April 26, 2007 Workers’ Compensation Panel Learning. Influencing. Protecting.
WC Panel Participants • Gail Blevins – Workers’ Compensation Manager – CCBCC • Charlie BonDurant – Director of Claims & Litigation – CCBCC • Dr. Craig Brigham – OrthoCarolina • Andrew Ussery – Defense Counsel - McAngus Goudelock & Courie • Bob Bollinger – Plaintiff Counsel and Mediator – Bollinger & Piemonte Law Firm Learning. Influencing. Protecting.
What Impacts WC Costs? • Notice of Claim/Injury • Medical Treatment • Return To Work • Communication • Reintegration into the workplace • Legal Learning. Influencing. Protecting.
Claim Scenerio • Employee: Phillip Hurtts • Employer: XYZ Automotive Repairs • Date of Injury: 3-03-06 Learning. Influencing. Protecting.
Investigation Facts • 3/02/06 (Thursday) – Phillip describes stepping down from the sidewalk onto the parking lot, twisting his right knee and temporarily losing his balance. He did not fall, but experienced pain in his right knee, leg/hip, and low back. • 3/03/06 (Friday) – He called his Supervisor to advise that he was not feeling well and would not be in to work. • 3/06/06 (Monday) – He called his Supervisor to advise that he had developed some back pain over the weekend, went to the Emergency Room and was signed out of work until Wednesday. He was told to follow up with his family physician if his back pain did not improve. • 3/06/06 – The claim was called into the Insurance Company and an adjuster was assigned to the case for handling. He was directed to Med-4-U Care for evaluation. Based upon the information obtained as part of the investigation, Phillip’s claim was accepted on the NC Form 63 (Notice to Employee of Payment Without Prejudice) and he began receiving weekly benefits. Learning. Influencing. Protecting.
Investigation Facts XYZ Automotive Repairs confirmed the following: • Phillip is a 34 year old male, has a High School education, and has worked in the automotive repair industry for 8 years. • Phillip has been employed with XYZ for 2 years as a mechanic. • No real performance issues other than being slow in performing his job duties and an occasional “tardiness” that was never formally addressed. • He has an Average Weekly Wage of $600. • Employer will attempt to accommodate restrictions during recovery period. • The Supervisor did confirm that on 3/02/06, Phillip did tell him that while retrieving a truck to repair from the parking lot, he hurt his right knee while stepping down from the sidewalk. He did not feel that he needed treatment and continued to work the remainder of the day without incident or complaints of pain. Learning. Influencing. Protecting.
Medical Facts • Phillip initially treated at a local Emergency Room for a knee sprain. He underwent x-rays to the knee and was prescribed pain medication. • Upon receipt of the claim, Phillip was directed to the Med-4-U Care facility. He complained of low back pain which radiated down to his right buttock and down to his right leg/foot. He was experiencing numbness and tingling in the right leg. He was treated for a back strain and prescribed medications, physical therapy, and lumbar x-rays. He was eventually referred to an Orthopedic. • Orthopedic ordered an MRI. Results showed degenerative changes at L4-L5 and some stenosis at L3 and L4; rather pronounced facet arthropathy, particularly at L4-5; also noted moderate scoliosis. It was noted that Phillip was not a surgical candidate, and he underwent a conservative treatment program which included pain management. Learning. Influencing. Protecting.
Controversial Issues • Phillip was released to return to work on restricted duty during his recovery period, however, he claimed that he was assigned to a job that exceeded his restrictions causing his condition to worsen. He also alleges that the job was created in an effort to make him miserable and to force him to quit. Phillip quit showing up for work and hired an attorney. • An FCE was performed and the results reflected possible malingering or lack of effort • On 4/03/07, Phillip was released at MMI with a 10% ppd rating to the back and the following permanent restrictions: no repetitive bending/stooping/twisting, he will be limited to light work, and limited to occasional lifting over 25 pounds. • Upon his release at MMI, Vocational Rehabilitation was assigned to Phillip’s case. Phillip appeared to be “cooperative” throughout the process, but did not present well to potential employers and was quick to point out his pain levels and what type of job duties he was willing to perform. Learning. Influencing. Protecting.
Controversial Issues • Surveillance was performed and found Phillip to be extremely active with yard work, running errands, and occasional car repairs in his garage. • A Form 24 was filed to terminate benefits. Learning. Influencing. Protecting.
Players Involved • Employer/Insurance Company/TPA • Nurse Case Manager • Surveillance • Physician • Defense Attorney • Plaintiff Attorney • Mediator Learning. Influencing. Protecting.
Questions? Learning. Influencing. Protecting.