Evansville, IN asked in Workers' Compensation for Indiana

Q: Workers' comp disputes knee surgery relation to claim. What can I do?

I'm in the process of negotiating a settlement, but workers' compensation is disputing that my knee surgery is related to my claim. I suffered a torn meniscus in my right knee, which was confirmed by two doctors, each with identical notes. After the company's doctor only did an MRI and claimed I was fine, I sought a second opinion. The second MRI confirmed the tear, and surgery was scheduled. All relevant documentation, including a note from the surgeon confirming it's the same injury, has been sent to my lawyer. Workers' comp still denies the surgery's relation to my injury. What can I do to ensure the surgery is recognized as part of my claim?

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1 Lawyer Answer

A: To begin, you are not "negotiating" a settlement. In Indiana, the treating physician would assign a permanent partial impairment rating (PPI). The value of your claim can be determined mathematically by plugging in numbers from the statute. If the claim is fully disputed, the only thing that you can "negotiate" would be a nuisance settlement From which you would still need to reimburse your group health insurance. If your group health insurance is an ERISA plan, I guarantee there is language in the plan that entitles them to reimbursement.

On your facts, you have an attorney. Why did you agree to pay your attorney 20% of your recovery if you have no faith in his/her advice? It's a rhetorical question. Your attorney should be able to guide you on this.

You have problems. you need to be preparing for trial so there can be some potential to make workers compensation responsible for all of your medical expenses. That is the only way that you will not be responsible to reimburse your insurance company. All group health insurance policies have an express exclusion for work-related injuries.

To be clear, there is no way to guarantee that you will win. To assure the greatest likelihood of success, your attorney needs to take the deposition of your treating physician who provides causation (explains how and why you were injured on the job). The transcript of that deposition will be admitted at trial. Very probably, the defense will take the deposition of the doctor who said that you were fine. That transcript will also be admitted into evidence. If you are able to convince the board member that your injury was work related, the board member will order the insurance company to be responsible for your medical bills and further order that your employer pay the amount of your PPI rating.

Trying to settle this case without going to trial is dangerous because whatever your health insurance paid for medical care is probably many times greater than the full value of your claim, much less nuisance value. The amount that an individual is compensated for any given injury in Indiana is among the lowest in the country, roughly 9% of what an individual would receive for the same injury in Illinois. All of which is to say that settling the case without going to trial and winning OR the workers' compensation carrier agreeing to assume responsibility for your medical bills, will almost certainly result in no recovery to you. You need to discuss all of this with your attorney. Good luck.

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