By: Eric D. Abes

Last week, the White House announced a new hotline for Veterans to call with complaints and concerns about the Department of Veterans Affairs. Everything from late payments, delayed or poor medical care, to poor hospital conditions can be reported. As the Military Times reported here, the new hotline is to collect, process, and respond to the complaints of individual veterans in a responsive, timely, and accountable manner.

The hotline is currently in the “soft launch” stage. By August 15, it is supposed to have staffing by live operators 24 hours a day, 365 days a year. All calls will be confidential, but veterans will be asked for personal information if it is needed to resolve a specific problem.

The number is 855-948-2311.

At Abes Baumann Attorneys, we applaud anything that can give veterans a voice. But sometimes a voice is not enough. When you need help obtaining the benefits you deserve, let us take point.

By: Sandra Weigel Kokal

As discussed in prior blogs, the Insurance Company may try to limit your benefits with the Impairment Rating Evaluation (IRE). An IRE is a physical examination where the doctor determines your level of disability. After receiving 104 weeks of benefits, the PA Workers’ Compensation Act requires an injured worker to submit to an IRE. If the doctor finds that your impairment is over 50%, you will continue to receive total disability workers’ compensation benefits. However, if the doctor finds your impairment is less than 50%, your status will change from total to partial disability.

A recent Supreme Court case, Duffey v. WCAB (Trola-Dyne, Inc.) has given doctors more direction on what is required in their IRE examinations. According to the Supreme Court decision, a doctor performing an IRE must consider ALL of the conditions that the doctor believes are related to the work injury, including any psychological injuries (such as depression or post traumatic stress disorder) that might occur as a result of the work injury. Therefore, even though the description of your injury on the Notice of Compensation Payable (NCP) might not include all injuries, the doctor must address all possible work related injuries. The Supreme Court stated that the doctor is required to render a detailed whole person evaluation in order to support any change in workers’ compensation benefits. This means the whole body evaluation cannot be withheld based on the employer’s description of your injury on the NCP. Your IRE could be found invalid if the doctor fails to perform a whole body impairment evaluation.

Since an IRE can limit your workers’ compensation benefits, the best way to protect yourself is to contact one of the attorneys at Abes Baumann to review the IRE and determine its accuracy.

By: James R. Burn, Jr.

Many of us are familiar with the tale of the Trojan Horse. Achilles and his soldiers, in order to defeat Troy and obtain access to their kingdom, created a Trojan Horse and wheeled it up to the gates of Troy. Inside of the horse, Achilles and his soldiers waited for the Trojans to wheel the Trojan Horse through their impenetrable walls. Once inside the walls, they slipped out and defeated their enemy.

We often advise our clients to beware of insurance companies bearing gifts. Insurance carriers and their adjusters will often display what would appear to be wonderful acts of kindness to injured workers. They may offer to have a nurse come with you to your examinations. They may tell you that they are looking out for your best interests and offer you what they say is a very fair settlement.

These “gifts” from insurance carriers are most times nothing more than a Trojan Horse. They try to earn your trust and allow you to lower your guard at which time you find yourself out of benefits or back to work before you are physically ready.

We caution injured workers from being fooled by insurance carriers and their Trojan Horse tactics. Please feel free to contact our firm and talk to an attorney for free about your workers’ compensation case and “friendly” insurance adjusters.

By: Roger D. Horgan

A careless person or business causes an accident. The accident leads to injuries and medical expenses. An insurance company or other type of health plan will pay expenses for the victim. But then seeks reimbursement if the victim recovers money. Certainly, the party that pays the medical expenses should be made whole every bit as much as the victim who suffers the injuries. What could be simpler?

However, health insurers pay medical expenses that arise from accidents with and without someone at fault. In most situations there is no expectation of repayment. Nevertheless, virtually every health plan includes language permitting them to recover what they have paid in cases where the insured obtains a recovery from a negligent party.

What happens in the situation where the person at fault has no assets, no insurance, or inadequate insurance? Shouldn’t the law require the available funds to be divided evenly between the accident victim and the health insurer? What happens when the case against the negligent party is not perfect, and the situation calls for a compromise? Is the health insurer compelled to join in the settlement of the case?

Generally speaking, the answer to these questions is no.

The primary example of this lack of equity is seen in the case of self-funded health plans established by employers. Most of these are written with language which permits the plan to receive 100% of what it has paid out. This is true whether or not the accident victim recovers any money. The insurers are not even required to reduce their claims to account for the costs of litigation, including attorney’s fees. The courts enforce that language literally, whether or not doing so will leave the accident victim without any compensation.

What about when the accident occurs during the course and scope of employment? If a truck driver is injured by the negligence of another driver, his employer will pay workers’ compensation benefits. The payment of those benefits creates a lien against the negligent driver. The employer is given first preference in recovery of whatever funds are available. The injured party (the employee), may be left with no recovery at all.

Liens arising from payment of medical expenses by Medicare, Medicaid, and private insurance plans also create similar problems.

There is no perfect answer to the problems created by liens and subrogation, but we handle them on a case-by-case basis. We recommend purchasing as much underinsured motorist coverage as possible in your automobile insurance policy. Purchasing private disability policies may also provide relief.

Abes Baumann and other plaintiffs’ attorneys, fight the battle within the battle. We pursue every legitimate avenue to reduce or eliminate liens and undertake tough negotiations to obtain reductions or waivers of the liens where possible. Despite the lopsided playing field, we may be able to resolve liens in a manner that is acceptable to our clients and the lienholders alike. If you find yourself in a similar situation, please call Abes Baumann for advice.