Make no bones about it, this is the story of a case that even doctors agreed was unusual, but because it involved extremely serious injuries to our client, we worked hard to figure it out and persuade the insurance company to give a great settlement.
Scott’s unusual work injury case started long before he hired me. Scott decided to go it alone after he got hurt at work.
While pushing a 550-pound cart, his right foot got caught in a drain grate, breaking his right ankle with resulting blood clots. When he got admitted to the hospital, he noted he heard a ripping in his calf that later swelled. Over the next two days, pain and swelling worsened.
Finally, he reported to the hospital two days after the injury. While an HR rep urged him to work, Scott realized it hurt too much. Soon after, he reported to Spartanburg Regional, where alarmed doctors admitted him for a life-threatening pulmonary embolism—a blot clot that’s broken off and worked its way up from his leg into his lungs.
Doctors eventually diagnosed him with:
- Acute pulmonary embolism
- Acute, large, right leg deep vein thrombosis, the medical term for a blood clot
- Acute post-thrombotic syndrome
Due to the severity of his condition, Scott required a six-day hospital stay.
Disputing the Need for Treatment
Because most workers’ comp doctors deal with broken bones or torn joints, workers’ comp didn’t really know what to do with him. Still, despite the complexity of his case, Scott really wanted to go it alone. I met him a couple of times before he hired me. He really didn’t want a fight, but the insurance company finally gave him no choice.
The adjuster told him she was shutting his case down, telling Scott his doctor said he didn’t need any more treatment. Scott knew that was wrong. His doctor told him so.
He took action fast when he needed to—he hired me, and we went to work immediately, requesting a hearing before the South Carolina Workers’ Compensation Commission to get him the medical treatment he needed.
I took it further. I met with his vascular surgeon, who oversaw the blood clot treatment. After that meeting, I secured a questionnaire from him that made clear in several “yes or no” questions and answers that Scott needed more treatment. Specifically, he needed pain management for chronic pain caused by his work accident.
Once the insurance company realized Scott’s treating doctor made it clear he needed additional treatment, they gave him the treatment he needed.
Reaching Maximum Medical Improvement
It was almost a year before pain management released Scott at maximum medical improvement.
That’s where our hard work really began.
One of the most important things a workers’ compensation attorney does is to maximize the settlement’s financial compensation for his client. But because this was not your typical injury, no one seemed sure how to arrive at a diagnosis that could give a proper impairment rating, a basic element of a workers’ compensation settlement. Even the doctors didn’t know what to do with it. While the pain management doctor worked at an orthopedist’s office, the injuries he was accustomed to handling included fractures, torn meniscus and ACLs in the knee, torn shoulder rotator cuffs, and spinal disk herniations and injuries. He needed help arriving at the most critical medical evidence in the case: Scott’s permanent impairment rating. The doctor got that from an unexpected source: me.
Originally, the doctor gave Scott a 9% rating. Considering Scott’s long-term pain and extensive limitations, I knew this was low. So I pulled out the book itself: the manual used by doctors to arrive at ratings, called the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition. I figured out the rating could be increased if Scott had a prior blood clot before his work injury. As it turns out, he had.
I went to the vascular surgeon to confirm this, as his records referred to a prior blood clot. After that, I gave this information to the pain management doctor. As a result of that medical evidence and the rules stated in the manual, he more than doubled Scott’s rating to 20%. The good doctor also pointed out that Scott was entitled to an additional 5% due to the anticoagulation (blood clotting) medication he took. So, Scott ended up with a 25% rating.
My work continued to prove the extent of Scott’s injuries. I obtained a vocational evaluation from an expert who reported Scott’s chronic pain and lack of computer skills prevented him from working a desk job—the only work his doctors approved.
Based on all of this, the insurance company offered more money than Scott could get if a commissioner found him totally and permanently disabled. After some considerable thought, Scott decided it was in his best interest to take it. He was pleased and relieved.
In the end, I am awfully glad I took on a tough, challenging case and did the hard work to help a good man who didn’t know what to do and almost lost his whole case before he came to me.