Workers’ Compensation Appeal Results in Settlement

Pothitakis Law Firm represented C.J. with respect to a workers’ compensation injury to his right and left feet. The claim was based upon him getting some steel shavings in his boots that resulted in some infections and difficulties with his right and left feet. As a result of the injury and infections, C.J. underwent extensive debridement and surgical intervention on his feet. Under the Iowa Workers’ Compensation law, an injury to the lower extremities results in a permanency entitlement that is simply based upon the impairment rating. It is very limiting and not a significant amount of money – regardless of whether it has a significant impact on the future of ability of the injured worker to maintain his employment. There are ways that can be used to try to increase the value of a claim such as this. One of those ways is to pursue what is called a Second Injury Fund claim. A Second Injury Fund claim is based upon having a prior condition with arms, hands, legs, feet or eyes, that when combined with the current work injury causes some level of disability or impact on the worker’s ability to perform labor. The prior injury does not have to be work related. With respect to C.J., he had previously had an injury to one of his feet and for that reason, a claim was made against the Second Injury Fund. Another way to obtain benefits beyond the payment of a small impairment rating for both feet is if those feet result in some body as a whole injury. With respect to C.J., because he was limping from the foot injuries, he started having hip and back pain. The Pothitakis Law Firm alleged a claim based upon a back condition related to the feet injury. If proven, this also could result in an award based upon how the injury affects the claimant’s ability to work as opposed to a simple math computation for an impairment rating. The case proceeded to hearing in 2021 and a decision was entered by the deputy workers’ compensation commissioner finding that the Claimant had a 60% loss of future earning capacity as a result of the new foot injuries and the preexisting foot injury. Pothitakis Law Firm felt that a more appropriate analysis would include the low back condition with the claim, which could result in considerable additional funds. Pothitakis Law Firm filed a notice of appeal to the Iowa Worker’s Compensation Commissioner. After submitting extensive arguments and briefs, the Iowa Worker’s Compensation Commissioner revised the prior decision with an appeal decision which granted the claimant benefits associated with a 75% loss of earning capacity. The Iowa Worker’s Compensation Commissioner found that the deputy workers’ compensation commissioner’s decision was wrong and that the claimant’s low back condition was permanently impacted because of the claimant’s foot injuries. Pothitakis Law Firm was extremely satisfied and excited the appeal decision. Shortly after the appeal decision, the defendant insurance company and employer reached out and offered to resolve the claim for a significant amount that is confidential. The claim was ultimately resolved by settlement after this appeal decision.
Pothitakis Law Firm pursued this claim for in excess of three and a half years. Mr. Pothitakis conferenced with the claimant’s doctors and obtained reports over those years to put the claimant in the best position to obtain a favorable result at hearing. When the initial decision was inappropriate, Pothitakis Law Firm filed an appeal and was successful on that appeal.

$450,000 Partial Commutation

On March 2, 2016, Pothitakis Law Firm received a Decision in a partial commutation case. The Decision resulted in an award to the client of $450,000.

In 2013, our client was a truck driver who was fatally injured in a tragic auto accident. He was married at the time and as a result his wife was entitled to Workers’ Compensation benefits. Those benefits would end upon her death or shortly after she were to remarry. The surviving spouse was finding it difficult to live on the weekly Workers’ Compensation benefits and for other reasons wanted to have the money paid in a lump sum.

Under the Iowa Workers’ Compensation laws, benefits are always awarded on a weekly basis. There are a few situations where the benefits can be awarded in a lump sum and one of those is when one seeks a partial commutation. A partial commutation is a request to have all benefits paid in a lump sum after reducing them to present value.

In this case, the surviving spouse had a life expectancy of an additional 29 years. Reducing the payments over her lifetime after reducing to present value would total $450,000. In order to obtain a partial commutation, the spouse was required to show that it would be in her best interests to obtain the funds in a lump sum as opposed to receiving around $400 a week. The question of whether it is in the best interest of the spouse is based upon the balance between the benefits to the spouse in comparison to the detriments to the spouse.

