Need an HR person to help regarding a personal injury situation (long)

[GolfVIDriver]

Long story short, my wife and I are between a rock and a hard place, and we do not know what to do. The cliffs notes are: She got hurt on the job, doing something that was probably outside of OSHA regulations, and the insurance company has told her they she has reached MMI and they are no longer helping her. While she IS better, she still cannot go back to work and cannot handle more than 20 lbs.

The situation:

My wife is a mobile radiology tech. This means she has a company car, and drives around to nursing homes with a 100lb X Ray machine in the car, which she wheels into the patient in question. The company is a very small company (5 people in the remote Southern Indiana home office, and a handful more out of my wife's office here in Chicagoland). The X ray machine is very large - it took up the entire back end of a Focus Wagon. She was able to deal with it by levering it out of the car onto its wheels over the bumper, and it wasn't a big deal up to that point. She had been with the company 5 years up to the incident, and is considered to be one of their best employees.

About a year ago, the president of the company changed the company focus from nursing homes to personal homes, and started sending my wife into seriously seedy areas of south side Chicago. We knew this was a recipe for disaster, as she was pulling her machine up 2 flights of stairs in old Chicago bungalows. We complained that this was not acceptable, but the boss assured us this was temporary.

2 weeks or so after this conversation, as my wife was easing the machine down a set of stairs, the machine got away from her, and took her with it. It tweaked her back. She immediately went onto disability, and she started getting medical care through the insurance company. She has tried everything from physical therapy to steroidal injections into her spine. Her diagnosis is musculo-skeletal in nature (I do not know the details) but I do know it is a soft tissue injury.

Her current situation is she has improved to about 60-65% of what she was before, and is slowly improving. Nobody can tell us how much further she will improve, as the insurance company is no longer covering medical visits. Carrying groceries are not a problem, doing laundry takes a bit of effort. Standing for a long period of time, or sitting on a wooden bench for example starts to become painful. Hoisting a 100 lb X Ray machine in and out of a car, and driving around 200 miles a day, is pretty much still out of the question.

She was sent to an Independent Medical Exam (IME from now on for short) that her insurance company provided for, and after 15 minutes, they reported that she is 100% healed and can go back to the job immediately - in fact, she had been healed 4 weeks after it had happened.

The insurance company told us 2 weeks ago that they are honoring the opinion of the IME and they feel she has reached Maximum Medical Improvement, and they are no longer paying for lost wages or medical attention in this matter. They further stated that we have the right to retain legal council.

Pushing the situation up to a supervisor, I had a friendly conversation with him. He has empathy for the situation. I explained that while she IS getting better, the findings of the IME are in direct competition with the personal doctors she has been seeing (recommended to her by the insurance company), and that she is far from healed. She cannot go back to work, and their findings have resulted in a loss of income. His closing offer was a settlement, and that he would have specifics in a week or so. THis was last week, and that's where the situation stands now.

Further complicating matters, there are no other X Ray jobs out there, and her company has no admin functions she can do remotely due to the fact that the company is headquartered over 400 miles away. She has decided recently to pursue a Business Admin bachelors degree because of this, and goes into school over summer session.

My questions:

I don't feel the insurance company is giving us a fair shake. What blurs the lines though is she IS improving, but cannot go back to work to pass the time till she goes to school.

What can we do? Are we really down to the lawyer option, and if so, is it even something we should pursue?

ANy help would be appreciated. Thanks!

[Numbersix]

Wow. I'm sorry to hear about this. That sucks.

DISCLAIMER: I'm in recruiting, I'm not a benefits specialist. I'll give you what my limited knowledge from the SPHR exam provided me.

Has she been on Short/Long-Term Disability during this time?

Unfortunately, the insurance company is going to do everything they can to stop paying claims and limit their liability. It also sounds like she cannot perform her job without reasonable accomodation. This may mean that she could be covered by the Americans with Disabilities Act:

http://www.eeoc.gov/facts/ada17.html

I assume you have all documentation of when/how the incident happened and all information from every medical professional, doctor visit, correspondence with the employer, etc? If yes, I think it is worth at least consulting with an employment law attorney to determine what is the best course of action at this point. It sounds like she CAN still do the job--just not in the way she had been until recently. So it's possible a 'reasonable accomodation' could be performed without it triggering the 'undue hardship' clause under ADA.

[GolfVIDriver]

Wow. I'm sorry to hear about this. That sucks.

DISCLAIMER: I'm in recruiting, I'm not a benefits specialist. I'll give you what my limited knowledge from the SPHR exam provided me.

Has she been on Short/Long-Term Disability during this time?

Unfortunately, the insurance company is going to do everything they can to stop paying claims and limit their liability. It also sounds like she cannot perform her job without reasonable accomodation. This may mean that she could be covered by the Americans with Disabilities Act:

http://www.eeoc.gov/facts/ada17.html

I assume you have all documentation of when/how the incident happened and all information from every medical professional, doctor visit, correspondence with the employer, etc? If yes, I think it is worth at least consulting with an employment law attorney to determine what is the best course of action at this point. It sounds like she CAN still do the job--just not in the way she had been until recently. So it's possible a 'reasonable accomodation' could be performed without it triggering the 'undue hardship' clause under ADA.

She cannot do the job. Period. She could do it under duress, but she'll be in agony at the end of the day.

We do have all records and correspondence, but I am afraid a consultation is all we have left.

[firefighterjunkie]

My questions:

I don't feel the insurance company is giving us a fair shake. What blurs the lines though is she IS improving, but cannot go back to work to pass the time till she goes to school.

What can we do? Are we really down to the lawyer option, and if so, is it even something we should pursue?

ANy help would be appreciated. Thanks!

I was a paralegal for 8 years doing personal injury, workers comp and med mal. Anyway, yes, you need to hire an attorney asap.

The insurance company has their own contracted doctor's who perform the IME's - and the sole purpose of the IME is for them to basically have a reason to cut you off from further treatment and incurring additional costs. Most IME's are not favorable to the patient. If you hire an attorney, your attorney can have another doctor perform an IME/exam to counter the findings of the first one.

Additionally, if you accept a settlement, you are closing your case - so do NOT do that.

Call an attorney immediately and bring in whatever paperwork, medical records, etc that you have. Most PI attorneys do their work on a contingency basis, so they would take a % of the final settlement, if there is one.