Part 1 of a 2 part story looking into a real life regular “Joe” Workers Compensation saga.
Let's Voice ...
Workers Compensation Permanent and Stationary.
Case Study:
WC: Is it really worth it?
Joe injured his back while working at a company that was self-insured. The company, according to the Director of Health and Safety, stated to Joe that the company has never paid for any of its employees to have back surgery and tosses Joe into the WC system. Joe, a senior member of the management team, learns that the company was required to place a $1M bond in his name as long as the case remains open.
After over a year and a half of dealing with doctors, lawyers, testing, more doctors and more testing, the company finally agreed to pay for Joe’s surgery which resulted in his lower back being fused at the L4, L5 and S1 vertebrate. While recovering from the surgery and receiving disability benefits, Joe was laid off. Joe healed from the surgery and was subsequently deemed by his doctors to be Permanent and Stationary; however, was told to get “Future Medical.” This was due to that type of spinal fusion in all probability will result in additional injuries to the surrounding areas in the future due to the nature of the fusion. Joe sought out an attorney and the case went before the judge.
For this article, let’s assume that a monetary settlement is reached, a permanent and stationary disability rating was given; say 40%, and the presiding judge orders “Future Medical” which is defined as, “On-going right to medical treatment for a work-related injury” with no additional stipulations. Time passes and Joe finds suitable employment in his particular field of expertise and is doing his best to stay fit, active, and living life as best he can given his injury and the resulting permanent injury (Chronic back pain and Sciatica.)
Top Workers Compensation Statistics:
12% of settlements were less than $2,000
55% of settlements fell between $2,000 and $20,000
13% of settlements were between $2,001 and $40,000
12% of settlements fell between $40,001 and $60,000
8% of settlements were between $60,000 and $100,000
Almost 20 years passes by and though Joe has been able to manage his pain level with over the counter medications. As predicted, further degeneration of the disk above the fusion, inflammation in the surrounding disk areas, SI Joint inflammation and other related pain causes Joe to once again seek the council of his original surgeon. The doctor attempts to reach the WC insurance company that handles Joe’s case but to no avail. After multiple attempts over several months, Joe’s doctor decide to simply use Joe’s regular insurance to treat him. At this point in time, surgery is not recommended and Joe is sent to see a Pain Management specialist for treatment.
Over time, Joe’s pain gets so bad that he begins losing much of his sleep, sometimes only getting 3-4 hours at night at best. His work and his personal life now suffers and it gets to the point that he can no longer hold down his leadership position at work. Joe has insurance to help with the financial burden of treatment, but has a very high deductible.
More Workers Compensation Statistics:
4.9 million workers compensation claims made each year by both private and government employees.
The typical workers comp claim is around $41,000.
The average cost of a workers compensation claim for sprains is $34,409.
Falls/Slips claims costs averaged $47,681 per claim.
Workers' compensation costs to employers total $100.2 billion as of 2021.
On his own, Joe proceeds to spend the next three (3) years trying to get hold of the insurance company and has documented ten (10) full pages of calls, emails, broken promises, and transfers from one agent to the next without success. He now fully understands the term, “Ghosting.” Finally, an attorney close to Joe makes a call to the insurance company and miraculously the WC insurance company’s supervisor calls them back. Now, Joe is back in the WC system and on his way to being treated in accordance with the court ordered, “Future Medical.”
Or is he ...
Watch for Part 2.