Meet The Liquidator: Why do some insurance companies refuse to pay injured workers?

I. The Workers' Compensation Attorney Believes

“Suspending disbelief” is one of the enjoyable things that makes stage dramas believable. We tell ourselves that we’re about to go and watch a presentation and be entertained. We suspend our disbelief. We trust the storyteller. Sometimes in much the same way, after an injury, when knowing that certain presentations of truth are essential, we really want to believe that everything will just work out for the best… that the promises inevitably made by the insurance company are not just make believe. But suspending our disbelief can also harm our legal case. Especially, if it means delaying getting help from an experienced Worker’s Compensation attorney. Many injured workers legitimately find reality too late: that their real injuries are not receiving proper, full attention from their employer’s insurance carrier. An experienced workers compensation attorney knows these ins and outs, and common attempts to frustrate valid worker injury claims. One interesting case revealed some of the inner workings of a major insurance company. In fact, the insurance adjuster was so well known for defeating apparently legitimate injury claims, that she became known as the “Liquidator.”

II. Liquidator Meets RN

The injured worker in this case was lucky to have two very important people in his life: first, his wife. She just happened to be a very experienced and knowledgeable RN, who lovingly worked with him constantly, over the course of more than two years, to try to get maximum medical improvement. The second most important partner in the ultimate success of this case was an experienced workers compensation attorney. At the same time, however, the decision to bring an attorney on board came only after a series of the most frustrating attempts to block an effective and fair settlement for the injured worker.

Working with his wife, the injured worker had managed to see the case develop fairly properly. Until, as the Worker’s Compensation attorney later showed, came the insurance negotiator, The Liquidator. She was so good at her job, at least from the insurance company’s perspective, that she had earned her nickname for liquidating injured worker claims. Her special ability was making tough cases go away, and push for low-cost settlements and compromise.

III.   Enter Stage Right: The Workers Compensation Attorney

This case represents a prime example of why it’s so essential to consult with a Worker’s Compensation attorney as early as possible after injury. Though the injured worker and his wife were clearly very smart and very talented, they inadequately recognized in the injury negotiations, an attempt to end-run their medical knowledge. Facing down The Liquidator obviously required extensive legal training in worker’s compensation, which the couple did not have. Even if they had legal expertise, the emotional toll taken by getting insurance promises ‘un’-broken, like in this case, are often devastating to the most sophisticated family.

IV.  Credibility is Key

Believability is essential to setting damages, and an experienced Worker’s Compensation attorney spends a great deal of time making certain of the facts of the injury and duration of resulting treatments. The key issues in this case were defining whether or not the insurance company and The Liquidator had been acting “in bad faith” or not. There is an element of contractual obligation that can arise, no matter how carefully an insurer may avoid putting apparent agreements into writing. Now, the background…

Mr. Chaisson was a middle-aged man who had a lifetime of positive work and great reviews as a crew foreman and utility lineman. The company he worked for serviced power companies and utility groups, all over the United States. This meant that Mr. Chaisson often worked away from North Carolina. His work was routinely dangerous and almost always strenuous…climbing poles or making repairs during the worst of weather. He was actually in West Virginia doing repair work to powerlines that had been collapsed in a significant ice storm.

His Worker’s Compensation attorney movingly described the dangerous, life-threatening conditions at the time of his injury. Mr. Chaisson had been in a remote WV area, with extensive drifted snow. Going down one of those snowy embankments, the man had fallen into a hole. Evidence from the Worker’s Compensation attorney’s crucial interrogatories showed how the injured worker “heard a pop noise, and (my) knee completely flipped to the right around (my) shoulder area.” It was a dangerous condition and situation. Mr. Chaisson’s Worker’s Compensation attorney next had evidence of the conditions at the time of the injury. Mr. Chaisson had been in a mountainous area, with 7 feet of snow. Going down one of those snowy embankments, Chaisson had fallen into that hole (masked by snowfall), which was shown to be over 5 feet deep. Evidence from the Worker’s Compensation attorney noted the worker’s cell phone didn’t work, owing to the mountainous geography and snowbanks. He was forced to crawl a great distance (also measured) to a roadway, causing further injury to his knee. Ultimately, he faced two years of intensive medical treatment because of the harrowing accident. Despite the long, long hours of therapy, there was mixed news on his recovery. The meniscal tear promised to be a permanently, life- changing event.

Conclusions:   

The initial offer from the insurance company was for $25,000. Unrepresented by a Worker’s Compensation attorney at the time, the couple declined that offer. They began to do more homework. Instead of just settling, they entered negotiations, which they thought were sincere on both sides. The injured worker and his wife then demanded $145,000. Facing a knee replacement, a couple realized that less money was not going to be right: or enough for his lost career.

A certain, fair figure (they thought) was finally reached to cover all the pain and suffering, and end-of-career decisions that they were facing. All this evidence was captured and later presented, when they had decided to retain an expert workers compensation attorney to face The Liquidator. The figure that had been credibly presented as minimally fair by the couple, and presumably accepted by The Liquidator: a number the Worker’s Compensation attorney would also prove, of almost $100,000. Thinking that they had reached a settlement amount, The Liquidator came back into the picture. To their horror, they found that instead of the $97,500 which has been communicated, this was (they were told) a “mistake.” Instead, the insurance carrier’s Liquidator refused to honor the compromise settlement, and again offered $25,000 again. All their work and preparation to put this behind them… apparently destroyed.

Now with the help of their experienced workers compensation attorney, the couple realized they could no longer “suspend their disbelief” about what was happening. The Worker’s Compensation attorney fought back, and won a commission award… an award based on the original settlement offer negotiated by the couple: $97,500. But the insurance company wasn’t quite done yet. They appealed that decision. This time, but with the continuing assistance of a qualified workers compensation attorney, the insurance company had to face the curtain call. They lost and then, finally, paid the couple what had been agreed to.

It’s not certain that The Liquidator would’ve acted any differently towards this couple if a workers compensation attorney had been on board from the first. This particular couple deserves a lot of credit for what they went through to present their case. What is almost certain however, is that the conduct of the case and their ability to know what was going to happen next would have been more definite. Additionally, frustrations of an appeal and further delays are often avoided by talking with an experienced workers compensation attorney immediately after an injury. If you, a family member or a loved one have been hurt in a workplace incident—or have questions about a prior or recent accident related to work or subsequent treatments, or involving related claims or your legal rights or hearings, payments or treatment, please contact us.  You will speak with a workers compensation attorney who can best answer your questions about how your case rights can be protected.  There is never a fee for this initial consultation.