Someone I know has had an open Workman’s Comp case for 4-5 years now. I asked when it gets settled and was told “it will probably go on for the rest of life - like many other people.”
I know next to nothing about Workman’s Comp. Is this what happens?
FWIW, it was a knee injury that required surgery and this person said it never healed properly (could be true), but they can still do all sorts of things around their house and yard (including mowing lawn with a pushmower, rototilling a garden, etc), so I’m confused why they “can’t have any job.” I know several people who have had the same surgery and still work, albeit, not in “knee stressful” jobs.
Who knows more about Workman’s Comp than I do and is willing to share how it works?
Workman’s Comp varies from state to state. In my state, awards for “work-related injury” have a financial component which involves whether you are totally or partially disabled from full-time work (vocational disability) based on the number of jobs in a geographical area that the employee could have done before the work-related injury vs. the number of jobs in that same geographical are that the employee could do after the work-related injury. The financial award in my state is based on a matrix of percentage of vocational disability vs. percentage of salary.
There is also a medical component which involves the employer’s liability to provide ongoing medical treatment for the work-related injury over a period of time, up to lifetime benefits. The financial component can involve a lump sum payment (for accrued benefits) as well as periodic payments that last a certain length of time.
Usually there are “vocational experts” who will provide an opinion on the amount of vocational disability – each side, plaintiff or defendant, often will have their own expert. Each side may have their own medical expert to offer an opinion on the need for ongoing medical treatment.
In my neck of the woods, it is not uncommon for public employees to be photographed golfing, horseback riding, or standing with a medal after running a 10K… which opens an investigation as to just how incapacitated can someone be and still finish in the top 10% of a road race.
I am not aware of any situations with private employers although I’m sure there are whistleblowers there as well. But folks seem to get more riled when someone whose job it is to take tickets at a booth at a train station is too disabled to work… but they can still maintain an athletic lifestyle.
So the OP- yes, there are abuses of the system. There have been a few huge, scandalous cases of physicians and PT’s “in on the scam” who are basically willing to treat patients who they describe/certify as disabled, but whose lifestyles don’t seem to be hampered by their disability. Also an eye doctor that I recall… he was treating elderly people for diseases they didn’t have AND certifying patients with normal eyesight as impaired.
In the early 2000’s I was exposed to, and become incredibly sick from black toxic mold at my job. Trying not to be too graphic but mold spores lodged themselves in my sinus cavities and needed to be (for lack of a better term) roto-rooted out. I was physically sick for 2 years, had surgery, and it took about 18 months after that before I had my strength back to work - so overall nearly 4 years. It truly stripped me of life as I knew it. I filed a workers’ comp case, and had my medical expenses covered and nearly 4 years worth of living expenses as well. My employer fought it tooth and nail, and eventually was found guilty of burying OSHA indoor air quality reports. The sad thing is I wasn’t the only one affected. 2 women became pregnant during the situation, one had a pre-term birth and the other had a baby with major heart issues at birth (knock wood, both are now thriving); and another guy was having spontaneous nose bleeds.
What some might have thought was me lounging around watching TV when I “could have” been working could not be further from the truth. I had zero energy. I was wiped, physically and emotionally. While I might have been on the couch, and the TV might have been on, I saw and heard nothing. It was only filling the room with sound. I looked fine (well other than the 50 pounds I put on because I physically couldn’t move), I sounded fine if you talked to me.
I think my point is “we” really don’t know what an illness or injury does to someone, and while it may look like that person is “fine” and “could” be working, there may be other things going on that “we” aren’t seeing. Disability comes in may forms, many cannot be seen.
I’m glad you’re “that” person. I like to keep my information up to date. All I know about this is what I’ve been told by the person receiving benefits. They’ve been calling it Workman’s Comp since the injury happened.
How true, but this situation is nothing like you’ve experienced. I know what’s going on very well due to the person sharing with me.
I hope you’re better now and feel bad that you had to go through it.
Prior to this experience I thought Worker’s Comp was supposed to pay for medical treatment and income while the person was out of a job, then with some compensation for any permanent loss if there were any.
I had no idea cases could be ongoing long after the injury happened. I thought there would be a “settlement.” I also never realized that anyone who got injured on the job was prevented from working “any” job afterward - once everything is pretty much said and done (stable) with the injury even if it’s not back to pre-injury perfection. I assumed desk jobs or jobs not at all related to their injury would be ok to have, especially when people can do such things on their free time.
Learn something new every day.
I’m not envious BTW. I just wish our tax dollars went to more true needs once the actual medical part is resolved as best as it’s going to be.
Seems like the case where the medical issues are hard to verify by a third party (physician or other medical staff), so that there is some level of trust in the patient required. While most patients may be honest, there are enough dishonest ones (and sometimes collaborating dishonest physicians or other medical staff) trying to cheat the system that it becomes a problem. Then institutional attempts to stop the cheating result in roadblocks for more legitimate cases, where patients feel like the system assumes that they are liars and cheaters when they are not. Examples:
As a private small business employer, I’ve had two Worker’s Comp cases.
First: Hepatitis B contracted supposedly on the job. This was at the start of blood borne pathogens/universal precautions 30 years ago so no way to know how, when, or where employee contracted it. The case was settled based on loss of income for lifespan of work, though several years later employee was back in the career in a different city.
Second: Employee developed carpal tunnel syndrome requiring surgery on both wrists. Medical and % of wages covered for both surgeries 4 weeks apart. Orthopedic surgeon released her for return to work after 12 weeks, but while the surgery was successful, arthritis prevented her from continuing to work.
My premiums did not increase in this second case, can’t remember the first.
Those of us who are familiar with the one I mentioned have more or less shrugged our shoulders and ignore it now. If that’s their dream life - living off Worker’s Comp - so be it. It’s just annoying when we also hear how devastated they are to not be working. They could if they wanted to in our opinions (based upon the oodles they do at home) and it’s not like they left a dream job of some sort.
Years ago a lawyer in my then-firm was taking a deposition of a plaintiff in a workers comp case, and had this colloquy:
Lawyer: What do you do now for a living?
Plaintiff: I draw.
Lawyer: Oh, are you a graphic designer?
Plaintiff: I draw disability.
And the plaintiff had no trouble with “drawing” into the foreseeable future. Sometimes it’s just a question of culture and/or character.
I also know of employers – when I was with my former law firm – who hired investigators to videotape plaintiffs that were engaged in activities quite inconsistent with their claimed work-related injuries and medical disability; and sometimes the employer was able to re-open the comp case on the grounds of fraud. But not often.
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