A Union employee from Raleigh, NC, working as a car hauler, sustained a work injury in September 2015 which the insurance carrier, National Interstate Insurance, accepted as Right knee strain / sprain. The injured worker was receiving TTD wage loss benefits when he contacted us. In March 2016, the employer offered the injured worker a modified duty job at an off-site program that fell within his doctor’s restrictions.
The injured worker worked the off duty job at a loss of wages and he received PTD benefits during the time he worked the 2nd job. During the same period of time the injured worker attended an FCE which found that he had difficulty squatting, he had functional weakness and increased pain below the knee, that he should attend work conditioning to gain the ability to tolerate his work activities. The insurance carrier issued a Notice of Modification due to his off-site job and we filed an Employee Challenge. Shortly thereafter, the insurance carrier filed a Suspension Petition alleging that the injured worker was offered a specific job. In May 2016, the parties entered into a Stipulation in which the insurance carrier agreed that they owed he injured worker TPD benefits from the time he began working the modified duty job in March and the Employee Challenge Petition was dismissed. In May 2016, the insurance carrier then filed a Modification Petition because they alleged that the injured worker had been medically cleared to return to full time work and In June 2016 the insurance carrier withdrew its Suspension Petition. The Judge then dismissed the Modification Petition as being moot because a Supplemental Agreement was issued which resolved the issues in the Petition. The insurance carrier had the injured worker attend an IME with Dr. Getz in September 2016 and he reported that he had not reached full recovery and that he was unable to perform the essential functional requirements of his original job and his post-op rehab was not complete but he could return to work under restrictions with no squatting until after completion of a work conditioning program. The injured worker did attend a course of work conditioning. The insurance carrier then sent the injured worker to another IME with Dr. Malumed in April 2017 who opined that he was fully recovered from his injury and they then filed a Termination Petition based on the Report. The insurance carrier had also filed a Utilization Review regarding the care the injured worker received from his orthopedic doctor. The UR Reviewer found Dr. Wood’s care to not be reasonable and necessary for his work injury and we filed a Petition for Review of the Utilization Review Determination and during this same period of time, the injured worker had stopped working but was looking for work within his restrictions. This case had several Petitions throughout the pendency of the claim. During this extensive litigation, the case ultimately settled for $150,000 via a full Compromise and Release. During the pendency of his claim including settlement, the injured worker received $237,848.74 in wage loss benefits and $17,815.10 in medical benefits for his work injury.
