Answers to Medical Malpractice, Workers Comp, Long Term Disability Insurance, and Car Accident Questions
Here are some of the questions people have when they first contact us about D.C., Maryland and Virginia medical malpractice, serious car accidents, long term disability insurance claims, or workers compensation.
We try to provide as much information as we can based on our experience as medical malpractice lawyers in D.C., Maryland and Virginia and based on representing many hundreds of people who have been injured in accidents or at work in D.C., Maryland and Virginia.
Here are the basics:
Patients permanently injured by medical malpractice, or the families of patients killed because of medical negligence, when a hospital, HMO or healthcare corporation doesn't follow basic patient safety rules deserve justice - resources to help with the harms and losses due to the injuries or death of their loved one.
Drivers who don't follow the rules of the road, driving recklessly, driving drunk, speeding, and texting should be accountable for the harm they cause when their actions cause a serious car accident or car wreck.
Workers hurt on the job deserve workers compensation benefits for lost wages, medical treatment and permanent injuries. If a worker is killed on the job, his family deserves workers compensation death benefits - to at least help with the financial loss of a loved one.
If you're on a long term disability insurance claim and your claim has been denied, you probably need an attorney to do the appeal. Insurance companies will use every trick in their aresenal to deny or limit your benefits. Don't try to handle an appeal on your own.
Since every person is unique, if you have questions or need information about an injury or death in your family, please contact us to talk it through. We'll talk to you, schedule a free initial meeting and give you all the information we can.
Call us today at 202-393-3320.
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I was working for a company in D.C. and became disabled. Why did my ERISA Long Term Disability Insurance Claim Get Denied?
Here at Donahoe Kearney, we believe that the clients should be informed about what's really in their ERISA long term disability insurance policy, and how they are vulnerable to having their claims denied if they ever need to file for long term disability after a serious injury or medical condition keeps them from working.
If your insurance was offered through your employer, it probably falls under The Employee Retirement Income Security Act of 1974 (ERISA), which is a federal law that governs long-term disability policies and other employee benefits.
Every case is different and because of all of the different types of medical conditions, illnesses and injuries we are at risk for, every situation is unique. But there are enough similarities in every ERISA employer-sponsored disability insurance policy, so we try to help people understand the difficulties with these cases, how to approach them and what they need to do if they ever need to file a claim under their long term disability policy.
First, you should know that the law allows the disability insuraance company a lot of discretion in deciding who qualifies (according to them) for benefits under an ERISA log term disability policy. Here are a few things we see in these policies:
• The insurance company has the “discretion” to determine your benefits - whether you qualify under the terms, conditions and definitions of the policy, how they decide that and what evidence they use. "Discretion" is one of those words, at least in the legal field, that means just about any reason you can think of to deny benefits is "reasonable."
• Manipulating your job description: what are the material and essential tasks of your job, and can you do these? If your job requires 19 things, do you prove your case and get paid benefits only if you can’t perform “each and every” important duty of your job?
• If you have a mental illness, anxiety or depression that causes or contributes to your inability to work, disability benefits are often limited to 24 months under the terms of these policies.
• The insurance company requires you to prove you cannot work through "objective medical evidence" but not all legitimate medical conditions that prevent you from working can be proved in this fashion. Objective medical evidence was typically considered test results - an MRI to diagnose a herniated disc in your back, an x-ray to diagnose a compound fracture, that kind of thing. Unfortunately, some doctors and insurance companies have taken this to mean that you need this "objective" evidence for everything and that medical conditions like fibromyalgia, chronic fatigue, chronic pain or any illness where the symptoms are reported by the patient and can't be verified by a test result are somehow suspect.
• A part time work clause: if the disability policy doesn't define part time work, usually by the number of hours or income earned, they could use this to deny your benefits because a doctor says you can work a few hours per week (and doctors make these mistakes all the time - maybe someone does have the physical capacity to work 2 hours per day with an hour break in between - what kind of job is that? It doesn't exist. But that's not the doctor's problem. He's just the doctor, not an employment counselor...)
None of these disability insurance terms are required by law, but let's face it, disability insurance companies know that if they control the terms and definitions (and employers who provide these policies don't realize or care) they can save millions of dollars by denying or terminating benefits on legitimate disability claims.
