Aug 25, 2012 | Uncategorized, Workers' Compensation
In order to win a denied workers’ compensation claim, the claimant must show the alleged injury arose out of and in course and scope of employment. This burden of proof usually requires the submission of medical evidence from a doctor or other health care provider relating the injury to the work accident. South Carolina law [Section 42-1-160(g)] defines “medical evidence” as “expert opinion or testimony stated to a reasonable degree of medical certainty, documents, records, or other material that is offered by a licensed health care provider.” For years, the use of a “check the box” questionnaire has been used by workers’ compensation claimants’ attorneys. The letter format is much less expensive than scheduling a doctor’s deposition, and treating physicians have become used to receiving these requests for virtually all of their workers’ compensation patients. However, as claims are increasingly being defended more aggressively by insurance companies, many are now starting to question their sufficiency as “medical evidence.”
Questionnaires are customarily used in claims where there is a dispute as to the causal relationship of an alleged injured body part; where there is a question of whether the claimant has reached maximum medical improvement; whether additional medical treatment is necessary; and/or where a prior medical opinion has been changed or even reversed. The questionnaires themselves typically consist of three or four short statements regarding the issue(s) in dispute and then provide “boxes” the option to check “yes” (to agree) or “no” (t0 disagree) with the question posed. However, the questionnaires almost never seek further elaboration from the health care provider of how the opinion was reached or what objective medical evidence was used to base the opinion offered. Hence, the dilemma. While the claimant has technically complied with the statute and produced an opinion from a health care provider, stated to a reasonable degree of medical certainty. However, there is no real foundation offered for a hearing Commissioner to consider the sufficiency of the opinion.
To date, the Commission has not issued any regulation nor given guidance on the use of these medical questionnaires. For now, the questionnaires remain admissible as “medical evidence” at a hearing. But, it appears that the sufficiency and probative value of “check the box” questionnaires will be the subject of defense challenge in the future. Better make sure your lawyer’s questionnaire is clear and shows a basis for the opinion being offered.
Robert J. Reeves of Reeves, Aiken & Hightower LLP has practiced workers’ compensation law for over 23 years. His first seven (7) years was as an insurance defense attorney. He has proudly represented injured workers and their families in York County since 1996. Prior to becoming a lawyer, he was a Registered Nurse (RN). Given his insurance defense and nursing background, Mr. Reeves understands and has successfully prosecuted all types of complex, serious injury claims. He stands ready to fight for you and your family during this difficult and scary time in your life. Call him directly today on his mobile phone 704.351.7979 for a private consultation about your particular circumstances.
Jun 27, 2012 | Uncategorized, Workers' Compensation
Often, when you have been hurt on the job, doctors will at first remove you from work entirely while you heal. During this time, you will generally get compensated at 2/3’s of your weekly wages after the first 7 days you are out of work. When the doctor your employer’s workers compensation insurance carrier chose for you determines you are able to go back to work, your benefits end (if not before). What if the doctor allows you to go back to work on light duty though?
If you are offered the opportunity to go to light duty employment by the doctor, you must take it. If you do not, you will lose all workers compensation benefits until you return to work. Fortunately though, if your employer is paying you less than 2/3’s of your weekly wages before the accident, you are entitled to the difference between what you are being paid and that 2/3’s figure, to bridge the gap.
If you feel that you are unable to perform the light duty work assigned, you should contact an attorney to be able to fully exercise your rights at a hearing. At the hearing, the Workers Compensation Commission will review the doctor’s determination and decide whether you are capable of performing the light duty work.
Workers Compensation Lawyers in South Carolina
If you’ve been hurt on the job, contact the experienced workers compensation lawyers at Reeves, Aiken, & Hightower. We know the South Carolina worker’s compensation system and are ready to get you the recovery you deserve. Browse our website, examine our credentials, and compare them to any other firm. Then call us at 877-374-5999 or contact us at this link for a private consultation.
Jun 26, 2012 | Uncategorized, Workers' Compensation
A lot of people who find themselves hurt on the job are surprised to find that they are entitled only to a set recovery based on the type of their injury. They find themselves wondering why they are not entitled to damages based on pain and suffering and why they are not able to argue that they are entitled to greater compensation.
The unsatisfying answer is mainly historical accident. The law in regard to injury developed before industrialization and factories. People rarely got seriously injured and when they did it was usually at their own hand. When the law that developed in that environment was applied to workers getting injured in factories and working on the railroads, invariably the worker was unable to win a lawsuit against their employer for some reason or another, whether because of contributory negligence or assumption of risk or some other doctrine. The worker who was enriching their employer by working for him was left out in the cold to fend for him or herself after being injured on the job.
Clearly this was unjust.
The state legislatures stepped in to create employer liability for the first time. Obviously, employers were well represented before the legislatures and workers, maybe not so much. The laws largely passed based on this compromise: workers get compensation without regard to fault, but that compensation is severely limited. Today that means no pain and suffering and mere fraction of what a recovery would be in a negligence action.
Still, workers compensation assures a remedy for those actually injured on the job. Proving the actually injured on the job bit is often the hard party and it is where especially clever lawyers can especially help.
Workers Compensation Lawyers
The SC workers compensation lawyers at Reeves, Aiken, & Hightower know the South Carolina worker’s compensation system and are ready to get you the recovery you deserve. Browse our website, examine our credentials, and compare us to any other firm. Then call us at 877-374-5999 or contact us at this link for a private consultation.