The Defendants argued that she would waste the money and that she would be better off having the money on a weekly basis for the remainder of her life.

The arguments that we make for the spouse included the following:

  1. Interest rates are at an all-time low and therefore the interest rate used to reduce the amount to present value resulted in a significantly higher lump sum at this time as opposed to other times in history.
  2. The spouse wanted to make sure to have something left for her children if she were to die. If she was paid weekly, the benefits would end upon her death. If they were paid in a lump sum, as we requested in the petition for commutation, she would have an estate to leave to her children.
  3. The spouse wanted to buy a home so that she no longer had to rent.
  4. The spouse intended to purchase an annuity that would pay her a monthly income.

In support of the application for commutation, Pothitakis Law Firm hired an expert to give an opinion and options for the surviving spouse on how the money could be used. This expert was a Certified Public Accountant and he provided an opinion that it would be in her best interest to obtain the funds in a lump sum at this time. The Defendants hired their own expert, an economist, who said that she was better off receiving the money on a weekly basis.

A hearing was held in January 2016. A Decision was received recently which found in favor of the Pothitakis Law Firm client and awarded the Defendants to pay the Claimant the benefits in a lump sum for an approximate total of $450,000.

Pothitakis Law Firm is very happy with the Decision as was the spouse. Still grieving from the death of her husband, the surviving spouse was happy to be able to secure for her and her family based upon the Decision.

The Defendants do have an opportunity to appeal the Decision and it’s unclear whether an appeal will be filed.

$1 million Workers Slip and Fall

The Pothitakis Law Firm was hired by D.D. who sustained an injury to his neck when he slipped and fell while leaving work. He ultimately underwent neck surgery as a result of the injury and was unfortunately left with chronic pain. As a result of the chronic pain, the Claimant also began suffering from significant anxiety and depression. The Claimant was taking pain medications as well as medications for his mental health condition to try and obtain some relief.

Prior to hearing, the Defendants made an offer of settlement that was rejected based upon the recommendation of Pothitakis Law Firm. The Defendants sought to pay a lump sum and close out the Claimant’s entitlement to weekly benefits as well as to close out his medical care. Given the cost of the Claimant’s medications, the Claimant was unwilling to close out the claim for the amount offered. The parties proceeded to hearing and presented extensive evidence concerning the Claimant’s injury and how that injury affected his ability to be able to return to the labor force. Pothitakis Law Firm argued that the Claimant was unemployable and was permanently and totally disabled. The defendants argued that the Claimant had been in a sales position and, therefore, his physical limitations and physical pain did not prevent him from returning to that type of work.

After hearing, the Deputy Workers’ Compensation Commissioner entered an award fully in favor of the Claimant finding him permanently and totally disabled. The Decision resulted in an award with the present value of in excess of $1 million. In addition, the Defendants were ordered to pay the Claimant’s medical expenses for the remainder of his life.

The case is now on appeal and Pothitakis Law Firm hopes to be successful in defending the appeal.

Over $100,000 Verdict for Injured Worker

The Claimant B.J. sustained an injury in 2014 to her low back. The injury did not result in surgery but resulted in chronic pain and discomfort for the Claimant. She sought medical care which included medications, physical therapy, and injections. She ultimately was told that she would have a restriction limiting her lifting to 30 pounds. The Claimant was able to maintain her employment with her employer as she was able to modify her job duties to work within her restrictions. But for these accommodations, the Claimant would have been unemployable in any of her past employment. At the time of hearing, the Claimant was earning more than she had been earning at the time of her injury.

Shortly before hearing, the Defendants made an offer to the Claimant of a 15% industrial disability. The Claimant on advice of Pothitakis Law Firm rejected that offer and chose instead to proceed to hearing.

