Recent IWIF Success At The WCC


Chicago, IL (CompNewsNetwork) - IWIF is in the business of paying legitimate workers' claims. Some claims, however, require close scrutiny to prevent claimants from taking advantage of IWIF. Here is a collection of recent litigation successes that demonstrate teamwork among Legal, Claims and SIU employees. This IWIF teamwork with thorough case preparation and defense help to keep premium costs fair by limiting unnecessary and excessive awards/claims payments.

Case of hanging out to dry

The willful misconduct defense was raised in this claim in which an MTA employee alleged that she was struck by a teenager who was sliding down the escalator of a subway station. The IWIF claims adjuster and lawyer, with the cooperation of the MTA, were able to view a videotape of the actual occurrence captured on the station's surveillance camera. The tape was shown at the hearing, and told a much different story. The claimant was seen striking the initial blows by holding her arm out and "clothes lining" the alleged assailant as he slid down the ramp. While there may not have been enough evidence for a finding of willful misconduct, there was clear evidence of the claimant initiated the confrontation. The claim was disallowed.

Case of no presumption prevails

When it comes to occupational disease claims, the presumption afforded under the statute (Sec. 9-503) to police and fire personnel makes it near impossible for employer/insurer to prevail. The IWIF claims adjuster and lawyer took on the presumption in this claim brought by a police officer for both heart disease and hypertension. IWIF's attorney focused in on the fact that the claimant was in administrative positions for most of his career rather than on the street. There was also an issue of whether there was a disablement as a result of these conditions given that the claimant went home from work following onset of symptoms. He lost no further time and has not had to modify his position. The claim was disallowed.

Case of suffering in silence

An IWIF claims adjuster and lawyer teamed up to defend this claim for accidental injury. The claimant, an EMT for a private ambulance company, alleged that she injured herself while lifting a 300 pound person onto a stretcher. After thorough investigation, including a visit to the insured and statements obtained from a co-worker eyewitness, the defense relied upon credible testimony from the co-worker and supervisor. The witnesses testified that the claimant never complained of injury at the time of the occurrence. Furthermore, the co-worker testified that the claimant told him she had arthritis. Evidence also showed that the claimant worked the remainder of the day and a full shift the next day, again without complaint or report of injury. Medical treatment was not sought until one week later. The claim was disallowed.

Case of say it isn't so

The claimant, an HVAC mechanic, was injured in a motor vehicle accident. Compensation and authorized medical treatment were terminated after five months. The claimant sought continuation of Temporary Total Disability (TT) and referral for possible back surgery. The IWIF claims adjuster and lawyer teamed up to defend these issues. The claimant testified that he still could not do the lifting, bending, stooping that was required of his job. With the assistance of our SIU department, surveillance video was obtained and shown at the hearing that proved to be very convincing. The claimant was observed driving his pick-up truck to various locations, lifting and placing items in the truck. The requests for additional ongoing TT and surgical consult were both denied.

Case of all washed up

The claimant, a driver's license examiner, fell off a curb sustaining an injury. What started out as a reported injury to both knees, evolved into a herniated disc in her low back, necessitating surgery. The IWIF claims adjuster raised causal connection of the back. At the hearing, one of IWIF's lawyers conducted an extensive cross-examination of the claimant, focusing on her inability to correlate her back pain to the accident. While the claimant denied any prior or subsequent accidents to her back, our attorney focused on the fact that the first mention of back pain in the records was one year later. The records further showed that the claimant had numerous medical provider visits and a Workability Exam, none of which contained a history of back complaints. A reference to back pain after "doing laundry" was noted. An Independent Medical Evaluation ruling out causal connection of the back further bolstered IWIF's defense. The Commission found that the disability of the claimant's back is not causally related to the accident.

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