This is a summary of recent results my office has obtained for our clients. We fight insurance companies’ denials on a daily basis! If your claim is denied, or the insurance carrier tells you the injury is preexisting or the pain you feel is because you are old even though you never had pain or an injury before, call my office so we can evaluate and fight for the money and benefits you deserve under the Texas Workers’ Compensation Act. Often times injured workers are made to feel as if the injured worker did “something wrong” or like a criminal. Injured workers are overwhelmed by the number of documents, terminology and having to deal with the insurance adjusters, medical providers and being look down upon. The insurance carrier will often get reports from “medical doctors” you have never seen who say nothing is wrong with you or the pain you feel is not related to your work accident. All of this is overwhelming. You do not have to face this alone! If you are injured on the job, call my office and we can help you fight the insurance company for the money and benefits you deserve! Read the results below. If the facts below seem similar to your claim, call me! It is better to call early in a claim rather than later. What you do now, will determine your outcome! My office handles auto accident claims, work accident claims, third party claims, offshore injury claims and any other injury claim.
Auto Accident Case Results
Knee and shoulder injury. Client was injured in an automobile accident, injuring her right knee and right shoulder. After paying attorney fees and all medical expenses, client received $92,342.78.
Lower back injury. Client injured her lower back in an automobile accident. The client received $121,000.
Workplace injury. Client was injured at work and after paying attorney fees, all liens and medical expenses, client received $73,220.25.
Wrongful death car accident. Client’s mother was killed in a tragic automobile accident. After the claim was initially disputed, the claim settled for a confidential amount.
Couple both injured in car accident. Husband and wife were involved in a motor vehicle accident, and the case settled for a confidential amount.
Work-Related Injury Case Results
Longtime employee’s workplace injury more extensive than insurance company claimed. Claimant was an employee of his employer for over 21 years. He was injured within the course and scope of his employment. The insurance company disputed the extent of the claimant’s injury to include L5-S1 herniated nucleus pulposus and radiculopathy. The claimant was evaluated by a designated doctor who determined that the compensable injury included a lumbar sprain/strain, L5-S1 herniated nucleus pulposus and radiculopathy. After a benefit contested case hearing, the hearing officer found that the compensable injury extended to include a herniated nucleus pulposus at L5-S1 and radiculopathy. As a result, the claimant was entitled to medical treatment and was able to get the surgery that his doctor had recommended.
Employee injured in work vehicle; insurance company claimed intoxication. Claimant was involved in a motor vehicle accident. The claimant left his house in the company vehicle in response to a repair call, and while on the way to the customer’s home, was involved in a car accident. The claimant sprained his shoulder and fractured his right foot due to the accident. The insurance company disputed that the injured worker was in the course and scope of his employment at the time of the accident; stated that the claimant was intoxicated at the time of the accident, relieving the carrier of liability; and disputed the claimant’s ability to earn his pre-injury wages from October 8, 2009, through the present. After a benefit contested case hearing, the hearing officer found that the claimant was in the course and scope of employment at the time of the accident, was not intoxicated at the time of the accident and had a disability that was the result of the compensable injury from October 8, 2009, through the date of the hearing. As a result, the claimant was entitled to reasonable and necessary medical treatment and lost income benefits from October 8, 2009, to the present, and the carrier was not relieved from liability because the claimant was not intoxicated at the time of the accident.
Longtime employee’s back injury was not pre-existing, despite what insurance company claimed. Claimant was an 18-year employee of a company and was injured in the course and scope of his employment. Insurance company disputed the extent of the claimant’s low back injury to include lumbar disc herniation at L5-S1 and lumbar radiculopathy. Insurance carrier also disputed claimant’s ability to earn his pre-injury wages as a result of his injury from September 5, 2009, to the present as a result of his work-related injury. The insurance also claimed that it could take credit for a job offer the employer made to the injured worker. After a benefit contested case hearing, the hearing officer found the following: The injured worker’s work-related injury extended to include lumbar disc herniation at L5-S1 and lumbar radiculopathy, the injured worker was unable to work or earn his pre-injury wages as a result of his work-related injury and the employer’s job offer did not comply with Rule 129.6 and the carrier could not take credit. As a result, the injured worker was entitled to reasonable and necessary medical care for his disc herniation at L5-S1 and lumbar radiculopathy and lost wage/income benefits from September 5, 2009, to the present, and the carrier is not allowed to take credit for wages that the injured worker would have earned as a result of the employer’s invalid job offer.
