This may be legal advice, or medical. I just need opinions, please.

In My Humble Opinion
1

I understand that you’re neither my doctor nor my attorney. You may be an MD or a lawyer, but you probably aren’t licensed in my state. I just need opinions, perhaps directions on where to go next.

Quick background: 2.5 years ago, my husband (a deputy sheriff in Georgia) was involved in a dreadful wreck in the line of duty. He suffered a host of injuries - concussion, broken orbit, broken teeth, broken collarbone, broken elbow, three broken ribs, collapsed lung, soft tissue injuries of both shoulders (SLAP tears, etc.,) fractured spinal processes (4 verterbrae,) broken pelvis, bruised kidney requiring transfusion, complicated tib-fib fracture requiring surgery - 23 rods and screws holding his leg together, SI joint injury, hip injury to soft tissue, etc. In the course of recovery, Tony also acquired infections - MRSA, enterobacter, C Diff - requiring IV antibiotics, etc. He has attended physical/aquatic/hyperbaric therapy - guesstimating here, but the grand total has been about 2 weeks in hospital, another 2 weeks in hospital-based rehabilitation, 30 or so episodes of hyperbaric chamber therapy, 200+ physical therapy sessions, and 100+ aquatic therapies.

He isn’t getting better. Twice, he’s returned to work for light duty - four hours maximum, desk duty. Both times, he was unable to even sit in a desk chair for a few hours at a stretch. He’s 46, and wants nothing more than to go back to work, on patrol, working his dog. Realistically? That’s not going to happen.

Tony’s wreck happened on 12/28/2012. Insurance covered everything, with minimal questions, for the first two years. Beginning with a shoulder surgery scheduled on 12/30/2014, however, workers comp has denied everything recommended by the primary orthopaedist - shoulder surgery, hip imaging, etc. If it means anything regarding this situation, we’re in Georgia. Statute requires that any lawsuits against a county be filed within two years, and the denials began at the two year & two day mark. (I think someone doesn’t realize that our attorney filed paperwork preserving the right to sue. Maybe that means something, maybe not.)

Meanwhile, my husband is barely functional. He can’t even sit at a desk for more than a few minutes. He certainly can’t help around the house, or play ball with his daughters, or work with his dog. We’re consulting with attorneys, but that doesn’t fix the real issue - that, until his major medical issues are addressed (hip/groin and shoulder,) my husband has no life. Is there any way to force the insurance wankers to at least authorize imaging/tests to SEE what the hip issue is? (They’re saying that it’s unrelated to the wreck. We’ve done the “independent medical examination” bit. Dr. Independent Medical Examiner is about as professional as my pet dog, 'Dora the Very Large Idiot. Dr. IME graduated from med school in 1969. When Tony visited, Dr. IME didn’t even bother to close exam room doors during consultations.) We’re fortunate, I guess, in that we are still covered under the county’s medical insurance, so Tony can see a doctor at our expense (co-pays, deductibles,) to figure out what’s up with the hip and shoulder. But that co-pay of $2500 is about $2500 more than we have - Tony receives $500 per week in pay from workers comp. That just barely pays our regular bills. And I can’t return to work, because we have two preschoolers - Tony can’t care for them on his own, and childcare would cost more than I can earn right now.

I guess my questions are:

  1. How do we “force” workers comp to actually treat Tony for his work-related injuries? I know we can go through regular medical channels and then sue if it can be shown that the treatment should have been covered by comp, but truly, we can’t pay the co-pay. I can cite Boaz v. K-Mart Corp., but that won’t protect our fragile credit rating during the months or years while we can’t pay an outstanding medical bill.

  2. We have an attorney who represented us when we sought relief from the auto insurance of the guy who caused Tony’s wreck, and the owner of the car. I think she’d represent us if we sue the county - and, in fact, she did file the paperwork preserving our right to sue the county. (Tony’s supposed to call her this morning to double check that.) The wreck happened when Tony was responding to a dispatch for an active house fire, around ten a.m., the Friday after Christmas. Tony actually recognized the address, and knew that the householders worked, and had minor children. He was running code because he was afraid that there were kids at home and the house was afire. As it turns out? There was no fire. The homeowner called because he smelled something, and asked whether the fire department could come out with thermal imaging cameras to make sure there was nothing afire in the walls. But dispatch managed to make a minor issue sound like an emergency. We hope that the recordings are still available. (The homeowner who placed the call? Called the non-emergency line. And happened to work at second-in-command with the police at the trauma center where Tony was treated. And happened to have worked with Tony at a nearby municipal police department. I already know that he’ll testify - believably - if a suit ever comes to trial.)

