Recently Thomas and Company attorneys utilized surveillance to defend against a fraudulent workers’ compensation claimant.

In this case,  the claimant filed a Permanent and Total Disability Application against the Employer, alleging that he could no longer perform sustained remunerative employment as a result of his work injury.  If PTD benefits were granted, the Employer faced potential exposure in excess of $700,000.  Once the application was filed, we engaged a comprehensive defense strategy which initially included surveillance monitoring of the claimant’s activities and an extensive search of medical records.  The surveillance revealed that although the claimant was alleging that he could no longer work, he  was actively working for another employer.  Relevant medical records were also discovered that had not previously been disclosed. Based on the surveillance evidence, we began a coordinated effort with the BWC Fraud Division to subpoena bank account records and to subpoena witnesses who could further prove that the claimant was actively working.  We also consulted with medical and vocational specialists and obtained sworn statements from these experts which are often more effective and persuasive than written reports.  Ultimately, our efforts led to the dismissal of the PTD application, saving the Employer hundreds of thousands of dollars.

The Claimant reached an out of court settlement with the pharmacy for $25,000.00. He was not represented by a lawyer in the claim against the pharmacy.

Unfortunately, the Claimant’s condition progressively worsened over the next several months. He was visiting family in Virginia and was forced to go to the Emergency Room due to his increasingly severe symptoms. He had progressive weakness/numbness/tingling in his arms and legs. An MRI scan revealed a severely compressed spinal cord in the neck. He needed immediate surgery, but it was determined he had significant coronary artery disease. He had a triple bypass to stabilize him for the cervical surgery. Thereafter, he had the cervical surgery. It was unsuccessful. A second cervical surgery was immediately performed. When the Claimant came out of the operating room from the second cervical surgery, he was a quadriplegic. He lived as a quadriplegic for only about nine (9) months. The Claimant passed away due to his cardiac complications, which were exacerbated by the quadriplegia.

This claim was initially handled by the department head/partner of a different law firm. The attorney had lost hearings before the District Hearing Officer and the Regional Board of Review. Further, he did not insure that the medical bills were properly paid after the Regional Board Order and a self-insured complaint was filed against the Employer/Client. A hearing was held before the Self-Insured Review committee. The Employer/Client was fined $10,000.00, which, at the time, was the most severe penalty short of having a company’s self-insured status revoked.

As a result of the allowance of the claim, the Employer/Client was forced to pay approximately $650,000.00 in compensation and medical benefits. Also, the widow filed a death claim against the Employer/Client.

THOMAS & CO. RESULTS

Thomas & Co. was asked to cover the final hearing (SHO hearing) before the Industrial Commission “just so the case could be appealed into Court and settled.” We attended the hearing and convinced the Staff Hearing Officers to allow us to depose a physician which had performed a review at the request of the Industrial Commission. The physician changed his opinion during this deposition and at a subsequent hearing before the Staff Hearing Officers. We were successful in convincing the Industrial Commission to deny and disallow the claim for the quadriplegia. Thereafter and through Thomas & Co.’s negotiations with the widow’s attorney, no appeal was taken into the Common Pleas Court.

The Employer/Client Received A Surplus Fund Reimbursement of Approximately $650,000.00.

The Claimant’s attorney filed an application for Permanent and Total Disability benefits. In conjunction with the Permanent and Total Disability application, the Claimant was examined by a physician and a psychologist on behalf of the Bureau of Worker’s Compensation. The combined impairment rating the Claimant received from these evaluations was 95%.

This claim was originally being handled by the department head/partner at a different law firm in Cleveland. The former attorney told the Employer/Client, “The Claimant is permanently and totally disabled. There is nothing we can do. We are going to lose.”

THOMAS & CO. RESULTS

The Employer/Client understood it was a difficult claim, but felt that her attorney needed to have some degree of optimism and decided to pull the file. She called Thomas & Co. and asked me if we would take it over. We agreed.

We scheduled various evaluations and obtained reports from our own physician/psychologist which revealed information that had not been discovered by the former attorney. This information related to the Claimant’s educational background and also suggested that the Claimant was exaggerating his symptoms and/or malingering. The matter went to hearing and, despite the 95% impairment rating given by the state physician/psychologist, we were able to defeat the Permanent and Total Disability application.

Prior to the Permanent and Totally Disability application, the Claimant’s demand for settlement was around $300,000.00. After we defeated the Permanent and Total Disability application, we settled the case for approximately $100,000.00.

The Employer/Client Saved At Least $200,000.00 As A Direct Result of the Permanent and Total Disability Application Being DENIED

The file was being handled by another law firm, a large defense firm that is now out of business.

THOMAS & CO. RESULTS

The Employer/Client pulled the file and sent it to Thomas & Co. to defend the Permanent and Total Disability claim. We were successful at the Permanent and Total Disability hearing. As a result, the Claimant’s settlement demand was reduced by several hundred thousand dollars and the case settled for around $100,000.00.

The Employer/Client Saved At Least $200,000.00 As A Direct Result of the Permanent and Total Disability Application Being DENIED

As a result of the additionally allowed conditions, the Claimant unfortunately had a very long and complicated recovery. He spent over one year in the Cleveland Clinic. It is estimated that the medical bills were in excess of $1,000,000.00.

THOMAS & CO. RESULTS

Because of the hearings which had additionally allowed some of the conditions, the Claimant’s medical bills should have been paid by the Employer/Client. However, the attorney previously representing it failed to properly advise the Employer/Client of the same following the administrative hearings. Due to this and other reasons, the Employer/Client asked Thomas & Co. to represent it in the litigated Court action and the file was pulled and sent to us.

