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A True Story: Names changed to protect the innocent and the employee
Big Star Productions was making a block-buster movie in Atlanta with a cast of thousands. “Extras” have no speaking parts, provide no action – they are just a part of the scenery. Big Star Productions hired Find-a-Star to provide these “extras, as background to the famous stars.
Ima Wantabe wanted to be a movie star from the time she performed in her elementary school play. Ima, unemployed for a few years, answered the casting call for extras. Ima just “knew” if talent agents saw her on the movie screen, they'd come chasing to sign her up. After completing the paperwork she was told to report on Monday at 5:00 a.m. for a job expected to last one-day. (open-ended)
Ima was disappointed to discover 200 other “extras” were also waiting when she arrived at city auditorium to start her “new career.”. She joined a group of 50 extras sitting in the balcony hoping for a glimpse of the movies famous stars. After delivering a series of announcements and instructions to the extras, Find-a-Star announced to be considered for the first scene, the extras needed to move to the auditoriums main floor by 6 a.m.
Not wanting to miss out on her big (and maybe only) chance at stardom Ima, along a group of extras, rushed to the stairwell, where Ima fell to the steps, landed on her knee, fell forward and rolled over. It was unclear how the accident happened. Ima said she was pushed by another extra but a witness said she tripped on the second or third step from the bottom and fell. Only one extra stopped to help her (the witness).
By the time Ima caught up to the other extras, were, Find-a-Star had selected a few of them and told the others to have a seat. Ima sat from 7 to 9 a.m., realizing her knee hurt and thinking her acting career might be over. Or was it? If only, the movie producer or a producer's assistant could see her act . . .
Ima began to moan, she closed her eyes, laid her head back and sobbed. An extras, not realizing t Ima was acting, ran and got — .not the movie producer, but Dan the paramedic who was on duty. Dan asked Ima what was wrong. Ima described how she pushed down an entire flight of steps, was in tremendous pain, and probably broke numerous broken bones. Dan, a trained medic with 25 years of experience, was a bit skeptical, but the easiest thing for him to was to send Ima to the nearby Walk-In Clinic.
Dan declined Ima's request for an ambulance with a stretcher to carry her. She walked on her own to a service van, and a Find-a-Star employee drove her to the clinic. After being checked out, Ima returned to the auditorium and waited fruitlessly to be discovered. It never happened. (WCxKit)
A bright light bulb went off in Ima's headwhen she found out workers compensation would pay for her trip to the Walk-In-Clinic. Her acting career was just beginning! Ima complained again to Dan about her “tremendous pain.” He gave her two aspirin.
Ima returned the following day to the Walk-In Clinic complaining about her “tremendous pain” “all over.” The Walk-In Clinic doctor, to protect himself from a malpractice suit, had X-rays taken of all her limbs, back, neck, and head, finding nothing. The doctor started Ima immediately on daily physical therapy.
Find-a-Star, who employed Ima for an hour before she was hurt, reported the workers compensation claim to Top Notch Adjusters their insurer. Before Top Notch even had the file set up, Ima called demanding to talk to the adjuster. She was transferred to Harden Steele, who listened patiently listening to Ima describe her ordeal, how she was in “tremendous pain,” could hardly move, with every part of her body hurting, even Ima's hair was hurting. Ima wenton to tell Harden that due to her “workers compensation injuries” she probably would “never be able to work again.”
Harden asked Ima where she worked before she started with Find-a-Star. Ima did not answer but described how her injuries would prevent her from ever working again. Harden asked Ima how she was able to drive herself to the Walk-In Clinic everyday and to drive to physical therapy every day. Ima took a sudden turn for the worse and advised Harden she was in too much pain to talk any more.
Once Top Notch created the claim in their computer system, Justin Noway (known in the industry as Mr. Noway) was assigned as the adjuster. To complete his 3-point contact technique, Noway called Find-a-Star to discover the personnel manager knew nothing other than what Dan the medic put on the First Report of Injury. Noway called the medical provider. The Walk-In Clinic was very familiar with Ms. Ima Wantabe, and immediately suggested Mr. Noway find Ima another doctor. Noway then called Ima.