Welding injury leads to amputation; insurance company claims it was as a result of a pre-existing condition. The injured worker worked as a welder for a company and was injured in the course and scope of his employment. On the day the injured worker got injured, he was severely burned and ended up having his foot amputated as a result of the injury. Insurance company disputed that the injury was caused in the course and scope of employment and tried to claim that his injury was a result of his diabetic condition. The insurance carrier also tried to claim that the injured worker’s testimony of how the injury occurred was inconsistent and there were no medical reports to support that this was an on-the-job injury. Insurance carrier also indicated that the injured worker’s inability to earn his pre-injury wages and work was a result of his diabetic condition and not as a result of his work-related injury. This left the injured worker without medical benefits or income for months. After a benefit contested case hearing, the hearing officer found the following: The injured worker sustained a compensable injury on May 3, 2007, and the injured worker had a disability from May 5, 2007, and continuing. As a result, the injured worker is entitled to reasonable and necessary medical care for foot amputation and is entitled to lost wage/income benefits from May 5, 2007, to the present.
Employee injured; insurance company claims it was pre-existing. Claimant sustained a compensable injury in January 2022 and had disability as a result. This injured worker was an employee or the month and had a stellar attendance record, but the insurance carrier denied the claim. The insurance carrier said the injury was pre-existing despite no evidence of an injury to the claim body part prior. The Admin Law Judge found for the injured employee and rejected the insurance carrier’s theory as well as the testimony of a doctor who is routinely hired by insurance carriers.
Insurance company claims employee did not notify employer correctly, despite text message evidence to the contrary. Claimant sustained a compensable injury in January 2022. Insurance carrier is not relieved from liability under Texas Labor Code § 409.002 because of Claimant’s failure to promptly notify her employer pursuant to § 409.001. Claimant had disability resulting from the compensable injury through the date of the hearing. The insurance carrier disputed the claim and said the injured employee did not report the injury, despite having text messages from injured employee to her supervisor, and stated the injury was because the Claimant was old. The Admin Law Judge found for our client and now she will get her surgery and income benefits.
Employee’s injury not due to old age, as insurance company claimed, but instead a workplace incident. Claimant sustained a compensable injury in June 2020. Claimant has disability resulting from that injury through the date of the hearing. This injured employee had worked for his employer for approximately 20 years. The insurance carrier denied his claim and said it was due to old age. The injured employee did not have any issues prior to his injury date. The injured employee at first tried a free service to get his benefits but eventually hired my office and the Admin Law Judge found in his favor. This injured worker received close to two years of lost wages and is now a surgical candidate.
Timeline on injury date do not line up with insurance company’s argument. Claimant sustained a compensable injury in December 2021 and had disability from that date. The injured employee worked from 6AM to 4PM every day and had no issues working from 6AM to 9:30AM when his injury occurred. The injured employee does heavy labor and insurance claimed the injured employee injured his shoulder when he was washing his vehicle at 4AM in the morning. The Admin Law Judge did not buy the insurance company’s argument and found for the injured worker.
Lack of maximum medical improvement means injured employee needs additional benefits. Compensable injury of January 2021 extends to and includes left shoulder tendinopathy. Claimant has not reached maximum medical improvement. Because Claimant has not reached maximum medical improvement, an impairment rating cannot be assigned at this time. Claimant had good cause for failing to submit to the designated doctor’s examination in January 2022, and she is entitled to temporary income benefits from January 2022 through March 2022. The insurance company disputed the severity of the shoulder injury, claiming old age and a preexisting condition. The carrier also tried to prematurely cut off injured employee’s right to income benefits by claiming that she had gotten as good as she was going to get. The carrier tried to claim she missed an appointment that was arbitrarily changed by a doctor. The Admin Law Judge rejected all these arguments and found for the injured employee. Just because the insurance company says it does not make it true.
Extent of injury disputed by insurance company, but we proved otherwise. The parties agree that the Claimant did have disability resulting from an injury sustained in January, from February through April. Parties agree that the compensable January injury does extend to an include avascular necrosis right posterior talus laterally, talus laterally, right lateral ankle ligament rupture, right syndesmosis rupture, right deltoid ligament rupture, right ankle synovitis and capsulitis. We were able to get the insurance company to agree on the seriousness or extent of the injury and get the carrier to pay income benefits while injured employee was off work due to surgery. The carrier tried to claim a preexisting condition and the injured employee had no medical to support. We presented the evidence to the contrary and the insurance company withdrew its dispute.
