Case Example: Injured Worker Disputes Return to Work

After crashing the company car, a taxi driver takes his fight to court over his ability to go back to work.

An injured taxi driver refuses to accept the workers’ compensation insurance company’s determination of his ability to return to work.

Here we explore the injured worker’s decision to fight the insurance company in court.

This case study is for educational purposes only. It is based on actual events, although names have been changed to protect those involved. Any resemblance to real persons or entities is purely coincidental.

We’ll cover how our victim was injured, his evaluation by workers’ compensation doctors, and his fight for disability benefits.

Our study finishes up with a list of important points about workers’ compensation claims.

Crashing the Company Car

Acme Taxi Company hired Arthur Reed in January. Reed, like many other cab drivers, worked by leasing a vehicle from the taxi company. Reed paid $150 a day to the taxi company for which he received a cab for 24 hours. The taxi company would dispatch pickups to him via radio, and any money he made would go directly to him.

The following month, while on his way to pick up a fare, Reed lost control of the cab on an icy stretch of road. His cab fishtailed and abruptly hit the curb.

The collision with the curb caused the airbags to deploy, hitting Reed in the face. His body was slammed sideways, so his left arm hit the driver’s door. Although stunned, Reed remained conscious after the accident. Another driver stopped and spoke with Reed. Reed said he was in pain and asked the driver to call 911.

Within minutes the police and paramedics arrived. They stabilized Reed and transported him to the local hospital’s emergency room. There he was treated for his injuries. The doctors ordered both an MRI and a CT scan. The examinations revealed Reed suffered a possible disk herniation in his neck and a broken bone in his lower left arm.

Workers’ Comp Medical Evaluations

Reed filed a workers’ compensation claim with the taxi company’s insurance carrier. The insurance company assigned two orthopedic surgeons to examine Reed to determine the extent of his injuries.

The first doctor concluded Reed’s injuries, although painful, were not debilitating. She said his arm would be in a cast for six weeks, and his whiplash neck injury would also heal in that time. She allowed another two weeks of physical therapy. The doctor reported that Reed could return to his regular work activities no later than eight weeks after the accident.

Reed thoroughly disagreed with the insurance company’s doctor’s assessment, and he asked to be examined by a second orthopedic surgeon. The insurance company provided him with a new orthopedic surgeon.

After reviewing the hospital radiology reports and performing a series of tests, the second doctor’s prognosis was similar to the first. His prognosis was that Reed should be out of work for no longer than eight weeks. The results of the examination were relayed to the insurance company.

Based on the doctors’ findings, the workers’ comp insurance company agreed to cover Reed’s accident-related medical bills and costs, but only agreed to award Reed wage benefits for the eight weeks he could not work.

When Reed had been out of work for six weeks, the insurance company notified him that his wage loss benefits would end in two more weeks.

Disputed Severity of Injuries

Reed disagreed with both the insurance company’s doctors’ findings. He decided to hire his own doctor to evaluate his condition.

Reed saw an orthopedic specialist in private practice who ordered a new MRI and a CT scan of Reed’s cervical spine and left arm.

After a physical examination, he diagnosed Reed’s injuries as a serious sprain to the tendons and ligaments of Reed’s neck, possible herniation to his disk at the C4 level and a partially healed fracture of the ulna in the left arm.

His doctors also said Reed’s neck injuries constituted partial to full disability but could not confirm such disability until at least 90 days after the initial diagnosis to allow time for further healing and recovery.

Reed brought this new information to the insurance company and requested continued wage loss benefits. The company refused, stating that their own doctors’ findings were accurate, and Reed should be able to return to work after eight weeks, as scheduled.

Taking the Fight to Court

Reed responded by filing a lawsuit in state court. He was so sure of his position; he decided to handle his case without an attorney.

The insurance company, adamant that Reed was exaggerating his injuries, filed a Motion for Summary Judgment with the court. A Motion for Summary Judgement asks the Judge to decide right away if the case should be dismissed.

The insurance company’s Motion asserted that Reed did not have a valid claim, nor did he present any material facts or law issues to support his claim that he should receive more workers’ compensation coverage.

The Hearing on the Motion

At the hearing on the Motion for Summary Judgment, attorneys for the workers’ compensation insurance company entered into evidence the diagnoses and prognoses of the doctors who they assigned to evaluate Reed. They also called the doctors to testify in support of their findings.

Each of the insurance company’s doctors was able to defend their findings thoroughly. They went through Reed’s medical charts from the time of his admittance into the hospital through their final examinations of him. Both were undaunted in their conviction that Reed was recovered and could return to work.

Reed presented the medical reports from the orthopedic specialist he went to on his own. Although Reed had asked the doctor to come to court, the doctor refused to testify on Reed’s behalf.

Reed wore a neck brace to the hearing. He told the court his injuries were so severe as to limit his abilities to walk, sleep, and drive.  He said he couldn’t be physically romantic with his girlfriend because of the injuries, or enjoy sports with his friends.

Under questioning from the insurance company attorneys, Reed admitted that he hadn’t used the neck brace for over a month before the hearing and had no witness statements from his girlfriend or sports buddies to back up his assertions.

They were also able to elicit an admission from Reed that he consulted with four other doctors before finding the one whose report he presented. The four other doctors did not find Reed’s injures to be serious enough to merit full disability. Reed admitted on the stand that he had been “doctor shopping.”

Outcome of the Worker’s Lawsuit

After reviewing the witnesses’ medical evidence and testimony, the court ruled in favor of the insurance company. Reed did not have a strong enough case to continue the lawsuit.

The court stated, in part:

“This workers’ compensation coverage case has come before us as a result of the inability of the claimant/plaintiff and the insurance company to come to an agreement regarding the injuries the claimant suffered and the resulting medical bills and degree of disability suffered by the claimant. As a result of the disagreement, the claimant filed his case in this court.

The defendant filed their Motion for Summary Judgment. In the Motion, the defendant claimed the claimant/petitioner’s evidence did not support his claim for damages. The defendant states the claimant/plaintiff’s case failed to provide material facts or issues of law sufficient to survive a Motion for Summary Judgment.

The court reviewed the evidence presented by the claimant. After so doing, we find the claimant/plaintiff’s evidence to be lacking in material facts or law sufficient to survive the defendant’s Motion for Summary Judgment. We, therefore, find for the defendant and grant their Motion.”

Key Points About Workers’ Comp Disputes

  • Most states have a worker’s compensation commission to handle disputes over an injured worker’s benefits. The worker’s comp commission is not part of the regular state court system.
  • Wage loss benefits are only paid so long as you are medically unable to work. You may get partial benefits if you are cleared to return to a light-duty or modified work schedule.
  • Disputes over disability ratings can be complicated and are best handled by a qualified attorney. Most injury attorneys offer a free consultation, with no obligation.
  • Your injury-related medical and therapy bills will continue to be covered, even after you’ve returned to work, so long as the insurance company approves the treatment.
Charles R. Gueli, Esq. is a personal injury attorney with over 20 years of legal experience. He’s admitted to the NY State Bar, and been named a Super Lawyer for the NY Metro area, an exclusive honor awarded to the top five percent of attorneys. Charles has worked extensively in the areas of auto accidents,... Read More >>