We represented a registered nurse who unfortunately found out what happens when South Carolina workers’ comp doesn't work for the employee. Luckily, she had us to help.
Our client Lynn got the shock of her life when the workers’ compensation insurance company brutally denied a medically necessary surgery just to save a buck in her case.
We won that battle. She got the surgery—then we won the war by getting her a good workers’ compensation settlement. Our strategic efforts resulted in a settlement to give her the solid financial footing she needs, as we proved she could qualify for permanent and total disability benefits under South Carolina workers’ comp law.
Lynn and How She Got Hurt at Work
Lynn is one of the kindest, most hardworking clients I've ever had. She devoted her life to the service of others. Before her career as a nurse, she served in the Peace Corp in Africa, helping villagers build fish ponds. When she got hurt, she'd served as a registered nurse for over 20 years.
While helping a patient into a wheelchair with an assistant, the patient’s legs gave way, causing Lynn and the assistant to support his entire weight unexpectedly. Lynn immediately felt a pop in her low back, followed by agony coursing down her low back, down her right leg, and through her big toe.
As bad as it felt right then, it only got worse. This was the beginning of a four-year, three-surgery medical struggle that created a highly-complex, high-stakes workers’ compensation case. Lynn never saw it coming.
Why Lynn Hired Us
Like many seriously hurt employees who become our clients, Lynn was unsure if she needed an attorney. She even resisted hiring one. But as her injuries kept worrying her, another thought nagged her: Can I really trust the insurance company to do what's in my best interest?
Lynn found me in a Google search. She loved how I sent her free info with no obligation to hire me, including a copy of my book on South Carolina workers’ comp cases. It meant the world to her that she could meet with me face to face in our free strategy session. Other firms tried to push her off on an “intake specialist,” or lower-level attorney. She wanted to meet with the attorney she picked, who'd actually work on her case. That's what she got in me.
She ended up needing us more than she thought, and her case was harder than it should have been, because the insurance company tried mightily to cheat her out of an operation she needed.
Lynn's Medical Ordeal and the Workers’ Comp Insurance Company’s Shocking Denial of Medical Care
It turns out Lynn sustained an L4-5 disk bulge, requiring a right L4-5 discectomy. The insurance company approved that pretty fast. But then the disk re-ruptured, requiring a far more serious operation, an L4-5 transforaminal lumbar interbody fusion with cage and bone graft, plus a redone laminectomy.
To our utter shock, the insurance company adjuster refused to approve the second operation. It left Lynn in agony, horrified, and afraid. It required me to exercise restraint and professionalism in urging the adjuster to do the right thing as Lynn suffered horribly. Using every ounce of composure and focus I had, I got the adjuster to agree to a second opinion. Even though the adjuster got to pick the doctor, Lynn’s honesty and her dire condition left me confident another neurosurgeon would agree she needed the operation. I prepared her to make the most compelling case to the second opinion neurosurgeon about the truth of her condition.
My confidence, and the truth, paid off here. To hear Lynn tell it, the second opinion neurosurgeon basically walked in the room and said “I read your scans and your medical records. I don't know why you're here, you need surgery.”
Faced with this, the insurance company caved. The adjuster sent Lynn back to the first neurosurgeon to do the operation.
Ever strategizing, I used the insurance company's unjustified denial and delayed treatment to Lynn’s advantage. In the first neurosurgeon’s medical records, I found a detailed letter from him to the insurance company, reflecting his fear the delay could worsen her condition. I prepared a questionnaire for the doctor to answer, where he agreed the delay increased her pain and led to his recommendation for one of the most extreme treatments available for her injuries, a spinal cord stimulator.
Unfortunately, the second operation failed to bring relief to Lynn’s agony. Ultimately, her workers’ comp spinal injuries required a spinal cord stimulator. Basically, that's an implant that sends electronic pulses to the spinal cord to reduce the pain that narcotics and other treatments just can't touch.
Our Strategy to Get a Good South Carolina Workers’ Compensation Spinal Cord Stimulator Settlement
If you suffer a serious back injury, you might qualify for South Carolina workers’ compensation permanent and total disability benefits. Not to be confused with Social Security disability, getting these benefits doesn't mean you can never work again. But permanent and total disability benefits are some of the highest financial and medical benefits available for seriously hurt employees.
For a back injury, there are two ways to qualify for permanent and total disability workers’ compensation benefits in South Carolina. One way is to prove your impairment rating is over 50% for your back. Another way is to prove you satisfy the “two injury rule,” meaning you hurt two body parts and can't qualify for any other employment. We went for both.
The most critical evidence in these cases is medical evidence. You've got to know how to handle and present it in order to give yourself the best shot at these critical benefits.
For Lynn's case, I obtained two medical questionnaires. These are yes or no questions about the most vital medical issues in the case. I developed them based on meetings I had with the doctors.
One was from the treating neurosurgeon. To lock down the two-injury rule, it established he diagnosed her with lumbar radiculopathy, a spinal condition that affects the legs. It also established Lynn’s pain would distract her from an adequate performance of daily work activities, and she’d likely miss work three to four times a month as a result of pain. The doctor also stated her permanent restrictions would keep her from working as a registered nurse.
Lynn’s pain doctor, who oversaw her spinal cord stimulator, affirmed the injuries required the spinal stimulator. He also locked down the two-injury rule. Most important, it established profound work restrictions. Among other things, it revealed Lynn is limited to sitting work but needs to get up every 20 minutes, requiring 15-minute breaks about every 30 minutes during an 8-hour workday. He assessed the impact of pain on her life the same as the neurosurgeon, adding that her medication side effects would limit her work effectiveness. He also provided the nature of potential future medical care, including epidurals, facet shots, and trigger point injections for flare-ups.
We had a solid argument Lynn could achieve a workers’ compensation disability rating of losing over 50% impairment to the back. The neurosurgeon gave her a lumbar spine impairment rating of 28%. Combining that rating with her restrictions and all the other medical evidence could justify a Workers’ Compensation Commissioner determining she'd lost over 50% of her back.
Because we alleged Lynn was entitled to permanent and total disability benefits, South Carolina workers’ compensation law required us to go to mediation. That legal proceeding brought her case to a fast, satisfying close.
Lynn’s Ordeal Ends With a Satisfying Settlement
Mediation involves hiring an experienced lawyer who isn't involved in the case to help the parties reach a settlement. My philosophy on mediation is, I lay out all our cards to give my clients the best shot at a settlement. That means sending the mediator a detailed summary of our case. Because I have nothing to hide and I want the insurance company to understand the full value of settling the case, I don't hide the ball. I send a copy of the letter to the insurance company too.
Well before mediation, we developed a strategy to get a solid settlement, and I made sure Lynn understood the best- and worst-case scenarios so she could make a good legal decision for herself.
We ended the day with a successful settlement reflecting her eligibility for South Carolina permanent and total disability benefits. Lynn agreed to a clincher settlement where she received $330,000.
Lessons Learned From Lynn’s Settlement
More than any other case I've had, this one showed me no matter how good you are, no matter how hard you work, no matter how severely hurt you are, you just can't count on the insurance company to do the right thing. In fact, the worse you're hurt, the more likely you can be to fall prey to their efforts to cheat you.
Pure honesty and an experienced lawyer who knows how to stand up for you and strategize your case can be the difference between justice and injustice.
My team and I are incredibly proud we got to play a role in standing up for a great lady and ending a long, hard case with a gratifying settlement to give Lynn and her family meaningful financial support as she navigates her future.