We aggressively defended the Employer/Client in the litigated Court case and were eventually able to effectuate a settlement of the claim. The settlement included having the additional conditions disallowed that were responsible for the $1,000,000.00 in medical bills.

The Employer/Client Saved At Least $1,000,000.00 As A Direct Result of the Aggressive and Effective Settlement Negotiations of Thomas & Co.

THOMAS & CO. RESULTS

The Tortfeasor’s insurance carrier had a single limit policy of $500,000.00. Thomas & Co. discovered the identity of the carrier and placed it on notice of our subrogation lien, which was basically the entire value of the liability policy. Ultimately, we were able to negotiate a resolution of the subrogation claim and a settlement of the death claim as follows:

• Tortfeasor’s carrier reimbursed the Employer/Client in the amount of death benefits that it had paid out in the claim – around $15,000.00.
• The Employer/Client waived the remaining aspect of the subrogation claim, which had a value of approximately $485,000.00.
• In return for waiving the $485,000.00 subrogation claim, the Claimant’s widow agreed to settle the Workers’ Compensation death claim against the Employer/Client and accept the $485,000.00 settlement against the Tortfeasor. This meant that Thomas & Co.’s negotiations eliminated the Employer/Client’s exposure and recovered all of its monies paid under the claim. As a result, the death claim did not cost the Employer/Client anything. Rather, the total cost of the claim was borne by the Tortfeasor.

The Employer/Client Saved At Least $500,000.00 As A Direct Result of the Aggressive and Effective Settlement Negotiations of Thomas & Co.

THOMAS & CO. RESULTS

Through joint efforts with a representative of the Employer/Client’s, Thomas & Co. learned the Claimant had a side business in which he performed excavating, but which he was less than forthcoming about. The Claimant actually had the business with another employee of the Employer/Client who also had filed a Workers’ Compensation claim against the Employer/Client, which was successfully defended against. The Claimant’s employment was ultimately terminated due to a drug infraction. On multiple occasions, he attempted to reinstate his Temporary and Total Disability benefits. Thomas & Co. successfully defeated the requests each and every time. He then attempted to have the claim additionally allowed for a psychiatric condition. We were also successful in defeating this condition. Ultimately, the case settled for approximately $4,000.00.

Through Thomas & Co.’s Thorough Claim Investigation and Through Its Close Working Relationship with the Employer/Client, the Employ.

THOMAS & CO. RESULTS

The Employer/Client and Thomas & Co. teamed up once again to investigate the Claimant. Excellent videotape was obtained which showed the Claimant working for approximately one hour on his car. He was bending over, twisting and working in various awkward positions. The investigator also caught the Claimant driving his vehicle and visiting with friends all the while exhibiting no obvious signs of distress.

Thomas & Co. was able to utilize this information and to effectively argue for the termination of the Claimant’s Temporary and Total Disability benefits. Further, we worked very closely with a representative in the Employer/Client’s legal department on this claim as well. The Claimant was ultimately terminated for dishonesty. The Claimant’s lawyer threatened to sue for a retaliatory discharge claim under the Ohio Worker’s Compensation Act. However, due to the handling of the claim and the close supervision of the discharge, we were able to prevent a viable retaliatory discharge lawsuit from being filed.

In addition, the Claimant filed a Motion to additionally allow the claim for a Herniated Disk in his lower back. The matter was heard on two (2) occasions. Thomas & Co. worked well with representatives from the Employer/Client, who testified at the hearings, and successfully argued for the denial of the additional allowance requests at both hearings. The additional allowance requests were denied.

Through Thomas & Co.’s Thorough Claim Investigation and Through Its Close Working Relationship with the Employer/Client, the Employer/Client Was Able to Avoid Paying Unwarranted TTD Benefits to the Deceptive Claimant and Obtain a Denial of the More Serious Disk Herniation Condition Being Allowed for in the Claim.

THOMAS & CO. RESULTS

Thomas & Co. took the claim. We thoroughly reviewed the claim, obtained necessary medical documentation, and developed legal, medical, and factual arguments in support of the Employer/Client’s position. The Claimant’s motion for the additional allowance was heard by a District Hearing Officer who found that the disc bulge at L5-S1 was caused by the industrial injury.

Thomas & Co. appealed this adverse decision to the Staff Hearing Officer administrative level. The Staff Hearing Officer reversed the previous lower order and disallowed the claim for a Disc Bulge at L5-S1. The Claimant did not appeal this matter into Common Pleas Court.

Through Thomas & Co.’s Relentless Defense of the Claim, the Employer/Client Was Able to Obtain a Denial of the More Serious Disk Bulge Condition Being Allowed for in the Claim.

The Claimant then requested nearly a year of Temporary Total Disability compensation benefits. Additionally, he also requested that the claim be additionally allowed for the conditions of Disc Protrusion L4-S1 with Nerve Root Compression and Posterior Disc Protrusion L4-5 with Stenosis and Marked Left Foraminal Stenosis.

THOMAS & CO. RESULTS

Thomas & Co. took the claim. We thoroughly reviewed the claim, obtained necessary medical documentation, obtained a critical defense Independent Medical Examination, and developed legal, medical, and factual arguments in support of the Employer/Client’s position that the additional allowances were degenerative in nature and not due to the industrial injury and, therefore, the Claimant was not entitled to over $30,000.00 in Temporary Total Disability benefits.

Thomas & Co. was successful in its arguments before the Industrial Commission. The Industrial Commission denied the requests for the additional allowances, as well as, the request for the Temporary Total Disability benefits.

The Employer/Client Saved At Least $30,000.00 As A Direct Result of the Requests for Additional Allowances and Temporary Total Disability Benefits Being DENIED