Just remember - insurance claims examiners and adjusters are trained to find ways to limit benefits. That's how insurance companies make money.
If you filed a claim for long term disability and your benefits have been denied or terminated, get a copy and see if these terms and conditions are in play. They make these cases difficult for people who can't work through no fault of their own.
But now that you know this, here's the most important tip
Don't let the insurance company just deny your benefits without a fight! You can still win your case if your policy carries these clauses, but you will need help from an experienced attorney who is knowledgeable about ERISA disability claims.
Give our office a call at 202-393-3320. We want to hear your story, and we're very sorry that your claim has been denied unjustly. Even if you don't need to hire an attorney, we will educate you about your situation and point you in the right direction. But don't wait - these cases have strict time limits to take action, so do it today.
What If I Am on Workman's Comp, but I Get Another Work Offer?
Someone getting full workman's comp benefits (usually called temporary total disability or TTD) can't work and get paid for both. Anyone working and concealing it from the insurance company is committing fraud - remember, the system exists to pay legitimate injured workers, not people who claim they can't work when they are working.
If you can work light duty work or in some reduced capacity, you should. You will still get workman's comp benefits but these will be based on partial disability, and the calculation goes like this: If your normal weekly paycheck (weekly wage) was $1,000.00 and your light duty wages are $700, you would get $200 in temporary partial disability benefits ($1000 - $700 = $300 x 2/3 = $200).
Many times, the light duty wages will vary so these benefits have to be adjusted every week. Our staff collects the data, calculates the benefits and follows up with the insurance company to make sure you get all of the benefits you should.
If you were seriously injured at work, especially if you need surgery, you probably need an attorney to help you take care of your family and protect yourself from the insurance company. Give us a call today at 203-393-3320 and we will get your started on your road to success in workman's comp.
The workers comp insurance company isn't paying me. Can I use sick leave or vacation time when I can't work?
I was injured at work but I'm not getting paid. Can I use sick leave or vacation?
Most of the time, yes. If you are out of work due to a work-related injury and workers comp has denied your claim and isn't paying you, you may be forced to use sick leave, FMLA, and/or PTO while you recover.
Sick leave and vacation time are earned benefits and you should be able to use them when workers comp isn't paying you, or the insurance company cut off your benefits or you are waiting for a hearing.
Some employers let you buy back your sick leave and vacation time when you later get a workers comp check.
If your claim was accepted, we recommend saving your sick and vacation time for when you need it and using workers compensation benefits for the time off after an injury on the job.
Want an experienced D.C. workers compensation lawyer to answer all of your questions?
Get the only book that will answer your questions, Protect Your Rights: The Ultimate Guide to D.C. Workers Compensation written by a Board Certified attorney, for free by ordering directly from our website or by calling (202) 393 - 3320.
How do you find a lawyer who specializes in cerebral palsy cases against hospitals in D.C.?
When you have a child with cerebral palsy, it probably feels like nothing is ever easy. You probably have struggled with feeding, washing, dressing and carrying your child up and down stairs, in and out of the car. And you probably also have struggled with questions about the cause of your child's cerebral palsy.
And there are TV commercials and ads that make it seem easy to get a lawyer - just call us right now - if you have a phone you have a lawyer - call now, operators are standing by, that kind of thing. And that's fine if you're buying a juicer or an exercise machine, but this is a child we're talking about.
So get the information you need to help you make the best decisions for your child and your family.
Start by ordering a free copy of one of our guides. We wrote them to help families, even if they never become our clients.
- Getting Everything Your Special Needs Child Deserves: A Parent's Guide to Resources
- Picking Up the Pieces: A Parent's Guide to Medical Malpractice
- 7 Symptoms of Malpractice: How Every Patient Can Recognize, Stop and Avoid Medical Mistakes
You can order these right here on our website, by emailing [email protected] or by calling us at (202) 393 - 3320. T
And before you call or meet with any lawyer, download and use our Medical Malpractice Lawyer Evaluation form to make sure the lawyer has the experience, qualifications and resources that are right for your child.