  3. This is a total “who knows, maybe not worth pursuing” question, but: I was not working outside the home when Tony’s wreck happened. The plan was for me to go back to work when the baby was weaned, about a month after the wreck. That didn’t happen, because Tony needed at-home care, and wasn’t/isn’t physically able to provide childcare. Is there any chance that I can claim hourly pay for the care I had to provide? (Everything from meals to administering IV antibiotics. I couldn’t even go to the grocery store until the big kids were home from school, to watch over the littles for a few minutes.) This is a minor point, but is it worth pursuing?

  4. Just background information: Thus far, we have consulted with the attorney who filed our claims against auto insurance, and who filed notice preserving our right to sue the county. We’ve consulted with a workers comp attorney, after the comp insurance company started making noises about wanting to settle the case. (That lawyer’s advice was to not settle, or even discuss settling. First, we need to fix everything that can be fixed, medically. It makes no sense to accept a settlement while Tony still needs substantial medical treatment. And the workers comp attorney has, in the past couple of days, referred us to a third attorney specializing in Social Security disability, to at least establish the framework of a claim. Tony is still seeing two doctors regularly - a back specialist, and an orthopaedist. Both continue to try to refer Tony for further treatment/diagnostics for the hip/groin issues, and to get approval for the shoulder surgery that is thus far being denied.

Essentially, I’m at the point of trying to convince Tony that we’ll pay $10 per week forever on our deductible - he has to get some kind of information/treatment for his hip. It looks to me like we’re going to have to sue the county anyway - might as well lump the hip treatment in with the lawsuit, and let our health insurance duke it out with comp. I suspect that the way the dispatch was handled gives us grounds to sue the county - it was their internally-managed employee who sent Tony on an urgent call that was never urgent. We aren’t, and never have been, after a big windfall - nothing would make me or Tony happier than for him to be totally underpaid for going back to work at the job he loves. I’m not seeing a better choice now, though. He can’t even get approved for diagnostics to figure out what’s wrong with that hip. (And, maybe not important, but when the ortho released Tony for light duty, one of the written conditions - I have a copy of the order - was a proper desk chair, adjustable height and stable, for Tony’s use. The first return to work included a throwaway chair, with broken hydraulics. By day 4, Tony couldn’t even walk back to his own vehicle unaided, due to sitting in the broken desk chair.)

I guess that the TL/DR version is this: what would you do if faced with an on-the-job injury that kept you out of work for 2.5 years, with no end in sight and the insurance company denying treatment for injuries connected with that incident? Are there alternatives besides a lawsuit?

2

Wow. Sorry to hear what you’re both going through.

There are appeals processes within workers comp. If you haven’t done that, do it now.

Since the main complaint is aimed at a government agency, next I’d move on to your politician. Contact your state representative or state senator. The fact husband was a government employee and it’s overall a sympathetic sounding case will help.

If that’s a dead end, the next move is the media. If you can get some outraged stories going you may even be able to attract a *pro bono *attorney this way.

All the above are free. And will work, or won’t, within a month or so. SO start pushing and see what you can do. If al these come up empty, then yes, you may be stuck with no better solution than suing the agencies.

3

Long rambling PM sent.

Hang in there.

One more item related to dispatcher liability…
Most 9-1-1 centers (and some police departments) train their dispatchers to be certified by a particular agency. (APCO is a big one. There are more) Find out which such certifying agency (if any) the department used. That should easily lead to copies of the relevant training standards.

4

That truly deeply sucks. I wish I had more advice for you, but this is so far out of my bailiwick that i can only say the above suggestions may be worth pursuing. Definitely talk to the 1st attorney again.

As far as the copay issue-- I agree with your plan to make arrangements. Further diagnostic results seem like it would bolster your case against workers comp, and any lawsuit that ends up proceeding.

And I have family in Georgia. Tell Tony that at least one Random Internet Stranger is grateful for what he has done (and hopefully will be able to get back to doing!) to protect and serve.

