This is a review of a workers compensation settlement appeal. The case originated as a claim for workers comp benefits filed by a woman who developed Carpel Tunnel Syndrome.
The woman had received a settlement from workers comp for her Carpel Tunnel, but she felt the settlement underestimated her disability. Using her own resources, she paid to have an independent doctor re-examine her injury and then filed an appeal based on the doctor’s findings.
Statement of Facts…
Wilma Roget was a 27-year-old single mother of four. Roget completed secretarial school in 2007. At or about the time of her graduation she was hired as a receptionist at Talmage and Associates, P. C. There her duties included answering multi-line telephones, mail sorting, appointment monitoring, and some light typing.
She began her job in excellent health with no significant physical impairments. Roget worked for the law firm as a receptionist from April 2nd, 2007, through May 1st, 2009. In 2009 she was promoted to the position of legal secretary and was assigned to work for a specific attorney in the firm. After about a year, Roget was promoted again, this time to the position of paralegal.
About a year into her position as a paralegal, Roget began to experience intermittent discomfort in her right wrist. At first she thought little of it. When the discomfort became impossible to ignore, Roget would take short breaks. As the weeks passed by Roget’s intermittent discomfort in her wrist gave way to acute discomfort and pain. Although the breaks she took helped somewhat, her discomfort and pain seemed to persist for most of her working day.
Roget notified the attorney for whom she worked that she was unable to continue to type the attorney’s legal pleadings at the same rate she had been for the last year or so.
She explained to the attorney how her once intermittent discomfort had given way to acute pain. Roget told the attorney she was unable to work for more than three hours a day. Even that amount of time, Roget said, produced severe discomfort and pain.
The attorney, sympathetic to Roget’s plight, referred her to the firm’s workers compensation benefits advisor. The advisor, in turn, sent Roget to one of the insurance carrier’s approved orthopedic surgeons.
The orthopedic surgeon ordered an MRI of Roget’s right wrist. The MRI showed the fibrous tissue surrounding Roget’s wrist’s median nerve was swollen. It was clear on the MRI that Roget’s claims of discomfort and pain were credible. Relying upon the findings of the MRI, the orthopedic surgeon diagnosed Roget’s condition as “Carpal Tunnel Syndrome.”
“Carpal Tunnel Syndrome” is caused by the tissue surrounding the wrist becoming inflamed. This inflammation causes the tissue to press down on the nerves running through the wrist, which in turn causes the subject to feel pain in their fingers and hand. The syndrome can be brought on by a person doing any kind of repetitive motion with their hands, especially typing.
The doctor’s diagnosis and prognosis were communicated to the workers compensation insurance representative. The doctor estimated Roget’s disability at 12% and recommended Roget be assigned, at least for the time being, to light duty which did not include typing. The insurance rep notified the law firm, and shortly thereafter Roget was transferred to the filing clerks’ pool.
With the transfer to the filing pool came a reduction in Roget’s pay. Roget complained to the law firm that she believed her workers compensation settlement was unfair. She said it was demeaning, especially after all the years she served the firm loyally.
Roget also told the law firm she couldn’t survive on the reduced pay, even with the additional 12% disability pay she was now receiving.
Although empathetic, the firm told Roget business was slower than normal, and only because of her many years of loyalty to the firm were they keeping her on as a filing clerk. They told Roget her only alternative was to resign from the firm.
Roget served notice upon the workmans comp insurance company and the firm she was appealing the workers compensation settlement award rating of only 12%. She asked for the authority to see another of the insurance company’s approved orthopedic surgeons.
When she went to see the newest orthopedic surgeon, the surgeon first examined the results from the MRI taken only 2 months before. At her request, the newest surgeon ordered another MRI. The latest MRI confirmed the first surgeon’s diagnosis of Carpel Tunnel Syndrome.
After an extensive consultation and Roget’s performance of a number of agility and physical limitations exams, the new orthopedic surgeon classified Roget’s disability at 22%. Although better than 12%, Roget still argued her disability was a minimum of 80%.
Frustrated, Roget sought out her own orthopedic surgeon. She paid for the surgeon from her own pocket. Determined to prove her disability was much greater than the 22%, she requested the doctor order an MRO and a CAT Scan exam as well.
Unfortunately for Roget’s appeal, the CAT Scan offered no new evidence of disease or injury to the muscles, tendons, or fibrous tissue in her right wrist or forearm. Her own orthopedic surgeon was only able to increase Roget’s disability to 25%.
Her appeal was heard by members of the workers compensation board’s appellate body. After reviewing all of the medical evidence from the three surgeons, the workers compensation insurance company increased Roget’s disability to 25%. They would go no higher.
Roget, frustrated with the insurance company’s decision and her inability to survive on her decreased pay, gave the firm thirty-days’ notice. During that time she searched for, and found a job with another law firm as a paralegal.
Her pay rate there was higher than it was when she was working as a paralegal for the first law firm. The new firm was larger and, because of the existence of a substantially larger secretarial pool, Roget was able to work as a paralegal with a minimum of typing.
- Workers compensation settlements are normally subjective. Because of the relatively intangible nature of diagnosing disability percentages, workers compensation awards are often lower than employees expect.
Regrettably, sometimes those employees’ only recourse after exhausting the workers compensation appellate process is resigning from their job.
- Carpel Tunnel Syndrome is a real, and often quite painful affliction. Those who in the past saw it as an excuse rather than a real injury, are now, with the burgeoning amount of medical evidence, rapidly changing their minds and their understanding of the seriousness of the injury.
*This case example 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.
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