By Donna Motley, Vice President of Claims

If you have ever been involved in litigation, you are aware that the legal process moves at a snail’s pace. Workers’ Compensation litigation is no different. The average litigated case takes approximately 2 years to resolve; that’s resolution without trial. If the case goes to trial, it would be even longer than 2 years. The Workers’ Compensation Agency has now put rules in place in hopes of expediting the process to “18 months”. As an employer, it is understandable how frustrating this can be – we feel your pain! Let me explain what happened on a recent case.

The “alleged” injury “allegedly” occurred on March 25, 2013. After a verbal altercation with a co-worker, the 52 year old employee walked off the job. The employee went to an emergency room the next day and returned to work on March 28, 2013 and proceeded to walk off the job again. The employer informed the employee to report to work on April 1, 2013 if they still wanted their job. Instead, the employee returned to the emergency room on March 31, 2013 and called the employer on April 1, 2013 to advise of the alleged work injury (first notice of claim).

The Claims Department was notified of the incident on April 11, 2013 – 17 days after the date of injury. The insured advised they wanted us to “take a hard line on this” claim. The employee alleged a back injury after lifting a box; names of witnesses were provided. Three witnesses were contacted, and no one knew anything about any type of injury the claimant may have sustained. Medical records were requested from the treating physicians.

On May 2, 2013 we received notice from an attorney representing the claimant. By May 24, 2013, the claimant had applied for Unemployment benefits (which were initially denied, but ultimately granted in July 2013).

The injury occurred in a small town. Claimant was seen by co-workers dancing at the local Lodge, walking and carrying grocery bags, picking up cans on the side of the road, was reportedly cleaning houses (for cash under the table), doing landscaping, etc. The claimant even approached one of the owners of the company while at the Lodge and asked if they could return to work. The employer requested a current disability slip, although the employee had technically been terminated when they did not return to work on April 1, 2013.

Medicaid filed a lien. We obtained an Independent Medical Evaluation that indicated, based on an MRI, the claimant had degenerative disc disease, no disc herniation, and ultimately no work related condition, although as of said date, August 2013, continued subjective complaints of back pain and numbness and the inability to sit for more than one hour. At this point the employee advised they had back and leg problems in 1997-1998 while working in Florida – so those medical records were requested.

Surveillance results found claimant lifting a lawn mower in and out of the trunk of a car, shopping, going to the casino, walking a dog, doing yard work and riding a bike.

We requested job logs from plaintiff’s attorney as the claimant has an obligation under Michigan W/C to be looking for work. Our attorney met with the insured. The insured advised they could not provide a “reliable” witness. The insured advised they “did not want claimant back”.

The employer was informed of what transpired at each hearing date; of all medical records received; of all surveillance results. The plaintiff’s demand was $38,560.08 (3 years of benefits) – we offered $1,000. The insured felt the MTMIC attorney was “getting rich” on this case when the truth of the matter was that the courts allowed plaintiff’s attorney “to do nothing”. At one point we even moved for a dismissal for lack of prosecution.

A lot of work went into this case, and the end result:

As of January 1, 2015, the insured found W/C coverage elsewhere because they were not happy with our handling of the case;

We facilitated the case, with all of the defenses we gathered, for $3,750 which includes payment of the Medicaid lien of approximately $700 – $34,810 less than the demand;

Plaintiff’s attorney will take approximately 1/3 or $1,000 – which leaves the claimant with an income of approximately $1,000 per year for 2 years;

Expenses on the case totaled: $1,045.82 for Medical / $14,938.91 for Legal & Surveillance;

The State average weekly wage for 2013 was: $886.56 with a W/C maximum benefit rate of $798

The average Redemption rate for 2013 was: $62,198.08

This case settled for $58,348.08 less than the State average. Litigated cases don’t “go away” – plaintiff attorneys only get paid if there is a settlement. I would think this employer would have been pleased with the outcome. We took the hard line.