Insurance network expert witness advises on a case involving a workplace injury and a long battle for benefits. The plaintiff slipped and fell on ice while working. She injured her head, lower back and neck. The employer notified its workers’ compensation insurer, which assigned a third-party adjusting firm to investigate the claim and administer income and medical benefits. The plaintiff saw her own doctor, who prevented her from working because of her injuries. The adjuster began paying temporary income benefits and requested the plaintiff see a designated doctor. The adjuster asked the designated doctor to assess maximum medical improvement (MMI) and permanent impairment, but not the extent of injury. The plaintiff’s personal doctor referred the plaintiff to a neurologist to assess her back and neck pain, headaches, dizziness and blurred vision. The designated doctor certified MMI with a 10 percent impairment rating for her back and neck condition; he did not consider the post-concussion injury. The adjuster began impairment income benefits. The neurologist continued to treat the plaintiff for concussion syndrome. The plaintiff was treated by an optometrist for visual disturbances. The optometrist confirmed the plaintiff suffered visual nerve damage from the injury. The plaintiff began to suffer from depression and anxiety. Nine months after the injury, the adjuster terminated impairment income benefits and filed a notice of disputed issue regarding the depression and anxiety and the vision injury.
At a contested case hearing before the state insurance department’s worker’s compensation division, the officer determined that the injury extended to include depression and anxiety. A year after the accident, a designated doctor determined that the injury extended to include cervical disc syndrome, nerve root compression, lumbar radiculopathy, cervical radiculopathy and bilateral scotomas. Four months later, another designated doctor certified MMI as of that date, with a 10 percent impairment. The adjuster refused to pay income benefits and instead found the first impairment rating was final. At another contested hearing, the officer said the first rating was not final and found that the plaintiff was disabled from two months after the accident. After another designated doctor assessment that resulted in a 15 percent impairment rating, the adjuster again refused to pay benefits and another contested case hearing was required. The officer rejected the dispute and ordered that the impairment rating was 15 percent. The defendant paid additional income. The plaintiff then sought supplemental income benefits, which the defendant denied but later agreed to pay. The plaintiff sued the insurer for breach of the duty of good faith and fair dealing.
