MG, a 33 yr old Spanish speaker working as an order picker for Grainger Company, contacted Lipkin & Apter following a back injury. He had to retrieve a 250 lb box racked near the warehouse ceiling. He used a fork lift truck to get to that level, then tried pushing the box onto a pallet, to take down to ground level. In so doing, MG began experiencing low back pain radiating down his leg.
MG went to his family doctor who prescribed light duty work, which Grainger accommodated. A CT scan failed to show nerve root involvement as a source of MG’s pain. At this point, Grainger referred him for an Independent Medical Evaluation (IME), mandatory under the rules.
What’s an Independent Medical Evaluation (IME)
An IME is where the Workers Compensation Insurance carrier selects a doctor to examine the worker, review pertinent medical records, then write a written as to whether the worker was injured on the job, needs to remain off work, and requires ongoing/future medical treatment. Once an IME gives an opinion favorable to the company- ie. that the worker either was not injured on the job or Is capable of returning to work, workers compensation benefits are cut off.
IME Dismisses Injury
In MG’s case, the IME doctor wrote that his complaint of pain could not be corroborated by any objective medical findings, that he had reached maximum medical improvement, and was able to return to his regular work duties. All benefits- medical and financial- were then cut off. This left MG in a position where he had no income, and no way of providing for his family. And still in pain.
Group Health Insurance Coverage
MG was able to get necessary medical treatment through his company paid group health insurance. Under the law, a company discharges its duty to provide medical treatment to an injured worker through company paid group health insurance. MG received 3 epidural injections into his back, which partially relieved his pain. His doctors did not believe MG required surgery, and beyond the injections, prescribed only that he not return to work at Grainger, but rather, find other, less demanding work. The Company had cut off MG’s benefits, and believed he had suffered only a minor low back injury worth very little money.
Settlement Proves the Prudent Path
This meant that case would have to go to trial to maximize benefits to which MG was arguably entitled. Yet with the absence of findings on the CT scan, and absence of medical treatment prescribed by MG’s own doctors, trial was not a sure bet. Moreover, MG made clear that he did not want to proceed to trial, as he could not hold out any longer without a steady income stream. He authorized us to obtain a settlement. After a brief period of negotiation, we were able to get the WC insurance carrier to pay MG $58,000, which he accepted,
Personal Circumstances Dictate Best Option
Resolving an injury case- be it work related or personal injury- must take into account the personal circumstances and certainly, the wishes of our client. As attorneys, our goal is to give our clients the information they need to make a decision that best suits their needs. Sometimes this involves the client making a tough decision. But we believe that a client taking into account the reality of his/her own situation is the best, really, the only way of resolving a case.