Answers to Medical Malpractice, Workers Comp, Long Term Disability Insurance, and Car Accident Questions
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Contact us directly 202-393-3320
At Donahoe Kearney, we believe it's important to empower through education. 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.
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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Why Are ERISA Long Term Disability Insurance Claims so Difficult?
We hear all the time from people who are on ERISA disability claims that they are frustrated, they don't understand why their claim has been denied, and they really need the money they assumed would come when they filed a claim. After years of helping clients with their disability cases, I am sometimes asked, "are there easy disability claims?"
It is logical to believe that if your doctor, employer, and the Social Security Administration recognize that you are disabled, then your disability insurance company must agree that you are entitled to disability benefits.
Unfortunately, this is NOT the case.
Once upon a time, disability insurance companies offered policies that actually helped the people who paid their policy premiums. They provided clear explanations and definitions, and required the insurance company to pay benefits within 30 days of approval. Sounds exactly like how it should be, doesn't it?
We don't see policies like this anymore. Most disability insurance policies are designed to help the insurance company reject disability claims and provide as little coverage as possible. It's a big problem, but under the current law (ERISA) it's easy to get away with this type of practice.
These thin, ambiguous policies ensure that there is never an "easy" disability insurance claim. That is why a federal judge said, "claimants not able or aware enough to hire legal counsel before the administrative process is complete, likely enter into judicial review facing a loaded deck."
Now if a judge thinks that these claim are difficult, you may want to think twice about handling your own ERISA long term disability insurance case.
If you have been denied disability benefits by your individual or group disability insurance policy, such as AFLAC, Guardian, or Unum, Donahoe Kearney will review your denial letter for free. Call 202-393-3320 and we will help you move forward.
Give us a call today at 202-393-3320 to figure out your next steps, and if we can help you. But don't wait. You only have 180 days to appeal a denied long term disability insurance claim.
What is substandard medical care?
Substandard Medical Care is another term for medical malpractice - and that can include hospital or office systems that fail, a doctor not following up on test results or ordering a consultation with a specialist, not working up a potential diagnosis, giving the wrong medication or wrong dosage - almost any medical problem that is preventable.
Some people call this medical negligence, or a violation of the standard of care or standards of practice - and these terms usually refer to the same thing - a situation where a doctor, nurse or hospital doesn't follow established safety rules for their patient.
Sometimes, there is no harm from this, like when another doctor or nurse catches a mistake and re-writes an order, so the patient never gets the wrong medication. But patients can be seriously injured or killed due to mistakes that can be avoided.
Want to learn more? Take a few minutes to order one of our free, no obligation guides - they are full of common examples of medical mistakes that we see over and over again. Or just call our office and we'll send it to you.
At the point where you're looking for a D.C. medical malpractice lawyer because you suspect a medical mistake?
Download our FREE Medical Malpractice Lawyer Evaluation Form. Make sure anyone you hire for such an important case can past the test. And remember, hospitals, doctors' insurance companies know the lawyers who specialize in medical malpractice and those who don't.
Can My Husband Get Workers' Comp Benefits for Two Different Jobs?
My husband works two jobs. He was hurt at work in D.C. on his first job and now can't do the second job either because of his injury. Can he get workers comp benefits for both jobs?
Say he worked construction in D.C. and fractured his ankle on the job. He can't go back to work as a construction worker because he can't lift or carry much and can't walk around the jobsite, but he was also working every weekend at a garage fixing cars and he can't do that job either because of his fractured ankle.
If he's making $900.00 per week as a construction worker and $300.00 as a mechanic, his average weekly wage should be $1,200.00, so his workers comp benefits would be $800.00.
Maryland and Virginia are different - Maryland workers compensation doesn't generally allow wages to be stacked and Virginia requires the second job be in the same "trade, business or occupation" as the first.
But in Washington, DC there are not the same limits to what they call "wage stacking" -- so don't forget to include your wages from both jobs when you file your husband's claim.