I was in an accident that wasn't my fault. Will the other driver's insurance company pay my hospital bills?
After a serious accident in the DMV, the other driver's insurance doesn't pay your medical bills as you go - here's what to do about that.
We get this question a lot. A lot of people think the other driver's insurance company will take care of their medical bills - the hospitalization, surgery, rehab, specialists you need after getting hurt in a big accident in DC, Maryland or Virginia. But it doesn't work this way. The other driver's insurance won't pay those medical bills directly.
Instead - here's what you need to do.
First, if you have health insurance, use it. Depending on where you live and what health insurance you have, you may have to pay back what your health insurance paid out of any settlement - that's ok for a couple of important reasons. First, your health insurance doesn't pay the full amount of the charges, so you only have to pay back what the health insurance paid, not what the hospital or doctor actually charged. Second, you only have to pay it back if you win or settle your case against the other driver's insurance company - they are not entitled to anything if you lose the case or never receive a settlement.
Second, understand how the system works. Educate yourself on the insurance claims process - what kind of damages are allowed and how will you prove things like medical expenses, future medical needs and expenses, pain, future lost income and the other types of damages you may be entitled to as a result of the accident.
Third, keep records of everything. In any case against the other driver's insurance company, if you can prove the other driver was at fault and that you were injured, you may be able to get a settlement, but this comes at the end of the process, usually after your injuries have healed or you don't need any more medical treatment from the accident. You need to have everything ready so you can make your best case to the insurance company.
If you don't have health insurance, part of your settlement will go to pay your medical expenses.
We help people with serious injuries every day in DC, Maryland and Virginia. Call us at (202) 393 - 3320 to order one of our free consumer guides, books or reports and tell us your story to see if we can help you and your family.
I was working for a company in DC and became disabled. How can I win my long term disability appeal?
If your long term disability insurance company denied or terminated your benefits, and you received a letter indicating that your long term disability benefits policy is governed by ERISA, you need to act fast.
You have 180 days to file your appeal to the same insurance company that just denied your benefits. So there is a lot of work to be done.
You need to request and review the entire claim file - if you were on claim (receiving benefits) for awhile, that file can be several hundred pages of information, or more. And you need to analyze your long term disability insurance policy - how does that define your occupation, covered illnesses and injuries, exclusions, length of different types of disability, medical information, etc.
You'll need to work with medical experts (your treating physicians and perhaps others), and you may have to research and review medical literature and studies depending on your medical condition, Functional Capacity Evaluations, plus submit interviews, vocational testing and reports. And there could be a lot more.
Remember, this is your one shot. By that, I mean that your appeal is not just a form you fill out and send in (please don't make that mistake) - it is all of the evidence of your medical condition or injury and disability. And if the long term disability insurance company denies your appeal, everything you submitted will become the administrative record that a federal judge will rely on to decide your case (since ERISA is a federal law, any lawsuit against your insurance company will have to be filed in U.S. District Court - and there is no discovery or right to trial by jury in these cases).
See what I mean about the appeal being your one shot to gather all of the evidence you can to prove you cannot work due to your medical condition or injury?
But there is help available. If you've received a letter from your long term disability company, send it to us. We'll review it, in confidence and at no charge, and outline the next steps for you. Just call us at (202) 393 - 3320 to get started.
Are you worrying about your workers compensation case?
Let's face it. Workers' comp is a lot to handle.
Once you get hurt on the job, especially with any serious injury requiring surgery, your life changes.
Your health and income depend on a whole new system, and it seems like the insurance adjuster, nurse case manager and doctors have all of the power. Rather than rely on yourself to feed your family, you're dealing with an insurance company - and you know who they're looking out for.
You have lots of questions. And the more serious the injury, the more at stake.
So take action. Get the information you need, written by a nationally Board Certified lawyer dedicated to helping injured workers and their families right here in D.C. Order one of our free, no obligation consumer guides that explains the workers comp system without a lot of legal mumbo jumbo.
As I say in my book, the insurance company's duty is to its shareholders, not to you. And the workers comp adjuster's job is to limit the amount the workers comp insurance company has to pay, either to you or for your medical care.
