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I ran across an interesting scenario, and curious what FWF folks have to say about it. It's a copy and paste from another online post, so you should note the reference to "I" is not in fact me, civ2k1, but the original poster:

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I got into a car accident about 2 years ago. Someone rear ended me and pushed me into the car in front of me. I went to the ER and had back problems since. I got the back problems taken care of from medical treatment about 7 months ago. During my doctor's visits I told the doctor that at 1 point, the pain got so bad on my way to work, that when I got out of my car at work, i fell to the ground and had to go home. The doctor put in the medical notes that I injured my back at work because of that.

So I got a lawyer to handle all my medical stuff with the insurance company. We ended up settling out of court since the lawyer said the doctor note said I hurt my back at work. The lawyer was unwilling to fight for me, and seemed to be an ambulance chaser for the quick out of court cash. I was sent a waiver to sign and I was told by the lawyer before I signed that all the health insurance fees were taken care of through subrogration process and my health insurance.

2 days after I signed the lawyer waiver, I got a bill from my health insurance for $9,000 saying that they were not covering the injuries because they happened at work. I did not hurt myself while on the job or on the clock. It just happened to be in the parking lot when I experience the pain, but it was not work related. I tried explaining that to the health insurance but they said they are going off the doctors notes and they will not cover it.

So, I contacted the doctor and they said they cannot edit the medical notes. The doctor said they will write a letter to the insurance company for me indicating that I did not injure myself at work.

They lawyer the whole time is washing their hands of this and will not do anything. They made a phone call and they said that I am responsible for the bill and that I should file a work comp claim. The lawyer said they can help with filing the work comp claim. (I think they set me up with that to try and get more money out of me and I think they lied to the health insurance company).

So I guess I am wondering what to do? Shouldn't the lawyer still be dealing with this as part of the %33 settlement fee? ANY advice is appreciated.

If you do respond, I thank you in advance.

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This is an interesting situation. Funny you should ask.

There are at least 7 different things at play here, so far as I can tell:
1. How to select (or not select) an attorney
2. How workers compensation medical care differs from regular health insurance
3. What "secondary injuries" are and how they should be handled from an insurance claims perspective
4. The implications of signing off on an insurance settlement
5. What to do if you suspect a doctor has made a incomplete/inaccurate diagnosis or if you have reason to believe his/her notes are incomplete or inaccurate
6. what to do if you suspect an attorney's negligence or incompetence has resulted in an adverse legal situation
7. What an attorney's retainer or share of settlement does and does not cover

Sorry to say, your friend made several mistakes along the way

BEEFjerKAY said:   This is an interesting situation. Funny you should ask.

There are at least 7 different things at play here, so far as I can tell:
1. How to select (or not select) an attorney
2. How workers compensation medical care differs from regular health insurance
3. What "secondary injuries" are and how they should be handled from an insurance claims perspective
4. The implications of signing off on an insurance settlement
5. What to do if you suspect a doctor has made a incomplete/inaccurate diagnosis or if you have reason to believe his/her notes are incomplete or inaccurate
6. what to do if you suspect an attorney's negligence or incompetence has resulted in an adverse legal situation
7. What an attorney's retainer or share of settlement does and does not cover

Sorry to say, your friend made several mistakes along the way


what kind of mistakes?
and what should he have done instead at each step?

I don't have time to write up all of it ... and don't want to pre-empt others discussions, so I will just provide a few thoughts on one of the items

3 - Secondary injuries
Often when someone is severely hurt and requires an extended period of time to recover, they can be involved in another, unrelated episode in which something happens to aggravate the original injury or causes a new injury.

Example: Driver Dan receives back injury as part of car accident. One year later, while still receiving treatment for the original injury, Dan slips and falls on a grocery store's wet floor injuring his wrists (from trying to break his fall) and re-injuring his back.

In that situation, the grocery store could be held liable for the wrist injury in full. However the grocery would only be liable for the amount the slip and fall incrementally aggravated the back injury. As you can imagine, this can get very complicated and it's very easy for mistakes to be made along the way.

If they want to claim worker's comp, why should this person argue against it? I want to say he should hand the bill to his employer, however they might not like it, and if he's worried about his employment after something like this, then I understand the issue.

The other thing I'm wondering about is why he hasn't brought in another lawyer yet, someone who can at least provide another opinion.

ankitgu said:   If they want to claim worker's comp, why should this person argue against it? I want to say he should hand the bill to his employer, however they might not like it, and if he's worried about his employment after something like this, then I understand the issue.

The other thing I'm wondering about is why he hasn't brought in another lawyer yet, someone who can at least provide another opinion.


I have no expertise in the topic at hand but my common sense question is how difficult (or easy) will it be to file a workers comp claim now for a fall that occurred somewhere between 7 months to 2 years ago?

Not to mention the ethics of reporting an injury that was not work related. Workers comp claims are expensive for employers in the form of much higher premiums.

Workers comp won't cover this. Reread what I wrote about secondary injury.

At best, WC will cover the incremental (secondary) injury.

At worst, the WC claim will cause the primary healthcare insurer to reassess coverage ... which is what they have done.

It is likely that this is no way no how a WC injury, since WC covers injuries sustained in the course and scope of employment.
That means when you are brushing your teeth before work and chip a tooth, its not covered, even if you would have slept till noon if it wasn't for your job.
And it won't cover you getting rear ended by a drunk driver while driving to work.
Nor will it cover you falling out of your car after you park your car before you enter your workplace.
All states are different, and who knows maybe falling outside your car near your workplace is covered in your state. But its unlikely. One rare exception at least for the state of Wisconsin is if your employer has some specific place you must park and some specific walkway you must take to get to work, then any injury sustained while you are on your way to work from your parking spot is compensible (i think). Who knows if its that way for you, tho, in your state.

my questions begin and end with the doctor's mistaken notation that OP was injured at work. despite all the other mistakes, the doctor is the crux of the problem. to compel the doctor to correct himself, then file an amended claim with the insurance company is the first step. step zero is to find a competent lawyer. your state law will guide you the rest of the way since insurance is state regulated.

There are several of us on here who deal with both sides of personal injury cases. Did the tortfeasor's carrier who offered the settlement consider the disputed ER bill? In my jurisdictions, I would owe for the reimbursement of the full value of the ER bill regardless of what health insurance paid, assuming I related the treatment to the motor vehicle accident.

I don't like the scenario that this was within the treatment period related to the accident and went unpaid. It may be worth a call to the other persons insurance to find out if they considered this treatment. They may try to put you back to your attorney, but they may be willing to assist, especially depending on the local reputation of the plaintiff attorney. Your attorney could easily write a letter to the health insurer and get them to reduce their bill. This is often a tool that they use to maximize settlement value and compensation to both the client and the attorney's fee.

I'd be mindful of your local statute of limitations. Typically it's 2 years but there are many exceptions. It doesn't help that you have signed a release of all claims against the other carrier. They are likely out, so the issue would appear to be between you, your attorney, and your health insurer. You would also have the option to make a complaint to the local & state bar, but I would give the attorney the option to resolve the issue prior to doing that. Ultimately, they could open themselves up to malpractice, but I'd want sufficient information before I tossed that word around.

edit for typo



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