This is a recent workers’ compensation case that Attorney Chuck Pappas handled. In this workplace accident Attorney Pappas got the injured employee the benefits she deserved, the insurance company to pay for surgery and obtained a one hundred thousand dollar settlement for his client.
The Work Accident and Injury
Our client was a licensed practical nurse (LPN) who worked at a well known hospital in MetroWest Massachusetts. In September 2015, the employee slipped and fell on a wet floor while at work. She fell to the floor and injured her right hand, right shoulder, right hip, left knee and lower back.
In Massachusetts, workers’ compensation benefits are considered no-fault benefits. This means that regardless of whose fault the accident was, the injured worker is entitled to workers’ compensation benefits provided the work accident occurred on the job and the injury is related to that workplace accident.
She was initially examined by a nurse practitioner at the occupational health center as required by her employer. But, after that initial examination the employee was free to see and treat with whomever she wanted. Her doctors ordered her to remain out of work while all diagnostic testing was performed and she underwent treatment. Her injuries kept her out of work for well over a year.
The Initial Payment of Workers’ Compensation Benefits
The workers’ compensation insurance company voluntarily paid our client disability benefits right away. They also initially paid all her medical bills for the treatment related to her work injury. In this case, there was no question about the accident and injury. The fall was witnessed by other co-workers and our client reported it right away to her employer. This is one of the three important steps we recommend after a work accident.
In the first month of her injury, the insurance adjuster mailed our client Form 105 asking her to sign the form and return it. A workers’ compensation insurance company can voluntarily pay benefits to an injured worker in Massachusetts without prejudice for the first 180 days (or 6 months) of the accident or injury. Because the payments are being made without prejudice, the insurance company has not accepted liability. Therefore, they are allowed to stop (or modify) the payment of disability benefits during that 180 day time period whenever they want as long as they send a 7 day written notice that payment will stop (or be modified). This gives leverage to the insurance company. The Form 105 extends the payment without prejudice period for an additional 180 days (or 6 months). If the form was signed, our client would have been giving the insurance company a whole year where they would have the power to stop or modify the benefits at will.
Luckily, our client did not sign it, but the insurance company modified her benefits to partial disability just before the expiration of the initial 180 day payment without prejudice period. This modification reduced her disability benefits by hundreds of dollars. This is when this injured worker contacted Attorney Pappas.
Legal Action was Immediately Taken
Chuck Pappas met with this injured employee right away to review and evaluate her case for free. He explained all of her rights as an injured worker in Massachusetts, answered all her questions, and took immediate action. A claim for temporary total disability benefits was filed right away to try and undo the insurance company’s modification.
The case was heard by a Judge at the Department of Industrial Accidents in Boston. The judge agreed with Attorney Pappas and awarded the injured worker total disability benefits and also awarded her money to compensate her for the retroactive benefits she should have received after the insurance company modified her benefits.
The Pursuit of Payment for Medical Treatment
Another major issue in this case was that the insurance company refused to pay for a surgical procedure that the injured worker needed. Generally, medical benefits from workers' compensation will cover the medical bills and expenses for all medical treatment related to the work injury. The surgery, however, was denied because the insurance company claimed that the surgery was needed for a preexisting medical condition.
Attorney Pappas diligently and thoroughly negotiated with the insurance company and their attorney. All medical records were obtained and meticulously reviewed. Based on the review of all the medical records and his familiarity with the medical conditions, Attorney Pappas argued that while this injured worker suffered from a preexisting medical condition, her work injury was the major, not necessarily the predominant, cause of her disability. This is the standard under our Massachusetts workers’ compensation laws. See M.G.L. c. 152 § 1(7A).
The insurance company ultimately agreed with Attorney Pappas and approved and agreed to pay for the surgery.
The Legal Fight for a Lump Sum Settlement
The insurance company had appealed the Judge’s Order. The parties both prepared for the appeal Hearing. While waiting for the Hearing to be schedule at the Department of Industrial Accidents, Attorney Pappas met with his client several times to review, discuss and prepare for the Hearing and also to discuss lump sum settlements in workers’ compensation cases. Together, Attorney Pappas and his client came up with a range for a possible settlement.
A demand for settlement was prepared and served upon the workers’ compensation insurance company. There were numerous phone conferences where Attorney Pappas and the insurance company’s lawyer argued and negotiated the case. One thing that was certain, we would not accept anything less than six figures. The insurance company initially offered $60,000. This was the point in time where Attorney Pappas began to more aggressively negotiate for his client. The insurance company ultimately offered a six figure settlement. Our client gladly accepted the offer. The $100,000 lump sum settlement was presented to the Judge, who approved it without hesitation, finding it to be a fair and reasonable settlement that was in the best interest of the injured employee.
This client was very thankful for Attorney Pappas’ work and called him the day she received her check in the mail to thank him. Likewise, Attorney Pappas was very happy to have helped this client.
Have you Been Hurt on the Job in Massachusetts?
If you, or someone you know, has been injured on the job in Massachusetts, you should know your rights and be sure you are getting the benefits you deserve. To schedule your free, no-obligation case review and evaluation please call us at (508) 879-3500 or contact us online. We are more than happy to meet with you and answer all of your questions.