What is a
Stalled Injury Case?
If you or your loved one suffered a serious work injury, time is of the essence. The worker’s compensation carrier likely will have denied life-altering treatment and as missed worked days begin to add up, missed paychecks soon lead to late bills and devastating stress for your family.
Before long, the bank is calling about the mortgage and the utility companies are threatening to discontinue service. As you continue to wait for updates, you realize that the case has come to a grinding halt. This is when it becomes a stalled case.
Why Do Cases Get Stalled?
Deliberate Stalling Tactics: The “reforms” that Governor Schwarzenegger promoted cut temporary disability to 104 weeks and made access to treatment more lengthy. That gives workers’ compensation insurance carriers the leverage and opportunity to delay cases so that at the end of 104 weeks your are in a grave financial predicament-settle on the insurance company’s terms or have no income at all. Some people either give up and let the case go at this point or become more willing to settle for much less than they are entitled to.
Volume of “Mill” workers’ compensation firms: Most workers’ compensation firms are built on a volume model. These firms, usually the ones you find on advertising on television, radio, etc. take on many more cases than they can handle. So, management of your case is often left in the hands of file clerks, secretaries or “litigation assistants.” Their model is built on taking as many cases as they can and settling them quickly, quite often for less than the full value. Take a look at our results pages for just a few examples. If your case is serious and complex it often takes more work than a mill can apply and your case is ignored. Or, the mill firm simply does not know how to get a staled serious case moving and it gets ignored and you are often told to just settle as there is nothing more to do. We won’t let that happen. If there is a way to move your case forward, we will move it forward.
Deliberate Stalling Tactics?
Insurance companies and employers have a number of ways to increase your levels of frustration. Silence is not the only tool at their disposal:
- Deliberately misstating or ignoring how the current laws apply to your specific case. A volume firm will often not dedicate resources to do the hard work of going to court to vindicate your rights.
- Reporting that someone else is responsible for making the final decision
- Responding to requests for information with notices about the case being under review
- Requesting records that are not even material to the case
- Requesting records that intrude on a person’s privacy
Types of Stalled
Serious Injury Cases
All types of injury cases can get stalled. This is especially true for cases involving workers as employers and insurance companies often work together to undermine the process. Here are some case types that workers and their families might struggle to get back on track:
- Cumulative trauma cases
- Cases where your employer actually lies about whether you suffered an injury or how the injury occurred
- Unwitnessed injuries
- Cases where the claims examiner deliberately performs a bad faith investigation when the law requires a good faith investigation
- Death cases as the worker obviously cannot provide testimony
- Catastrophic injury cases because the claims examiner simply does not want to accept that the case is a large exposure case
How We Can Help Your Stalled Case
There are several options to consider when facing a stalled case. Usually, a combination of the following can help and if your case is stalled you should be asking why these things are not being done:
Utilizing the MPN Process: Most volume firms will tell you that once Independent Medical Review has made a decision of treatment there is nothing else to be done. That is flat out wrong. Where there is a Medical Provider Network in place a separate dispute resolution process is available under Labor Code 4616.3, 4616.4 and that process is binding no matter what IMR decided. Yet, most attorneys simply do not use the process any many are not even aware that it exists. Ask you current attorney about the process.
Deposing Medical Experts: Taking an effective deposition of a reporting doctor takes preparation, skill, experience and a willingness of the attorney to invest time and money. Most volume firms do not have these assets available in enough supply to treat all of their clients’ cases with that level of care. We do.
Hiring Vocational Experts: In serious cases one of the realities is that even though an injury may have a presumptive rating that suggests the injured worker can compete in the open labor market the reality is that the severe and chronic pain makes that impractical. But, is it presumed that the rating is correct. To overcome that presumption takes work and an investment by your attorney on expert analysis by a vocational expert. It takes time to set up the medical testimony, but if it falls into place it may be possible to prove total permanent disability entitling the injured worker to lifetime medical care and lifetime deniability payments. This is a common scenario in failed back surgery cases, reflex sympathetic dystrophy or complex regional pain syndrome cases, brain injury cases and any catastrophic case where severe chronic pain is present.
Negotiating from strength, not weakness: The insurance companies and their lawyers know which are the weak firms that deal in volume. Sadly, because of mass media advertising a large percentage of serious cases end up with high volume firms where they are settled for far too little. A firm that has a reputation of aggressively developing cases will put your case in a position of maximum strength for settlement.
Pressing the case to trial: Large workers’ compensation defense firms have a high degree of turnover among younger associate attorneys. These inexperienced attorneys tend to follow a script and often take cues from claims adjusters that are not analyzing cases objectively. When the case is well prepared and is pressed to trial usually a more experienced defense attorney and claims adjuster are called in to review the case and a better appreciation for the danger presented ensues. Insurance companies are afraid of one thing and one thing only-a well-prepared case that is on its way to trial. It is then when your case has maximum settlement value. We treat each case as it is going to trial and do what will best get the case in a maximum value position. That is why we specialize in serious, high value cases.
If the terms of any related contracts allow arbitration, this is a good option to consider. It reduces legal fees, keeps proceedings confidential and can speed things up. Good results, however, depend on the employer’s and insurance company’s willingness to negotiate fairly.
Communicating: If your case is with a high-volume, firm chances are you have not even met your attorney let alone provided input useful to case preparation. Chances are you are just on an assembly line. Your input is important to preparing the case for maximum value which is why you will speak with your attorney for strategy and tactics to get your case ready for trial.
What Happens Next
If you are not satisfied with the progress of your case, simply call us for a free consultation. You only pay one attorney fee even if you hire a new lawyer. But, feel free to call and find out why we are different. A routine comment we hear after a free consultation is, “I learned more about my case in this consult than in years with my current lawyer!”
A serious workers’ compensation has dramatic effects on your family. It requires serious lawyers proven results that the insurance companies fear to get you a good result. It’s worth a free consultation to find out if you have a better option.
Give us a call at (760) 340-2777.
is personal to us
Did you get hurt at work?
Were you denied the extra time you earned?
We can help.