Philip Garrow LLC

Work Injury Q and A: Insurance Claims

Q: I have a work injury claim and the insurance company representative tells me not to contact a work injury lawyer because the work injury lawyer will just take part of my settlement. Is that true?

A: No. Oftentimes persons with workplace injuries are unable to work and rely on the lost wages (called temporary disability benefits) paid by the Workers’ Compensation insurer. The insurer is also required to pay medical treatment requested by the treating physician to aid in the workers’ recovery after a work injury claim has been filed. Injured workers receive these benefits because they are authorized by Oregon law. Workers’ Compensation laws were designed to protect injured workers from disability and financial ruin and facilitate a quick return to work. Insurance companies are required to comply with the law and pay all benefits accordingly. Lawyers who represent injured workers can advise the injured person and his or her family without the worker paying Worker’s Compensation attorney fees. In most cases any legal fees are paid by the insurance company. The worker may also be entitled to additional benefits or penalties if the insurer is not properly processing medical bills or disability payments.

You can contact an attorney experienced in Workers’ Compensation Law at no charge for a case evaluation. You can also contact the State of Oregon Workers’ Compensation Division for help or with questions. The State Injured Workers Hotline number is 1-800-452-0288.

 

 

Oregon Workers’ Compensation Denial of Medical Services

We recently helped a workers’ compensation client receive needed medical services which had been wrongly denied by her employer.  In Jeld-Wen v. Cooper,  the Oregon Court of Appeals agreed that the Workers’ Compensation Board correctly said that the employer’s denial of medical services was an invalid denial of future treatment, because our client,  the injured worker, had not submitted a bill for medical treatment and had not actually required medical services. The employer unlawfully attempted to close the worker’s claim and deny her future care. The Court agreed with the Board that the employer acted wrongly and reinstated Ms. Cooper’s right to treatment. If you have received a denial of medical services or need other assistance with your Oregon workers’ compensation claim, please contact the law office of Philip H. Garrow

Clarify Your Job at Injury in your Oregon Workers’ Compensation Claim

In a recent case decided by the Workers’ Compensation Board, an injured worker was awarded additional money for permanent disability because the workers’ compensation insurance company misapplied the law and failed to award the proper amount of disability benefits.  The injured worker was also entitled to a penalty (in this case, an additional 25% of her award) because of the insurance company’s claim processing errors.

The injured worker had an on-the-job wrist injury.  Her attending physician had restricted her to light duty lifting in her “at-injury” position as a cook/kitchen helper when he released her to return to work.  However, the insurance company gave the physician an inaccurate  job description, which said that the job the worker was doing at the time of her injury only required light lifting.  Based on this incorrect information, the doctor said the worker was released to her regular work, thereby reducing the worker’s disability award.  The  insurance company closed the claim giving the injured worker some permanent impairment, but no work disability benefits based on her “regular” work release.  When the Worker’s Compensation Department reconsidered the closure, the claimant offered an affidavit that explained that her lifting requirements at her “at-injury” job were heavy, rather than light.  She was then awarded work disability, as well as a penalty.

The insurer objected to the penalty and argued that it had no reason to question the job description that it gave to the attending physician until after the claimant had given her affidavit during the reconsideration proceeding.  The Workers’ Compensation Board affirmed her work disability award and the penalty because if the insurer was uncertain at the time of claim closure exactly what the attending physician had said about the claimant’s disability, it could have simply requested clarification from the physician.  The insurer’s “mistake” would have cost the worker a substantial amount of disability benefits if she had not challenged the insurer’s closure of her claim.

It is always a good idea to have an experienced workers’ compensation attorney review your case to look for errors or omissions by the insurance company.  There is never any charge for a case evaluation.  If you have any questions regarding your Oregon workers’ compensation claim, please contact the law office of Philip H. Garrow

Oregon Workers’ Compensation Information for Traveling Employees

Here is some new news about traveling employees.  The worker’s injury happened when he was struck by a motor vehicle after he got out of his employer’s truck, at the driver’s suggestion, to cross a highway to walk to a convenience store to get a beverage and cigarettes while the truck was getting gas.   The claimant traveled every day as a passenger in his employer’s truck, from the employer’s offices to the job site. The truck would regularly stop at one of two gas stations for refueling, at which time claimant and his coworkers would frequently purchase food and drinks at nearby convenience stores.

When the worker asked if the truck would be stopping at the convenience store, the driver pulled into the turn lane of the highway in the intersection and stated that if claimant and his coworkers wanted to get out, “now’s the time.” The claimant and a coworker got out of the truck while it was still in the intersection, the claimant was struck by another vehicle, while trying to cross the highway to get to the convenience store. The insurer denied his claim, saying that he was injured while engaging in a purely personal activity that was unrelated to his employment.

The injured worker’s claim was ordered to be accepted because when an employee’s work includes travel away from the employer’s premises, the worker becomes a traveling employee, even if the travel is local and it was not a long trip.  A traveling employee is considered to be continuously on the job unless the employee is on a “personal errand”.  This injury was covered because the injured worker was not on a personal errand. Crossing the street to purchase cigarettes and a drink was an activity reasonably related to his travel. Even if  the claimant’s method of crossing the highway to buy cigarettes and a drink had been questionable, it was the type of activity that the employer might reasonably know that a traveling employee would do. And, the claim was covered even though the claimant’s activity was prohibited by the employer’s policy.  This was because lead workers had let him and his coworkers get out of the truck in the middle of the highway before, and they had never been told that this was prohibited, the claimant’s activity did not violate an employer rule, and did not result from a personal risk, but rather was a risk of his travel.

