Our team helped a BMW contractor get a good workers' compensation settlement in a case that shows sometimes even the professionals have no idea where a case will go. I took on Arnold's case, thinking he might have a pretty serious brain injury. Luckily, he didn't.
When his head got better, Arnold's case turned into a double shoulder injury case. When I realized the case could qualify for South Carolina workers' compensation permanent and total disability, we were able to negotiate a higher settlement.
How Arnold's Workers' Compensation Case Got Started
Arnold got hurt because of an ice storm. He worked as a router at the BMW plant, driving BMWs off assembly lines to another location at the plant.
On the day he got hurt at work, Arnold got dropped off to pick up a car for delivery to another part of the BMW plant. As he took his first step out of the vehicle, he slipped on black ice with both feet shooting out from under him, slamming his head into the footboard, bouncing off and landing in the parking lot on both elbows, jamming his shoulders straight up, causing pain to shoot from his shoulders up to his neck.
Initially, Arnold suffered a serious concussion with major side effects, including massive migraine-like headaches every day and frightening dizzy spells. Doctors ordered him not to drive for nearly three months. He spent six months under a neurologist's care, who prescribed several medications and vestibular therapy to restore Arnold's balance and battle dizziness.
Two New Problems Emerge for Arnold
As his head got better, Arnold noticed awful pain in both shoulders. We figured that problem was easily solved with a referral to an orthopedist. We were wrong.
Arnold's second problem was the workers' compensation insurance company. The insurance company denied the shoulder injuries. This is yet another example of the lengths a workers' compensation insurance company will go to save money at the expense of an injured worker. The insurance company claimed Arnold wasn't hurt because he didn't say anything about his shoulders immediately. Of course, this defies common sense. When you've got a migraine every day and suffer sickening dizzy spells, you're focused on the agony in your head, and you're not moving around much to detect shoulder pain. It also defied the medical records, as they showed he started mentioning the pain to physical therapists and doctors within a couple of months of the injury.
Here's why the insurance company really fought it. It did approve MRIs of both shoulders. Those MRIs revealed full thickness rotator cuff tears plus damage to the long head biceps tendon in both shoulders. I've handled these cases long enough to know there's likely one way to fix that: surgery. The insurance company just didn't want to pay.
I filed for a hearing to get the insurance company ordered to send Arnold to an orthopedist.
We Reach an Early Settlement That Benefits Arnold
The insurance company had a sharp lawyer. He saw the handwriting on the wall: Arnold's serious injuries to multiple body parts affecting his ability to work as a physical laborer could result in an award of some of the highest workers' compensation benefits available in South Carolina. Those benefits are called workers' compensation permanent and total disability.
Before a hearing date got set, he asked if we might be interested in mediation to attempt to settle the case. While I wanted Arnold to get the orthopedist referral, I remembered who his case is about, him. The idea of being freed from the workers' compensation insurance company controlling his treatment was attractive to him.
We agreed to mediation. A critical part of mediation for me is the mediator summary letter pointing out the major parts of the case. I send it to the insurance company so they can see the strength of our arguments, which I'm convinced helps me get a better result than hiding my cards.
I organized our mediation argument around a central theme: this is a permanent and total disability case. Arnold suffered a concussion with disturbing, long term side effects that masked massive rotator cuff tears in both shoulders.
With Arnold's help, I pointed out the nagging aftereffects from his concussion. As for his shoulders, we highlighted how it hurt to perform the most basic movements, like reaching overhead, pushing and pulling, and basic acts of everyday living, like bathing and dressing. It also kept him from his lifelong hobbies of shooting pool and weightlifting.
The mediator guided both sides to a successful settlement that gave Arnold the financial and medical freedom he wanted. The insurance company paid $95,000. This gives Arnold a hefty financial cushion while he figures out his next career move. Best of all, for him, he has total freedom to pick and choose his doctors without fearing insurance company delays and denials.
Lessons Learned
This case reminded me that sometimes I just never know where a workers' comp case will go. Other important points:
- Injuries to multiple body parts can dramatically increase a workers' compensation settlement in South Carolina in the right case.
- South Carolina workers' compensation insurance companies will sometimes stop at nothing to deny legitimate claims. That needs to be fought by experienced South Carolina workers' compensation lawyers who know the system and know how to organize a case to get an injured worker the help they need.
- I can never lose sight of who a case is about: my client, the boss. It's their body and their life. While I personally would have fought to get the shoulder treatment, it was better for Arnold to get out from under the stress and strain of the workers' comp system. I'm thankful for the role I played in giving him the financial freedom to do that.
