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Long Fight Refusing Surgery Costs Insurance Company

Gerald’s case shows how one workers’ compensation insurance company’s long fight against providing medical care ended up costing the insurance company, because we never gave up on him. 

Gerald worked in a warehouse. While helping an employee move 2 giant, heavy trash cans up some stairs with a hand-truck,  the co-worker unexpectedly yanked the hand-truck, jerking it up as Gerald tried to pull it lose, causing his right knee to slam into 2 steps. 

Insurance Companies Doctors Refused to Recommend Surgery

Gerald treated faithfully with the workers’ comp doctors for months.  But his knee just didn’t get better.  The injury left him with severe right knee pain, made worse with squatting, kneeling, twisting, and turning. The insurance company doctors refused to recommend surgery, despite the fact everything they tried didn’t work.  

Worst, the defense attacked Gerald’s character – they claimed he malingered (faked how bad his injury was).  Desperate for treatment, Gerald had no choice but to take matters in his own hands.  Using his personal health insurance, he got an independent opinion from a local orthopedist. An MRI by that doctor showed a lateral meniscus and medial meniscus tear. The doctor concluded Gerald needed an operation. We presented this evidence to the insurance company. Even then, we offered a cash settlement allowing Gerald to pay for the operation that might save the insurance company money.  The company refused.   

We prepared for a contested hearing. The defense took the independent orthopedist’s deposition.  A kind, gentle soul, the doctor finally had enough of repeated questions why he recommended the surgery when the insurance company doctors didn’t. He bluntly stated, “Because they’re wrong.”

Insurance Company Finally Accept Surgery Cost

After this convincing testimony and our presentation of Gerald’s extensive medical treatment showing nothing else worked, the insurance company finally caved, agreeing to pay for the operation and related treatment.   

We made sure the insurance company paid every penny of Gerald’s bills. After Gerald got done treating, we agreed to settle for an amount almost as much as our original offer.  In the end, the insurance company’s denials got overcome by our determination to fight a worthwhile battle over a long time, ending with the company paying more for medical treatment and a higher cash settlement to Gerald.  While it wasn’t an enormous amount of money, we were proud to stand up for what was right for Gerald, getting him medical care and compensation he needed.   

Rob Usry
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Rob is a South Carolina personal injury and criminal defense lawyer.

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