ETA I am not a lawyer, doctor or anything relevant to your issues…Just a Random Internet Stranger.

5

Thanks all, for the input. I suspected that our only recourse was to seek independent treatment and hire a good attorney, but hoped there was another avenue I hadn’t thought of. This situation truly sucks, and just the thought of a court battle gives me the vapors. Time to call Attorney #1 on Monday, I guess.

6

In my opinion if the county’s attorneys allow this to come to a court battle, they’re crazy. I would think they’d settle, and you would never have to endure a trial.

I’m so sorry this happened to you and your husband. Tell your husband thank you for his service. :frowning:

7

Don’t bother with your auto attorney. What you need is a worker’s comp attorney. It’s a very specialized field*. Also, nearly all of them offer free consultations AND are paid (at least in my state) out of your end settlement so you may end up with no real money out of pocket.

*Unlike other areas types of insurance, in some states, and it looks like your’s might be one, WC is all handled by the state so going with a lawyer that handles this type of stuff will help you. There’s very specific laws that mandate everything, even down to how the lawyer gets paid. It’s sligtly different than arguing with another attorney about who said what to whom or which person had green light. You need someone that can talk to your adjuster on your behalf and “remind” them of how the law works. The insurance company is well aware that you don’t know the law and will push you around. Trust me, they did it to me. I haven’t used a lawyer (yet), but I picked up what I needed to know very quickly and pushed back when I needed to. But who knows, there may be stuff I don’t even know that I didn’t know and lost out on.

Regarding the fees, I’m looking at a few GA websites and they seem to be a bit different than WI. In Wisconsin, they can only charge 20% of your settlement and it’s taken out of the settlement after it’s paid out. In GA, it looks like they can take up to 25% of your weekly benefits (up to 400 weeks). So I’d check into that more deeply. But still, get a WC lawyer, not an ambulance chaser. WC is a whole different ballgame.

8

I’m a workers’ compensation attorney in Florida (and part of my practice is representing municipalities and counties.) Georgia’s system is very similar to ours. Your litigation goes through an administrative hearing office. There’s no jury trial, and the rules of procedure are somewhat relaxed. I won’t say it’s going to be a pleasant experience for you, but it will be cheaper, faster and less of a hassle. Your attorney (assuming you retain one) will be paid on a contingency basis.

It would be unprofessional for me to criticize an attorney in a state I’m not licensed in based on secondhand information, but frankly any semi-competent personal injury attorney should have been able to explain most of this to you (even with no direct WC experience.) I’m going to assume that you have misunderstood or misremembered what she said.

As a general rule, you won’t be able to “sue the county,” at least in tort; the flip side of WC is that you can’t pursue civil claims against employers for workplace injuries except in limited circumstances. I am assuming your husband’s agency is the county sheriff’s office, rather than a state police agency.

You can PM me with any general questions. Understand that I am not your attorney, not licensed to practice in your jurisdiction, and can’t give you any advice about your husband’s specific case, etc.

9

What’s the long-term prognosis, assuming unlimited medical care? Is he ever going to be fully functional again? Are his disabilities and lingering limitations ever going to be corrected? Or is what he (and you) are facing is a lifetime of coping with intensive medical support?

10

I have no idea how WC works in Georgia, but here in CA, there comes a time where the worker gets certified to return to work, or retrained to a job that he can do. When that time comes, the MDs come up with a degree of disability (permanent) and a cash award is based on that.

If police work is no longer possible, will they retrain your hubby for another job?

11

Just to clarify you are saying that a worker’s comp settlement will effectively terminate the county’s insurance company’s responsibility to pay for any future medical treatment and that’s why your worker’s comp attorney has told you not to file suit yet?

.

12

Trying to answer questions, but I’m as confused as a chameleon in a bag of Skittles anyway:

  1. At this point, we have no idea what a long-term prognosis may be, as workers comp is now denying every treatment avenue recommended by the ortho and the back specialist. Relatively minor shoulder surgery is definitely needed, but we don’t know what’s going on in the hip/groin area - hernia? cyst? avulsion fracture? who knows? In addition, the spinal injuries Tony suffered in the wreck are causing arthritic problems, which have thus far been treated with nerve ablation in the lumbar and SI regions. Those treatments have resulted in temporary improvement, but each seems to last about two weeks. (And, if it gives an indication of how much pain Tony has been in, it took him about three days to realize that he had shingles last fall, because the rash/nerve pain was actually less intense than his daily back pain.)