After hearing, the judge set forth a decision awarding the Claimant a 50% industrial disability. This entitled her to benefits for 250 weeks. These 250 weeks resulted in an award of over $100,000. This was 5 times as much as the insurance company’s best and final offer shortly before hearing.

The decisions made before hearing as to whether to settle a case or proceed to hearing are very important and can result in significant differences in the ultimate payout. For that reason, it’s important to understand all of your options before a hearing and make a decision based on all of the evidence available.

$300,000 settlement for injured worker

The claimant was working as a union laborer for a major construction project in Iowa. While performing his work activities, the claimant felt a pop in his right shoulder and right arm. He reported it to the nurse that same day and ultimately we referred to the occupational doctors. They determined that an MRI was needed of AD’s right shoulder. The claimant was right handed so this injury had a significant effect on his home and work activities. It was determined that surgery was needed to repair a rotator cuff tear and the surgery was scheduled and undertaken a few months after the injury. Although the surgery provided some relief to AD as it relates to pain, it did not improve his strength. Pothitakis Law Firm helped to obtain authorization for medical care with a more specialized doctor as it related to the shoulder injury. The claimant was seen by a doctor and the University of Iowa Hospitals and Clinics.

It was determined that the best course of action was not an additional surgery, but additional injections. Those were undertaken, which provided the claimant some relief. The claimant was ultimately determined to be limited in terms of his work activities and any attempt to return as a union laborer for major construction projects would be prohibited. A functional capacity evaluation was secured, which was testing that determines what AD could undertake physically in a safe manner and without resulting in re-injury. This functional capacity evaluation determined that AD would be limited to 5-10 pounds with his dominate right arm and right shoulder.

The Pothitakis Law Firm wanted to make sure AD received maximum compensation for the fact that he could no longer work as a union laborer. The Pothitakis Law Firm and Nicholas Pothitakis, a top Iowa Workers’ Compensation lawyer, filed a petition with the Iowa Workers’ Compensation commissioner seeking benefits based upon the extent of the injury to AD and for benefits relating to how this would impact his ability to perform work in the future. The Pothitakis Law Firm assisted by obtaining a second opinion for AD to detail the extent of the injuries as well as the permanency and impairment rating associated with injury. Further, the Firm obtained the services of a vocational rehabilitation expert, who provided testimony concerning limits that the claimant would have in seeking further employment. With a 5 pound lifting restriction, an 8th grade education, and past work all being construction the Pothitakis Law Firm took the position that AD would not be able to find work without extensive re-training, and given his lack of education, that that re-training would be difficult at best.

The Pothitakis Law Firm also had the claimant educationally tested to show the limitations with respect to reading and math and how those would also effect AD’s ability to perform a non-physical employment position. The Pothitakis Law firm was instrumental in maintaining weekly benefits for the claimant up until the time of settlement. The initial offer of settlement was a small and unreasonable offer. The Pothitakis Law Firm took and extremely firm position as it related to the case and was able to successfully resolve the matter for a payment of $300,000.

Workers Slip and Fall Injury Results in Settlement

In early 2017 the claimant DC slipped and fell while working for a local company. The injury resulted in trauma to his left shoulder. He was seen by a local orthopedic surgeon who performed surgery on his left shoulder. Despite the surgery, he continued to have difficulty with his left arm and shoulder. At that time Pothitakis Law Firm helped D.C. to obtain additional medical care for him, including a referral to a spine surgeon. The spine surgeon ultimately determined that his neck was not significantly injured, but the primary problem was from his shoulder. Because of continued problems, DC was sent to an additional doctor for an evaluation. Unfortunately, they determined that his left shoulder condition was permanent. With the assistance of the Pothitakis Law Firm, a functional capacity evaluation was undertaken. A functional capacity evaluation is where testing is done to determine the level of activity that a person can do safely. After the functional capacity evaluation permanent restrictions were assigned, limiting DC to lifting of around six pounds.