Ima, feeling much better after talking to Harden, proceeded to tell Noway about her “tremendous pain.” Noway expressed his sympathy for her pain, but advised under workers compensation, pain was not paid for, only medical bills and two-thirds of her lost income, with limits on the maximum and minimum indemnity benefits.
Ima asked what the maximum was for her “life time of lost income.” Noway advised he could not say for sure until he obtained more information from her and Find-a-Star. Noway asked Ima for a recorded statement. Ima took a sudden turn for the worse and advised Noway she was in too much pain to talk any more.
The next day Ima called Noway and asked if he had figured out how much her “workers compensation settlement” was going to be. Noway said he needed her recorded statement before he could calculate her “settlement.” Ima reluctantly agreed to the recorded statement. When Noway said she would need to be off her pain meds, Ima said she had taken no medication since the previous day and because she had “just gotten out of bed at noon today.”
Noway obtained all the background information in the recorded interview. When asked about her other employment, Ima told Noway she did not work anywhere else. She was only hurt while working for Find-a-Star. (Noway ruled out concurrent employment for the purpose of calculating benefits). Ima again described the accident and how she laid on the floor in pain until the medics came and helped her up and took her to the clinic (conflicting with the witness and Medic Dan's versions of the accident.)
Ima listed her injuries as: headaches, back ache, neck ache, pain radiating through both shoulders, butt hurts, pelvis hurts, both thighs hurt, both lower legs had a sharp pain, both knees hurt, numbness in her hands and fingers, difficulty standing, lying down, sitting and was now clumsy where she was not clumsy before this “workers' compensation accident.” She also had a bruised knee requiring her to wear pants so her knee could not be seen. Noway asked Ima with her severe injuries, what other medical professional saw her knee besides the clinic doctor office and physical therapists. Ima took a sudden turn for the worse and advised Noway she was in too much pain to talk any more. (WCxKit)
Ima called Noway the following day and said she really needed to see a specialist. Noway, realizing he needed to put an end to Ima's new acting career, agreed. He asked the telephonic case management nurse (TCM) to schedule an appointment with an orthopedic doctor. Dr. Paine agreed to see Ima, but by the time Ima was seen. it was be sixteenth day from the date of injury.
The TCM nurse, assigned the claim based on the insurer's parameters on all lost time claims, contacted Ima to discuss her medical care. When the TCM nurse noticed inconsistencies between what Ima said during the first part of her interview and the later, Ima took a sudden turn for the worse and advised the TCM nurse she was in too much pain to talk any more.
In the meantime, Ima decided to check herself into the Good Charity Hospital for treatment. When the hospital contacted Noway for approval of the hospitalization, he refused to authorize treatment. Ima checked out.
Ima went to see Dr. Paine who did a complete examination and found nothing objectively wrong with her other than a now-fading bruised knee. Dr. Paine released Ima to return to work with a ten pound weight lifting restriction. He also agreed to let Ima continue her physical therapy as Ima felt “it was slowly helping” her.
In the meantime, Noway contacted Find-a-Star to get a lost wage statement and was advised Ima no lost income, as they paid full $130.00 for her one day employment contract, even though Ima was not chosen to be an extra. Noway asked the employer if the ten pound weight lifting restriction could be accommodate and they said it would not prevent any extra from working. When Noway asked for a comparable or similar employee working for at least thirteen weeks he was told one of the extras worked more than three days. The maximum any extra earned was $390.00.
Noway divided the $390 by 13, for an average of $30 per week. He multiplied the $30 by two-thirds, and got a weekly indemnity benefit of $20. As $20 per week is below the state's $50 weekly minimum indemnity benefit, Noway utilized the $50 per week for payment of TTD. Ima would be paid for 9 days of indemnity benefits – the sixteen days between the date of injury and the day Dr. Paine released her to return to work, less the 7 day waiting period (Georgia has a 21 day retroactive period).Ima was owed $64.29 in indemnity benefits. (WCxKit)
When Noway contacted Ima to advise her she would be receiving an indemnity benefit check for $64.29, Ima asked in an indignant voice, “That's all per day?” Noway said, “No that was all, forever.” Ima was done acting. She replied “You mean I went through all of this for just $64?” Noway replied, “Yes, this is your workers compensation settlement.” Ima hung up the phone, she was done acting.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
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