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A Long Battle for Highly Expensive Workers’ Comp Benefits Ends in Victory

Jane found me online when she sustained a shoulder injury she suspected was a whole lot worse. She was right, but I don’t think either of us expected the legal battle that followed—or the end result.

How She Got Hurt

Jane worked as a supervisor for a huge package delivery service in Gaffney. Part of her job required her to open tractor-trailer cargo doors—the massive doors on the back of the truck. One day as she yanked one up, it stopped short, violently jerking her neck and left shoulder through her arm.

Jane found herself in immediate, intense agony like she’d never known. While her employer’s insurance company sent her to the doctor, even the powerful narcotic painkillers he gave her—like Norco 7.5 and Percocet 7.5—didn't help. Neither did an epidural shot in her spine—it actually made her way worse.

Jane Hires Me and Things Move Fast

Jane hired me because her lack of effective medical treatment made her alarmed that the insurance company wouldn’t look after her at all. She needed protection and someone to speak up for her because the pain made it nearly impossible for her to fight for herself. Like many people who come to me, she just needed peace of mind.

Not long after I got hired, she finally got referred to a neurosurgeon. He wasted little time in diagnosing her with an extremely severe injury, a large disc herniation with spinal cord compression in her neck at spinal disc C6-7. That also caused cervical radiculopathy, a disturbingly painful condition causing scorching pain plus numbness, tingling, and weakness through her entire left arm into her left hand.

Within two weeks, he scheduled a serious operation to fix it: an anterior cervical spinal discectomy with decompression of the spinal cord and its nerve roots, fusing her spine together with a cage and plates. Unfortunately, like many spinal work injury victims, Jane’s problems didn’t end here.

New Symptoms and an Unexpected Godsend Create a Legal Battle

While successful in reducing her symptoms, the operation didn’t eliminate them. The neurosurgeon referred Jane to pain management. Along the way, Jane developed a shocking new symptom: uncontrollable spasms in her left face. Because she couldn’t work and remained in agony, she also became depressed.

Jane did find a stoke of luck in her pain management doctor. He’s a compassionate, highly skilled professional who’s not a pill pusher. He helped push the insurance company to get her a referral to determine the cause of her facial spasms.

The insurance company sent Jane to a neurologist, who shockingly diagnosed her with a potential case of multiple sclerosis. Because that was completely unrelated to her work case, the insurance company was no doubt thrilled. But the neurologist ordered a spinal tap to rule that out first.

Because this potential diagnosis seemed so drastic and unexpected with a huge impact on her case and her life, we asked for a second opinion from another neurologist. The insurance company fought against it. We actually had to request a hearing to get that done. Just before the hearing, the insurance company finally agreed to our second opinion. The second opinion neurologist concluded Jane’s facial spasms were caused by the stress, pain, and disability of her injury.

The insurance company stopped fighting on that, but another battle still loomed.

A Breakthrough for Jane’s Pain

Jane’s talented pain doctor found an excellent medication that made her pain livable. While it’s an opioid, it’s revolutionary because it has low side effects, which for Jane meant she didn’t feel like a drugged zombie. It helped her live her life as much as she could with her limitations. There was just one problem.

The insurance company thought it cost too much. As the case drew to a close, the insurance company scheduled a second opinion of its own with another pain doctor, who concluded Jane could take other medications. He also stated Jane’s medication was too expensive. We knew we’d have a battle over that. Before we could really fight it, it got much worse and we had to respond.

A False Negative Drug Test?

When you’re in opioid treatment, good pain management doctors give random urine drug screens. In the most unfortunate timing, Jane got hit with one right after she had run out of her prescription. Her drug test came out clean as a whistle for it. Once the insurance company got wind of that, we knew they’d try to use it to show she wasn’t taking it. Even worse, they’d use this “false negative” drug test to argue she was lying about the severity of her injuries.

We had to move fast to counteract it. There was no time to waste before the insurance company cast her in the worse possible light. So I got a hair strand drug test, which could show the medication in her system from BEFORE that false negative drug test. I had to find a drug testing facility that could actually test for this drug, since it’s not widely used. But I did. It came back with the result we needed—and expected.

Moving the Case to Settlement

We took steps to prepare the case to get the most benefits for Jane—total and permanent disability. A functional capacity evaluation ordered by the insurance company showed her profound limitations. Impairment ratings by her neurosurgeon and the pain management doctor’s office weren’t eye-poppingly high. But I investigated further, resulting in her pain management doctor completing a questionnaire I sent him that reflected the immensity of her pain essentially kept her from meaningful work.

I also sent her to a vocational expert for a vocational evaluation to see what type of work she could qualify for. That evaluation came back with the conclusion I expected from Jane’s symptoms: she was totally disabled.

Mediation Yields the Result Jane Needs

Because we alleged Jane was permanently and totally disabled, the law required us to go to mediation. We prepared a full brief for the mediator to help him push the insurance company to understand two things:

  1. Jane clearly qualified for permanent and total disability benefits.
  2. Her medication had to be part of the settlement.

We were able to reach a settlement giving Jane a nice financial recovery. But most importantly, the insurance company agreed to an unusual arrangement where they created a fund that will function like an insurance policy to pay for all Jane’s medical care related to her injury—including her medication they fought so hard against. Best of all, it’s designed to cover those needs for Jane’s life.

After a long, hard-fought ordeal, Jane is relieved and happy. It means all the world to me.

 

$830,242.82, including medical trust fund of $745,242.82

Rob Usry
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Rob is a Spartanburg personal injury lawyer. Rob also practices as a criminal defense attorney.