DC was middle aged and did not have a high school education. He had worked maintenance and construction for most of his adult life. Because of his injury, chronic pain, and restrictions he was unable to return to his prior types of employment.

Pothitakis Law Firm immediately placed his claim on file and scheduled the matter for hearing. Short of hearing, the insurance company contacted Pothitakis Law Firm to discuss settlement. The parties met and were able to resolve the claim in a manner that was extremely beneficial to DC. Although the amount was confidential, DC was provided the equivalency of several years of salary that would allow him the time to re-train without having to worry about his finances.

Functional Capacity Evaluations are sometimes very helpful to establish the limitations an injured work will face in the future. Doctors sometimes want them so that they can set forth restrictions consistent with an injured person’s capabilities.

This case illustrates the steps that are taken by Pothitakis Law Firm to maximize recoveries for injured workers.

Negations with Medicaid Results in Client Pocketing More Money from Settlement

In October of 2019, the Pothitakis Law Firm was able to successfully settle a claim relating to an auto accident. Our client was on a motorcycle when the accident occurred. She sustained severe injuries as a result of the accident which resulted in surgery and hospitalization. The negligent party’s insurance carrier offered the full extent of their policy limits to settle the claim. It became clear that the insurance limits would be the only funds available to pay for our client’s damages. The primary problem that we had with respect to the claim was the fact that our client’s medical expenses were paid by Medicaid. Medicaid had a significant lien and claim to be reimbursed from any settlement. Under Iowa law, if Medicaid pays medical expenses associated with an auto accident that is the fault of another, Medicaid has a right to seek and be reimbursed any amounts that they have paid. In this case, the Medicaid lien was significant. When Pothitakis Law Firm initially contacted Medicaid they indicated that they wanted 100 percent of their money back. The Pothitakis Law Firm took the position that federal case law should force them to reduce their claim significantly so that our client could receive a majority of the settlement funds. After back and forth negotiations the Pothitakis Law Firm was able to successfully reduce the Medicaid claim by approximately 80 percent. This reduction resulted in a significant amount of money going directly to the client.

The claim was settled for a confidential amount. Our client thanked us and was very satisfied that we were able to provide most of the settlement to her, as opposed to it being paid over to Medicaid.

Verdict Results in Permanent Partial Disability Benefit for Worker

The Pothitakis Law Firm was approached by a worker who sustained an injury to his low back while performing repetitive type work for his employer. The difficulty in the case was the fact that the Employer took the position that the Employee did not report the injury within 90 days of the date of injury. Under Iowa Workers’ Compensation laws, an employee is required to report the injury within 90 days of when he or she knew or should have known that the injury was work-related. The 90-day notice is subject to what is called the “discovery rule.” The discovery rule allows an employee additional time when they do not discovery, until a later date, that their condition is work-related.

What complicates these claims even more is the fact that this was not a traumatic injury, it was more of a cumulative type injury that developed over time. In those situations, the date of the injury can sometimes be difficult to ascertain. In this case, the Pothitakis Law Firm presented evidence that the Employee did not know his injury was work-related until months after the date he last performed the repetitive work for the employer. The testimony of the employee was consistent and the judge found the employee to be credible. Based upon the Employee’s testimony the Judge found that the injury date was not until the Employee was told by his doctor that his condition was work related.

The Employer and Workers’ Compensation Insurance Carrier denied the claim from the start and paid no benefits. The Judge’s Decision resulted in a significant award for the Employee with respect to having all of his medical expenses paid, all of his time off work paid, and a significant permanent partial disability benefit.

Under Iowa Workers’ Compensation laws, an Employee who sustained a permanent injury is entitled to benefits based upon that permanency. In this case, the Pothitakis Law Firm presented evidence of the impairment sustained by the Employee as a result of his back injury as well as a evidence from a second opinion physician detailing the nature and extent of the permanent condition.