If you have questions or need help with your Oregon Workers’ Compensation claim, please contact the law office of Philip H. Garrow

Will a Social Security Retirement or Disability system exist when I need it?

The Social Security Retirement program is the result of a bill enacted by Congress in 1935, 80 years ago this year.  In 1956 the Disability program was added, initially only for workers aged 50-64.  FICA taxes fund both programs.  There are separate Trust Funds for both programs, though there have been frequent transfers of funds between the Disability and Retirement Funds over the years.  You may have heard about the possible insolvency of either the Disability Fund or the Retirement Fund, or both, if changes are not made soon.  The rumors are true.  If Congress doesn’t act, both funds could run out of money, despite the fact that nearly every working person in the United States continues to pay into the funds.  Just recently the House of Representatives passed a law that restricts the transfer of money between the Disability and Retirement Funds – despite nearly universal opposition from Social Security advocacy groups. The bill insures that the Disability Fund will run out of money, as soon as next year!  Hopefully, that bill will not become law.  The Social Security solvency problems are fixable and many smart people, including those in the Social Security Administration, have proposed solutions, some of which are quite simple.  It will take political will, and an act of Congress, to put the ideas to work.  We all know that waiting for Congress to do something can be very frustrating, but that is the answer to this dilemma.  Ask your Congressman and Senators  what they are doing to avert the Social Security Funding crisis.  Tell them to do something now.

If you have questions regarding your Social Security Disability Insurance Benefits (SSDIB) claim or your Supplemental Security Insurance (SSI) claim, please contact the law office of Philip H. Garrow

Permanent Disability versus Preexisting Condition

In a recent decision,  the Worker’s Compensation  Board disagreed with a reduction in an injured worker’s disability award.  A Medical Arbiter, appointed to evaluate a worker’s permanent disability, had reduced the injured worker’s  award because he thought that 50% of the worker’s reduced range of motion was due to a preexisting condition. Oregon law states that when an injured worker has a preexisting condition that is either arthritis, or another condition that was diagnosed and treated before the work injury, the amount of permanent disability is “apportioned,”  or reduced, by the amount of contribution from the preexisting condition.  The Board said that the worker’s preexisting spondylosis was not a legally recognized preexisting condition that would allow for a reduction and the State did not accurately apply the law. The Board increased the worker’s disability award accordingly.

If you have any questions regarding your Oregon workers’ compensation claim, contact the law office of Philip H. Garrow

Insurance company has to follow the rules!

The Oregon Workers’ Compensation law has very strict time limits for appealing insurance company denials.  Injured workers who do not file timely appeals can lose all their rights and benefits.  The insurance companies must also follow the rules.  In a recent ruling, the Workers’ Compensation Board said that an injured worker’s request for hearing was timely even though it that was mailed after the 60 day deadline had passed.  This was because the insurer had mailed the denial to the wrong address.  The Board said that the injured worker had a good reason for the late request for hearing because he did not receive the denial in the way the law requires.  When the post office returned the denial to the insurer with notice of the correct address, the insurer did not re-mail the denial as is should have.  Therefore, even though the injured worker eventually received the denial one week before the appeal deadline, it was still not properly served on him so that his appeal filed a week after the deadline was accepted.

If you have received a denial on your workers’ compensation case or have questions regarding an on-the-job injury, contact the law office of Philip H. Garrow

Curative Treatment?

Thanks to the efforts of the Garrow Law firm, the court has issued a more important decision helping injured workers:

In SAIF v. Camarena, 264 Or App 400 (2014),SAIF claimed the injured worker was not entitled to have his claim reopened for his back strain.  The claim had been closed for more than 5 years so there was a requirement that the injured worker must be receiving “curative” treatment  order to reopen the claim and pay disability benefits.  The court agreed that the medical records showed  that the injured worker was not “medically stationary” and that his condition could improve with additional treatment.  Therefore, the Court ordered SAIF to reopen the claim and pay benefits.

The court held that the medical record easily would permit a reasonable person to find that the attending physician had prescribed treatment to bring about recovery from the injured worker’s back strain and the worker should have had his claim reopened.  The Court specifically disagreed with SAIF’s argument that it was up to the insurance company to decide if the proposed medical treatment was necessary to “cure” the injured worker’s condition

If you have questions or need help with your workers’ compensation claim, please contact the law office of Philip H. Garrow

Court of Appeals News

There has been some good news for workers from the Court of Appeals this year:

In Brown v. SAIF, 262 Or App 640 (2014), the Court held that an “otherwise compensable injury” is not defined by what conditions the insurer has accepted, but is rather “the work injury resulting from the work accident that caused the disability or need for treatment.”  The Court applied this principle  in SAIF v. Carlos-Macias, 262 Or App 629 (2014).  In Carlos-Macias, the Court said that the terms “compensable injury” and “accepted condition” are not interchangeable.  The insurer had refused to pay for a proposed diagnostic medical service, arguing that it was not needed for the “accepted conditions.”  Because the law says that injured workers are to receive medical services for the compensable injury, this includes diagnostic procedures for conditions not yet discovered.

If you have question regarding your workers’ compensation claim, please contact the law office of Philip H. Garrow

Permanent Disability

In a recent case, the Workers’ Compensation Board held that, because the insurance company had reopened the injured worker’s claim for both a new medical condition and an aggravation of a previously accepted condition, the worker was entitled to have both conditions rated for permanent disability when the claim was closed.  This resulted in a greater disability award for the injured worker. If you have questions about your on-the-job injury claim, including your possible entitlement to permanent disability benefits, contact the law office of Philip H. Garrow