Do you have more questions about DC Workers' Comp? Give us a call today and order our free comprehensive book all about DC workers' compensation.
What do the best medical malpractice lawyers look for in a medical malpractice case?
Whether a patient is injured by a hospital, HMO or doctor in D.C., Maryland or Virginia, as experienced medical malpractice lawyers, we look for certain factors to help us evaluate a case and determine whether we are the best lawyers for you.
First, we can only take cases involving very serious injuries or medical conditions - paralysis, cerebral palsy, brain damage, blindness, death, etc. - injuries or conditions which forever change a patient's life or a family.
The reason for this is that medical malpractice cases in our court system (at least in Washington D.C., Maryland and Virginia) are complex, time consuming and expensive to prove. We want to make sure our case can make a difference in a patient's life. And we never want to put a patient who has been harmed by the medical system, through the legal system unless we can help make up for the harms and losses caused by the hospital, doctor or HMO.
And that's sometimes hard, because it means we can't help everyone with a legitimate malpractice case.
Second, are you someone we can work with - we view a medical malpractice case as a relationship, working together with a patient and his or her family to try to get everything they need to make their lives better. So we want trust to develop over time and be able to work toward a common goal.
Third, of course is the actual investigation of the case, learning what really happened, studying the medical literature, reviewing the medical records with experts and consultants.
There is more to it than that, of course, but our medical malpractice cases and trials have taught us this is where to start. And if you're thinking you have a medical malpractice case, don't wait (there are time limits). Call us today at (202) 393-3320 to see if we are the right medical malpractice lawyers for you and your family.
Can filing your D.C. workers compensation case in Maryland or Virginia cost you hundreds of dollars per week?
Can filing your D.C. workers compensation case in Maryland or Virginia cost you hundreds of dollars per week?
Absolutely it can.
Filing your workers compensation case in the wrong state can cost you hundreds of dollars - every single week!
You see, all states (or at least Washington, D.C., Maryland and Virginia) have maximum compensation rates. That means that if you are a high wage earner, a union worker, professional, athlete, or have been working a lot of overtime before your injury, you could be at that maximum compensation rate and not get 66 2/3% of your average weekly wage.
Here's the thing insurance companies don't want you to know...
The maximum rate in D.C. is much higher than Maryland or Virginia. So your benefits will be much higher. And here's the catch - if you accept benefits in another state, you can't come back and get them in D.C. for the same injury. So you can't even get the difference between the maximum compensation rates.
Unfair? It sure is.
Here's what you have to do. Don't sign any forms the insurance adjuster, safety man, your boss, or anyone else gives you until you talk to us or read this book Protect Your Rights: The Ultimate Guide to D.C. Workers Compensation.
Your co-workers, family and friends may all have advice and mean well, but don't make the mistake that will cost you and your family hundreds of dollars per week.
Get the information and help you need by calling us at (202) 393-3320.
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?
What Are the Rules About Working When I'm on Workers Compensation in DC?
We always advise people to be careful about working while you are on workers compensation. You may be able to get some partial benefits if you go back to work at a lesser role or less pay. Or, if you are on light duty at the same position.
But, if you are totally disabled and collecting workers compensation (usually called temporary total disability or TTD), you cannot work at a different job and get paid for that. 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. And if you do decide to commit fraud you will be found out because the insurance company will most likely put surveillance on you if they suspect something. It's never pays to commit fraud against the workers compensation carrier.
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.
Most people who have been seriously injured at work are very anxious to get back to work, but don't go back before your doctor releases you to go back. Going back on light duty or at a different role is one way to make sure you are healthy before returning to heavy duty. We have found that our clients who have been able to do light duty or a modified role will continued to get paid by the insurance company to help make up the difference in their earning power, and often times they get to maintain that positive relationship with their employer that many workers worry about when they are not working.
Are You Unsure About What to Do Next After a Serious Injury? Get the Help You Need Now
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.
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.
Contact Our Experienced Car Accident Lawyers Today.
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.