If you'd like a FREE GIFT available only to injured workers and their families, one that will give the information you need to get started, and make sure you don't make a mistake with your health, income and future, just call us at (202) 393 - 3320 and we'll send it to you today.
Why Does Donahoe Kearney Have a Communications Policy?
Q. Why do some businesses have a communications policy?
A. That is a great question. For us, our communications policy is really like a secret weapon, one we only use for good, of course ... but we do use it against insurance companies.
Our communications policy allows us to do really important, high-level work for you. You see, many law firms are chaotic, and their lawyers go from one crisis to another based on a random order of phone calls and emails. They can’t do the real, important work on cases to help people, and they don’t get good results. We are different.
So, that’s why we are very strict with this policy. We want to update you and inform you on your case — that’s why we schedule calls ahead of time and only read and respond to emails during scheduled times. And when we are working on your case, there are no other interruptions.
We want to talk to you and take care of you and your family. That’s our responsibility, and we love it.
I'm getting workers comp benefits. When do I need to get a workers comp lawyer?
If you have a serious injury working in DC and needed surgery or don't think you'll be able to go back to your regular job because of your work injury, the best time to get the right workers comp lawyer for you and your family is...right now!
You see, this is all about protecting your future - your financial, physical and emotional health (I feel so strongly about protecting people that the title of my book on DC workers comp is Protect Your Rights). This is critical even if the insurance company is paying your benefits and authorizing your medical treatment.
The insurance company is in business to make money for their stockholders - not to help you and your family. Workers comp insurance adjusters in DC are specifically trained to limit the amount of money the insurance company has to pay to you directly or for your medical treatment. They have a team of insurance lawyers, investigators, doctors, nurses, case managers, vocational specialists - you name it. And the average insurance adjuster has handled thousands of workers comp claims over her career. That's a lot of experience, knowledge and resources going against you.
How many have you handled?
So yes, you may be getting paid now, but in DC, they can stop your benefits for almost any reason. If that happens, what do you do? Plus, do you know if you're being paid the right amount? Can you be taking action on your case now that sets you up for additional benefits in the future?
The best part is - it doesn't cost you anything up front to hire us (at least that's the way we work). Our fee comes at the end of the case, so you can have the benefit of all of our counsel, resources, experience and hard work making sure your benefits continue, and it doesn't cost anything extra. So let us take care of everything with the insurance company and the case, so you can focus on getting better.
Just call us today at (202) 393 - 3320 to schedule a time to talk (no obligation and completely confidential, of course).
My child has shoulder dystocia from birth. Could his condition have been caused by medical malpractice?
Shoulder Dystocia and Medical Malpractice at a DC Hospital
Shoulder dystocia can sometimes occur at birth when the obstetrician or other hospital providers do not follow the rules of good patient care, or the hospital doctor, interns or residents do not recognize this complication and treat it as an obstetrical emergency. There are also certain risk factors, such as maternal diabetes or a fetus suspected of weighing more than 4,000 grams that make a baby more susceptible to shoulder dystocia during delivery. The hospital staff should test and be looking for these well known risk factors.
Umbilical cord compression due to the baby getting "stuck" during delivery can also lead to a lack of oxygen for the baby, increased acidosis and ultimately brain damage for the baby if the lack of oxygen to the brain is prolonged. That's why the condition needs to be recognized and evaluated by experience hospital staff, so that actions can be taken to prevent or limit harm to the baby or mother.
Shoulder dystocia usually refers to when one of the baby's shoulders is caught behind the mother's pelvic bone after the baby's head is delivered. This can lead to brachial plexis palsy, a permanent nerve injury that leaves the child unable to use that arm, or with extensive damage that prevents him from doing things normal kids do.
If your child has a permanent injury after birth or during his time in the neonatal intensive care unit, or NICU, call us today for a confidential, free consultation. We may be able to help your family get him the resources you need to provide for your child's future medical care, therapy, rehab, occupational therapy, vocational training and other things that can help him manage and cope with the effects of the injury.
The sooner you get started, the better - all parents want to help their child if they can, and so do we!
Just call us today at (202) 393 - 3320 or click here to order a copy of our free guide to medical malpractice so we can help get you answers today.