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Recent Success Cases at the Workers’ Compensation Commission
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Thorough and ongoing claim investigations
Prompt and accurate compensability decisions
Skilled legal representation in all stages of workers’ compensation claim litigation
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IWIF’s Legal and Claims professionals work hand-in-hand to litigate numerous cases in front of the Maryland Workers’ Compensation Commission (WCC). IWIF’s thorough case preparation and defense help to keep premium costs fair by limiting unnecessary and excessive awards/claim payments. Here a few summaries of recent 2008 hearing cases where the WCC ruled in favor of the policyholder and IWIF.
Case of No Assault by the Boss
In this contested accidental injury claim, the Claimant alleged that he was physically accosted by his employer, thrown to the ground, injuring the claimants arm. An Independent Medical Examination (IME) doctor did causally relate Claimant’s injuries to the occurrence, however the employer and a witness testified that the employer merely grabbed the Claimant’s shirt to calm him down and denied any physical assault. The claim was disallowed. Congratulations to the IWIF Claims, Nurse and Attorney team for successfully defending this claim.
Case of the Animal Droppings Not Causing Asthma
IWIF’s Claims and Legal professionals collaborated to convince the Commission that the Claimant did not sustain an occupational disease of asthmatic bronchitis as a result of working in a courthouse. Claimant testified that she worked in an area where there was mildew, pigeon and rat droppings. She began to develop hoarseness, cough and wheezing. An IME was submitted in our defense. The Commission specifically found that: “there is insufficient evidence to show that asthmatic bronchitis… is inherent to the nature of the claimant’s job as a circuit court clerk” and disallowed the claim.
Case of the Claimant “Not Giving His All for Recovery”
The Claimant was seeking resumption of Temporary Total (TT) compensation since it was terminated in May, and a referral to pain management. Our defense pointed out that medical and vocational rehabilitation was stopped after reports indicated that the Claimant was self-limiting and was giving a sub-maximal effort. Both the TT and pain management were denied by the Commission. Great job by our IWIF Claims and Legal team in defending against this claim.
Case of the questionable “Hot Tub” installation injury
IWIF’s Claims and Legal staff teamed up with the employer and their witnesses to defeat this claim for accidental injury. The Claimant alleged that he was helping to move a large hot tub in a backyard, lost his footing and tripped near a bush, injuring his back. He informed his employer the next day that he was going to the hospital to get checked out. One Employer witness testified that he was one of seven men carrying the hot tub, and at no time did he observe the claimant lose his footing, nor was he carrying it when they went over the bushes. A second witness also testified that he did observe the claimant trip over a bush, and furthermore, the claimant said nothing about being injured during the drive back from the delivery. This is a great example of the employer providing information and witnesses to help defend against this claim.
Case of the “High and Hazy” Trash Truck Worker
IWIF’s Claims adjuster and attorney worked together to get the Commission to see through the haze in this claim in which there was evidence that the Claimant was under the influence of marijuana at the time of his injury. The Claimant, a sanitary engineer, was riding on the back of a trash truck when he alleged that it ran over a speed bump and he fell off. The claimant alleged that he last smoked marijuana 2 days before the accident and was fully alert at the time of the accident. Our expert report indicated that Claimant had 5 times the minimal concentration of cannabis in his system and that it could have contributed to the accident. While most difficult to prove that intoxication was the sole cause, our team was successful in convincing the Commission that intoxication was the primary cause, thus barring claimant from anything except payment of medical bills.
Case of No Physical Contact with the Prison Inmates
This was a claim filed alleging an occupational disease from contracting Methicillin-resistant Staph Aureus (MRSA). The Claimant, a correctional officer, alleged that she contracted MRSA by coming into contact with inmates. Our defense centered on the fact that claimant was more of an administrator who did not really come into physical contact with inmates. This defense was supported with an IME. The Commission found that Claimant did not sustain an occupational disease and disallowed the claim. IWIF’s Claims and Legal professionals worked together to defend against this claim.
Case of Not Seeing the Stop Sign Excuse
IWIF’s Legal and Claims experts teamed up in this claim to successfully defend the issues of causal relationship and temporary total disability from April to the present and continuing. The Claimant initially injured her eyes, had extensive treatment following an infection, and was eventually released by her physician to return to work and start to drive. While driving her son to school one day, the claimant ran a stop sign and hit a house, sustaining severe injuries to her foot, ribs, chest and back; all of which she contended were a result of her original eye injuries which caused her sensitivity to the sun and inability to see the stop sign. The Commission found that the injuries from the car accident were not related to the original eye injury and denied the TT claim.
Case of the Unlucky Horseshoe
The claimant was seeking additional TT from June to the present and continuing in this claim in which she testified that she cannot stand or sit for long periods, and has constant pain, numbness and tingling. She also claimed to spend most of her days in bed. She constantly grimaced and leaned over throughout the commission hearing. An investigator was called upon to show videotaped surveillance footage of the claimant out and about, contrary to her allegations and appearance at the hearing, even showing her at a horseshoe tournament at the fire hall where she had worked, but had denied going to in recent months. Medical evidence was also introduced to show no difference in her symptoms since 2002 and recent normal diagnostic tests. Congratulations to the IWIF Claims and Legal team for convincing the Commission to deny the requested TTD compensation.
Important Employer’s Tip: Remember, prompt and thorough investigation of the claim starts with you. Report injuries immediately to IWIF and use IWIF’s accident investigation forms to document the event. The more information IWIF has to prepare for a possible hearing, the stronger our case. Please work with your claims adjuster by staying involved throughout the claims process.
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