Answers to Medical Malpractice, Workers Comp, Long Term Disability Insurance, and Car Accident Questions
The Best Way To Reach Us Is Call 202-393-3320. You Can Also Send Us An Email Through This Form
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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Can you get workers comp in DC if you were exposed to coronavirus at work?
Healthcare workers who are coming into contact with Coronavirus at work should definitely get the best information they can on workers compensation. If you caught the Coronavirus as a result of being exposed while on duty, you could be off of work, need medical care and you will need to file for benefits.
If you're like most healthcare workers, you never planned for an injury or illness caused by helping patients. We see this a lot, a nurse or other healthcare worker, who injures her back lifting and turning a patient, a torn rotator cuff from restraining a patient suffering from addiction, a concussion caused by a violent psychiatric patient.
And now, Covid-19.
Don't wait too long to get started on your claim. Contact us at 202-393-3320.
If you have had exposure at work, you still need to prove that the illness was caused by work, but for healthcare workers, there should be enough of a link for you to go ahead and file for workers compensation. And obviously, if you've been exposed at work get tested now so you can take care of yourself and your family if you are sick, quarantined, or both.
If you call us today we will send you what you need from our DC Workers' Compensation Library - You will get our signature book, along with the DC forms you need to file your claim (we can email these to you - the book is a real book so has to be mailed).
You can use these forms to file with the DC Office of Workers Compensation to get your claim started, but don't do it without speaking to us first. There are certain mistakes that you can make when filing for workers' compensation that we want to help you avoid.
We are available to take calls and answer questions about work injuries in DC, MD and Virginia, so if you need anything, please reach out to us - we're here for you.
Can You Get DC Workers Compensation and Social Security Benefits At The Same Time?
Workers Compensation Benefits And Social Security Disability Insurance Benefits Can Be Drawn At The Same Time With An Offset
With a serious work injury that prevents you from working for more than 1 year, you may be eligible for both workers compensation benefits and social security disability. Workers who have a permanent injury that will prevent them from working for many years are often awarded social security disability as well.
In order to receive workers compensation benefits, you have to prove your work injury prevents you from working. Social security looks at the whole person - all of the person's medical conditions or injuries.
There is an offset, however. That means that social security benefits will be reduced to take into account the workers compensation benefits you are getting after an on the job injury. Currently, the Social Security Administration uses a formula to determine the offset, or reduction, in the amount they pay. Click on this Fact Sheet for the specifics.
It's important to know that the workers comp benefits are not reduced. Also, once the workers compensation case settles, you have the ability to reduce the amount of the social security offset, so your social security benefits should go up.
Also, a lot of our clients tell us they applied for social security, got denied and had to appeal. It seems most people are awarded social security after an appeal and hearing.
If you're trying to figure this out - its complicated - call us and see if we can answer your questions. We handle every kind of workers compensation issue for private sector workers (people who don't work for the federal or D.C. government).
Contact us today at 202-393-3320
What is the difference between medical malpractice and negligence?
Malpractice vs. Negligence
Someone called me yesterday about a wrongful death case in D.C. after a relative died from what sounded like inadequate medical care by an HMO here in the District.
I explained some of the elements of a medical malpractice case in D.C. - the standard of care, proving the malpractice caused the person's injury or conditions, the damages allowed in wrongful death cases, etc.
After we finished, she asked a great question - what's the difference between negligence and medical malpractice?
Usually there is no difference. Medical malpractice lawyers tend to use the terms interchangeably - I know I do.
Medical malpractice is negligence by a doctor, nurse, hospital, HMO (any healthcare provider providing medical care to a patient) where they fail to do what a reasonable and prudent doctor, nurse, etc. would do in the same situation. The harm is to a patient. Many times this is also called medical negligence.
Negligence is anyone failing to do what a reasonable person would do in the same situation - it can be a driver, store owner, landlord, anyone who does something (not intentionally) that hurts someone else, usually because they weren't being careful.
So if an anesthesiologist doesn't monitor a patient during surgery and she is injured due to lack of oxygen, that is medical malpractice. If the same anesthesiologist runs over someone in the hospital parking lot, that's negligence.
Order a free copy of one of our books, consumer guides and/or reports for more information on this and a number of other topics.
I’m on workers’ comp: can the insurance company just stop my benefits?
Unfortunately, yes. In Washington DC, the insurance adjuster can (and often does) stop your benefits for no reason.
In D.C. workers compensation, insurance companies can stop your benefits for any reason - or no reason at all. All they have to do is file a notice of controversion, a simple forming stating a reason.
What are some of the reasons for an insurance company to stop your benefits?
They can have you examined by one of their doctors (an IME - insurance medical exam), say they are still investigating the claim, or that they don't have evidence of any current disability, or you didn't "cooperate" with a vocational counselor. They could also claim you're not cooperating by giving them all of the medical records they ask for (basically they want all the records from the day you were born). They can even make up a reason.
Then its up to you to win your case and get the benefits reinstated - but that could take many, many months by the time you go to a hearing and an Administrative Law Judge issues a decision.
That's why we take steps so our clients don't benefits cut off in the first place and act immediately when they do. We cover a lot of this in the book Protect Your Rights: The Ultimate Guide to D.C. Workers Compensation or you can call us at (202) 393 - 3320 and speak to a live person who will help you and can tell you what we do in this situation.
Should I Use My Health Insurance To Pay Medical Bills ?
You Have To Use Your Personal Insurance To Get Medical Treatment After An Accident
If you are injured in a car accident in Maryland, Virginia or D.C. you can use your health insurance to pay for medical treatment from the accident. Its really a question of whether your health insurance company has a lien or right to be paid back from a settlement with the other driver's insurance company. In D.C. and Maryland, most health plans require repayment of what they have paid for medical treatment if someone gets a settlement or verdict from the other driver's insurance company. In Virginia, most health plans cannot recover their payments from a settlement (this is also called subrogation) because of Virginia's anti-subrogation statute.
It's Crucial To Understand How Insurance Actually Plays A Part In Your Case
Typically, most health insurance plans pay less than the actual charges, so it is usually better for someone injured in an automobile accident to use their health insurance rather than agree with the doctor or hospital to pay the medical bills out of any settlement because the health care providers will be entitled to the full amount from the settlement and if the case doesn't settle, is lost or not pursued, you are still on the hook for the medical bills. The analysis also depends on whether you were injured in an accident in D.C. Maryland and Virginia, where you live, where you work (if that's where you get your health insurance), other car insurance you may have, etc.
Contact Our Lawyers Today To Recieve The Help You Need
If you have questions about what to do after a D.C., Maryland, or Virginia accident, just call us at (202) 393-3320 and we'll talk it through.
Can My Husband Get Workers' Comp Benefits for Two Different Jobs?
Getting Benefits for Both Jobs is Called Wage Stacking and You Can Do It In DC
Your husband's average weekly wage and workers compensation benefit rate (also called temporary total disability or TTD) should include his wages or salary from both jobs.
Here's how it works: 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 at 202-393-33200 and order our free comprehensive book all about DC workers' compensation.
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.
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.
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.