In this case, our legal and claims team successfully proved that the claimant’s left foot and ankle issues were not causally related to the accidental injury. The claimant’s past medical history was used to prove that the left foot and ankle issues were from previous problems and not from the accident.
Claims and legal professionals paired up with our Special Investigations Unit (SIU) in order to build a case for denying authorization for knee surgery and terminating temporary total disability benefits for a claimant who they suspected had fully recovered. After obtaining video of the claimant working on the side fixing cars, the video was sent to our Independent Medical Examination (IME) doctor for addendum. The video was shown at the Commission and the claimant was found to be at maximum medical improvement.
The claimant in this case alleged that a defective step on a truck caused the claimant to injure their hand. Our attorney and SIU prepared their defense and after testimony from witnesses stating that the injured hand was a result of an altercation and not a faulty step on the truck, the Commissioner disallowed the claim.
Employer’s TIP:Remember, prompt and thorough investigation of the claim starts with you. Report injuries immediately. The more information Chesapeake Employers has to prepare for a possible hearing, the stronger our case. Please work with your claims adjuster by staying involved throughout the claims process.
Compensable Injury – An injury caused by an accident arising from the employment and in the course of the employee’s work. The employee is entitled to receive compensation.
Maximum Medical Improvement (MMI) – The point at which the condition of an injured person is stabilized. No further recovery or improvement is expected, even with additional medical intervention.
Temporary Total Disability (TTD) – A condition where an injured party is expected to recover, but is unable to work at all during the recovery period. Compensation is paid at 2/3 the average weekly wage, not to exceed the state maximum or go below minimum.
Temporary Partial Disability (TPD) – A condition where an injured party's capacity to work is temporarily impaired, but he or she is able to continue working in a reduced manner and is expected to make a full recovery. Compensation is paid at 50% of the difference between the average weekly wage and the present wage earning capacity not to exceed one-half of the state’s average weekly wage (TTD rate).
Permanent Partial Disability - A condition where the injured party's earning capacity is impaired for life, but he/she is able to work at any gainful employment for his/her remaining lifetime. Maximum permanency rates vary by weeks/length of the award and the affected body part(s).