and I don't hear from this lawyer and he never returned my calls, called him twice in the third week.
I was really pissed by now so I started calling a few lawyers around town for advice on where to go next. Turned out there is a local bar association that will point you in the right direction. After talking to one lawyer and telling him my case, without mentioning the jerk's name that had cost me $10k, he gave me the name of the head of the local bar association and I talked with him. Naturally, they don't want to take action against one of thheir own members, but he did refer me to a fellow lawyer he knew from the county just north of us that had worked cases like this in the past.
I went to talk to this guy once and took all the paperwork I had given the first lawyer that screwed up my case. He looked it over and told me he would be back in touch with me soon. He called me within a week saying he had talked on the phone with the other lawyer and after looking over my medical bills and time off work and such that he felt I should get $10k from my first lawyer, not the $5k he had offered. This guy said he would draft a letter and send it to the schmuck. Within another week he called me and said he had a check for me and that I needed to sign some papers first. I had to agree to not pursue any further action against the first lawyer. He must have threatened to take him to court for more if he balked at $10k. In two weeks, with just a phone call and a letter, he got me my $10k minus his cut of $2k. I was still happy, especially since I had received $3k more than I was expecting.
If I were you I would at least talk to someone else about this, maybe even your State's Attorney General's office.