How much does a workers comp insurance carrier pay for serious injuries is a complex question. If injuries are severe, the Board may find the worker to suffer from a total disability. A claimant suffering from a permanent total disability will receive lifetime weekly payments at the max rate on their case. The Board determines the max rate by looking to the worker’s average weekly wage. In comparison, a permanent partial disability finding results in a cap on the length of time weekly benefits will be paid. As such, the carrier will always argue against permanent total disability, even if its own doctor makes such a finding.
Permanent Total Disability
The Board Panel recently dealt with a carrier that did not want to pay for a worker’s serious injuries. In that case, the worker injured his neck, head and back due to a slip and fall at work. He lost consciousness due to the fall. The accident resulted in headaches, memory problems, dizziness, anxiety and depression. The worker also had an unsuccessful back surgery with the placement of screws at the L5-S1 level in the spine.
The carrier hired a medical consultant to examine the injured worker. This medical expert, or “IME doctor,” found the worker to suffer from post-concussion syndrome and depression related to the accident. The IME doctor, a neurologist, also found the injured worker to be totally disabled. The doctor opined that the worker was capable of less than sedentary work. This basically means the worker is not even capable of desk work. The judge at a hearing found the injured worker to suffer from a permanent total disability in accordance with the insurance carrier doctor’s report. The insurance carrier objected to the decision and appealed to the Board Panel. In usual fashion, the workers comp carrier did not want to pay for the worker’s serious injuries despite its own doctor finding total disability. This is a common situation at the Board.
The Insurance Carrier’s Attempt to Avoid Paying for the Worker’s Serious Injuries
On appeal, the comp carrier argued that its doctor’s opinion is not credible and it should not have to pay for the serious injuries. Specifically, the carrier argued that a neurologist is not qualified to diagnose depression and anxiety. The carrier also argued that claims for those injuries were time-barred. The carrier further contended that the injury to the worker’s back was not severe enough to warrant a total disability. In response, the injured worker argued that both the IME doctor and claimant’s treating doctor agreed on the level of disability. Also, depression and anxiety are not direct injuries. They were consequential injuries which were not barred by the two year statue of limitations. The injured claimant also argued that the workers comp carrier must pay compensation for the workers serious head and spine injuries.
The Board Panel’s Decision on How Much the Insurance Carrier Must Pay for the Worker’s Serious Injuries
On appeal, the Board Panel agreed with the Judge and the injured worker. The Court noted that the IME doctor’s medical opinion was uncontested. Doctors were in agreement as to the worker’s serious injuries. Also, there was no time bar as to depression or anxiety because the two year statute of limitations does not apply to consequential injuries. The Board Panel found that the comp carrier did have to pay for the worker’s serious injuries. In fact, the Board directed the carrier to pay for those injuries on a weekly basis for the rest of the worker’s life.
This case shows how insurance carriers will do everything possible not to pay on a claim. They will argue against their own doctors’ reports. Another common strategy used by carriers in these situations is to raise fraud. In such a case, the carrier may argue the worker is trying to hide prior accidents. Or, the carrier may hire an investigator to take video footage of the injured worker to show they are not completely disabled. A seasoned workers comp lawyer knows what to do in these scenarios. We know the strategies used by insurance carriers and what it takes to win at trial and on appeal. Contact us for any questions or concerns regarding your case.