This case illustrates that it is very important to report an injury to your employer whenever you think you have a condition that may be connected to your work. Even if you miss the 90-day deadline to provide notice to your employer, it’s important to speak with an attorney about the same as there may be ways to extend that time deadline.

Rear End Auto Accident Results in Large Settlement

The Pothitakis Law Firm was contacted by C.T. and C.M. concerning an auto accident that occurred in late 2018. C.T. and C.M. were waiting to turn on a highway when another car struck them from behind. The collision resulted in fractures and chronic headaches for C.T. and an arm fracture and surgery for C.M. In addition, C.M. sustained a laceration to her mouth.
Initially, there was a question as to whether the negligent party had permission to drive the vehicle and had insurance coverage. Without permission and without insurance coverage, there would likely be no recovery for the Plaintiffs. Fortunately, the Pothitakis Law Firm was able to confirm and convince the insurance carrier that coverage applied and that the significant damages were the responsibility of the automobile insurance carrier.

The Pothitakis Law Firm initially assisted C.T. and C.M. in making sure that all of their bills were submitted and paid by medical payment coverage as well as their own health insurance. This resulted in a significant benefit to C.T. and C.M. in that the bills would be paid and no longer outstanding and they also would be reduced from the charged amount to the contracted amount paid by their health insurance.

After negotiating for several months, Pothitakis Law Firm was able to obtain a significant offer from the insurance carrier for the settlement of the claims. Because health insurance had paid for the medical expenses, under their contract, they had the right to be reimbursed. Pothitakis Law Firm contacted the health insurance carrier and negotiated with them to reduce the amount that they would require back as part of any settlement. This resulted in significant additional monies being put back into the pockets of C.T. and C.M.

As the Pothitakis Law Firm instructs all of its auto injury clients, it is very important to turn all bills for medical care into health insurance and to their own auto insurance medical pay coverage before negotiating with the negligent party’s insurance carrier. Ultimately, the Pothitakis Law Firm’s job is to put as much money as possible in the pocket of our injured clients. We do this by using a number of techniques with respect to negotiating the claim as well as negotiating the amount of any funds that have to paid back to health insurance providers.

Work Injury Due to Repetitive Stress

Pothitakis Law Firm represented an employee of a local automobile parts manufacturer. The employee sustained an injury to her right upper extremity based upon the repetitive activities she performed as part of her work. There was not a specific injury on a specific day, but it was a more gradual injury from doing work activities over and over. As a result of the repetitive activities, the employee underwent two surgeries on her right upper extremity. Despite those surgeries, her pain and discomfort continued. With the help of Pothitakis Law Firm, the client was able to be seen by a pain clinic physician who installed a spinal cord stimulator. This stimulator blocked the pain receptors in the employee’s spine. Despite the injury and surgeries, the employee was able to continue her work for the employer full duty and without restriction.

The Claimant had no restrictions from her doctor and was told to do the best she could with her pain, discomfort, and limitation. The Workers’ Compensation insurance carrier argued that the injury was solely to the employee’s right arm and therefore a very small amount of benefits would be owed for the permanent condition. The Pothitakis Law Firm took the position that the spinal cord stimulator changed the nature of the injury to one that extended beyond the right arm to the body as a whole and an assessment of the employee’s ability to work and earn a living was needed to assess the employee’s entitlement to benefits.

The Pothitakis Law Firm used a second opinion to clarify the nature of the injury. The second opinion physician set forth that the injury extended beyond the right arm and affected the nerves and the spine. Pothitakis Law Firm also argued that although the Claimant had no restrictions, she was skipping overtime because of pain and discomfort. This skipped overtime resulted in a financial loss that needed to be compensated.

After submitting the case at hearing, a Decision was ultimately entered finding that the Claimant had lost 35% of her ability to work and earn a living despite the fact that she continued to work full time and without restrictions. The Claimant was very happy with the result

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