Light duty job offer does not counteract concussion and PTSD. The insurance carrier denied income benefits and treatment for a concussion and PTSD. The income benefits were denied based on a light duty job offer. We were able to provide a medical report showing the lost wages were a result of the work injury and the offer was not valid. The insurance carrier paid the back pay and began weekly income benefits. If your benefits are denied, contact our office.
Insurance company claimed intoxication; judge ruled against this argument. Claimant sustained a compensable injury in November 2021. Claimant has disability resulting from the compensable injury through the date of the hearing. The insurance company claimed that the injured worker was intoxicated at the time of his injury. There was no testing done on the date of the injury and this argument was rejected by the Admin Law Judge. Compensable injury did not occur while Claimant was in a state of intoxication, as defined in Texas Labor Code § 401.013 and therefore the insurance company is not relieved of liability for compensation. This injured employee received his back pay and treatment and is now pain-free and back at work.
Claimant did not have pre-existing condition; Admin Law Judge rules in favor of claimant. Claimant sustained a compensable injury in October 2020. Claimant had disability from October 2020 through March 2021. Insurance carrier argued that the initial medical records did not identify a specific incident at work and that Claimant’s underlying, pre-existing medical conditions could be the cause of Claimant’s pain. The insurance carrier had no evidence of a prior injury. Doctor provided a peer review report and testified at the hearing that Claimant’s lack of a specific mechanism of injury in the early medical records is consistent with how chronic, disease of life findings present, not acute injuries. The Admin Law Judge rejected this argument and found the injured worker sustained an on the job injury and was to be paid for time off work.
The insurance carrier disputed income benefits based on a job offer. We were able to present evidence that the job offer did not comply with the law nor the work restrictions. At the benefit review conference, the insurance carrier withdrew its dispute and entered into an agreement to pay the injured worker.
Injured worker did not reach maximum medical improvement; required more care. The carrier tried to stop the injured worker’s income benefits and claim he was at maximum medical improvement. We were able to show the claimant needed additional treating and possible surgery and the Admin Law Judge found for the injured employee. Claimant has not reached maximum medical improvement. Because Claimant has not reached maximum medical improvement, an IR cannot be assigned at this time. Claimant had disability from September 2021 through the date of the contested case hearing, resulting from September 2021 injury.
Claimant missed a designated doctor exam due to doctor’s fault. The insurance company claimed an injured worker did not have good cause for missing a designated doctor exam. However, the designated doctor did not follow the rules in changing the appointment. Once presented with this information, the carrier agreed to pay our client the back income benefits he was owed.
Insurance carrier claimed a more limited injury than what actually happened. The compensable injury of January 2021 extends to and includes intervertebral disc herniation lumbar region L4-L5. Claimant has not reached MMI. Because Claimant has not reached MMI, an impairment rating cannot be assigned at this time. The first certification of MMI and assigned impairment rating from the doctor in August 2021 did not become final under Texas Labor Code § 408.123 rule 130.12. Insurance carrier maintained its position that the compensable injury was limited to a lumbar sprain/strain and relied on the opinions of three doctors it hired to fight this claim to which all three doctors explained that the MRI findings were degenerative and there was no medical evidence to support. The carrier also claims the impairment rating became final. We collected medical evidence of the severity of the injury and the ALJ found for the injured worker. The injured worker had surgery for her serious work-related injury. If you are injured on the job, do not let the insurance company scare with their doctors and denials. Call my office.
Insurance carrier claimed the injured employee didn’t work on the date of injury. The insurance carrier denied the claim saying the injured employee did not work on the day of the claimed injury. We were able to get time sheets, text messages and video footage showing our client worked on the claimed injury date. We presented this information to the insurance carrier and the insurance carrier withdrew its dispute that the injured employee was injured during the course and scope of employment. This injured employee is now eligible to receive income benefits and reasonable and necessary medical treatment for her work-related injury.
Insurance carrier claimed employee was intoxicated at time of injury. Claimant sustained a compensable injury in March 2022. The compensable injury did not occur while claimant was in a state of intoxication, as defined in Texas Labor Code § 401.013, therefore Insurance Carrier is not relieved of liability for compensation. Claimant had disability as a result of the compensable injury from March 2022 through the date of this hearing. The insurance denied the claim based on a urine sample that had a different name than the injured worker. The insurance carrier maintained this frivolous dispute and the Admin Law Judge soundly rejected the carrier’s position. This injured worker will get paid his lost wages and have his medical bills paid.