Jane hurt her neck and right shoulder lifting a heavy box at a kitchen where she worked as a grill cook. When she came to see me, she revealed a single, driving fear brought her to us. I wrote it down on her intake sheet: “Don’t let the insurance company take advantage of me.”
Her fear was well-founded. I am happy to report we helped her get the treatment she needed after the insurance company denied it. Best of all, she ultimately reached a settlement that achieved her end goals of financial stability and taking her healthcare out of the workers’ compensation system.
You could say we earned this settlement despite the absence of a critical factor from some bigger workers’ comp settlements: high medical impairment ratings. Because we didn’t have that, our strategy focused on the permanent work restrictions revealed by a functional capacity evaluation, plus a vocational evaluation I obtained to show her injuries left her unemployable due to her unique skillset and background.
Jane’s Background and Job Skills
One of the most important things any lawyer ever does is see their client as a unique person. That proved invaluable in this case. To help Jane obtain a settlement reflecting a potential permanent and total disability award from workers’ compensation, I had to fight for who she is.
Jane’s life's work has involved heavy physical activity. When she got hurt, she was a grill cook.
Jane’s Injuries and Impact on Her as a Person and Employee
Jane’s work accident seriously injured her right shoulder and neck. She eventually required an extensive shoulder operation, including a repair to her torn rotator cuff. She also suffered serious spinal injuries in her cervical spine, located in her neck. She got diagnosed with cervical disk herniation at C5-6 and C6-7, which caused cervical radiculopathy—intense pain and weakness down her arms.
Unfortunately, the extent of her injury was just too much for medical science to fix. Nearly two years of treatment revealed she suffered a complex injury that was hard for specialists to unravel due to the complex relationship between her injured shoulder and neck. Even now, hounding pain and weakness just doesn’t go away for Jane.
As a strong, determined woman and worker, it was hard to see her suffer through this. It was especially hard to see her realize after some emotional, tearful treatment sessions, voicing her frustration over constant pain, that it wouldn’t get a whole lot better. I made sure we protected her in the end.
Treatment Denied, But Not for Long
In a shocking turn for Jane, the insurance company inexplicably denied her physical therapy for her wounded neck. It didn’t surprise me because I’ve done this long enough to know the insurance company can cut you off at the knees without a moment’s notice. Luckily, I know how to handle it. I requested a hearing before a workers’ compensation commissioner to order the treatment.
It worked. Before the hearing took place, opposing counsel announced he’d secured the insurance company’s agreement to provide the treatment.
Critical Numbers for a Serious Workers’ Compensation Settlement Don’t Always Add Up
In most workers’ compensation cases, one of the most important numbers is the permanent impairment rating given by the doctor. Jane’s rating just didn’t reflect the impact these injuries took on her life. She got ratings of 7% to her cervical spine [neck] and 15% to her right shoulder.
I knew that wouldn’t drive the settlement Jane should get. I also knew what would.
Doctors sent her for a functional capacity evaluation to determine her permanent work restrictions. This became the driving factor for her settlement. The FCE’s major conclusions helped form our strategy:
- She gave sincere effort.
- Despite that effort, she could not meet the physical demand requirements of her job.
- She had severe restrictions. She could only lift or carry up to 15 pounds. She couldn’t climb stairs or ladders.
This was only a start. I knew the Commission would need more evidence before we could justify an argument for the highest benefits of South Carolina Workers’ Compensation, permanent and total disability. She needed a vocational evaluation to prove what, if any, work she could do with these limitations. It required me to go the extra mile in work and expense, but I was happy to do it.
A Vocational Evaluation Can Tip the Balance for Higher Benefits Under South Carolina Workers’ Compensation
A vocational evaluation is done by an expert called a vocational evaluator. He reviews your medical records and employment history, plus tests you for basic skills to arrive at a conclusion on what type of work you can qualify for with your permanent work restrictions.
Again, this formed part of my strategy to take into account who Jane is, as this evaluation focused intensely on her unique job and intellectual skill set.
The evaluation revealed Jane lacked basic skills to make her employable outside the physically-intensive work she’d done her whole life. She reads and does math on an elementary school level. She has no computer skills.
The evaluator concluded she’s totally disabled, meaning there are no jobs out there for her skills with her limitations.
This formed the backbone of our strategy for a settlement based on eligibility for permanent and total disability.
Reaching the Goal
When you have a case for permanent and total disability in South Carolina Workers’ Compensation, it has to be mediated. At a mediation, an experienced comp lawyer who’s not on either side helps both sides reach a settlement.
Under the strength of or vocational evaluation that proved Jane’s permanent restrictions left her virtually unemployable, the relatively low impairment ratings were no longer a factor.
We were able to secure a settlement that satisfied Jane’s financial needs and allowed her to take control of her own healthcare instead of having to go through the workers’ compensation system.
She was pleased with the result, and it was clear to me she felt protected by us. That’s the most important thing, and it makes me awful proud that I get to stand up and protect someone who was rightfully fearful of an insurance company that cares nothing for her.