  2. If Tony’s hip and back pain can be treated or managed in a way that would allow him to sit at a desk, get in and out of a vehicle a few times a day, and walk around a bit, a job can be “created” for him - his former shift supervisor is now in charge of keeping track of sex offenders in the county, and the sergeant is undergoing a kidney transplant very soon (Hooray! He found a donor!) That will limit the sergeant a bit, due to the immunosuppressant medications he’ll be on, and Tony would basically become the person who does the face-to-face verifications of addresses, updated photos, etc. If he can’t even sit at a desk, I don’t know what else he could be trained for.

  3. We are talking to three separate attorneys, each with different specialties. The workers comp attorney is very well-respected in her field, has practiced for more than 20 years - actually is a past member of the Executive Committee of the Workers Compensation Section of the State Bar of Georgia and a past member of the State Board of Workers Compensation Chairman’s Advisory Council (and locally, very well-connected politically, if that matters. Can’t hurt!) In the past month, she has advised that we not even begin to discuss settlement with workers comp - we’re cooperating with the “independent” medical exams, second opinions, etc. In the meantime, though, Tony isn’t getting better, and his back and groin conditions are actually deteriorating.

The second attorney was recommended by the comp attorney, to establish a claim for Social Security disability. That’s probably down the road, but if the paperwork is filed now, the claim may be backdated.

The third attorney (who was actually our first consultation, the one who handled our claims against the auto insurance companies,) seems to believe that Tony may actually have a claim against the county itself. She may be wrong, but I do know that she has consulted with a well-respected retired state judge about this case. (The judge happens to be our lawyer’s mom, and sat on the bench for about 3 decades.) That’s why she filed the initial paperwork preserving our right to file suit directly against the county, from what she told us. Thus far, Tony has balked at filing suit, because he knows that he’ll never return to work as a cop if he files. At this rate, though, he’ll never be physically able to return to that job, so I don’t know that it matters that he’ll be blackballed.

  1. Tony is receiving weekly workers comp payments, plus mileage reimbursement, drug coverage, etc. That has only been an issue once, when the county’s human resources department dropped the ball and didn’t inform comp that Tony’s return to work/light duty status ended after only a few days, due to physical inability to sit at a desk. Even with that payment, plus food stamp benefits, we’re always one car repair, emergency room visit for one of the kids, veterinarian bill, etc., away from financial disaster. I can’t return to work, because Tony isn’t physically able to take care of the little kids right now - he’s barely able to take care of himself some days.

I don’t even know whether I have real questions that can be answered - I think I’m just frustrated because Tony refuses to accept that it’s going to probably require legal action (via workers comp mediation, lawsuit, something,) to force the parties involved to just do the right thing. And I’m weary, and tired of trying to stretch too few dollars to cover too many expenses, and sad when I remember all of those promises from Tony’s colleagues and supervisors when he was in that hospital room - “we’re there for you, we’re a family, etc.” have become “Tony who?” I’m just tired.

13

(please just ignore if not applicable!)
I am wondering if some kind of general counseling for both of you would be helpful. It seems to me that Tony probably has disabilities that are likely to affect him in the long-term, and it doesn’t seem that he has really accepted that. He may well still return to work, but I get the feeling that is not going to happen quickly or easily. It might be time to “burn the bridges” that would keep him from returning to a police job, if that can’t be avoided. Just to my uninvolved ears, if he needs several more surgeries, it’s going to be months or years before he’s going back to work anywhere.

Also, sounds like you need an emotional break from the situation, and sometimes a “paid sympathetic ear” is a wonderful thing. You may want to consider working a few days a week, even if it’s not a financial benefit, just to get out and deal with some normal stuff you can control.

14

Thanks, Snowcarpet. Jobs are scarcer than hen’s teeth in the summertime in a college town, but I’ve signed up to volunteer at the summer lunch program a couple of days a week. It will get me out of the house, dealing with “normal” people who aren’t part of my household, and the big kids are out of school, so I won’t have childcare costs to worry about. Counseling would be great, but our insurance coverage is lousy, and that $75 co-pay per session just isn’t in the budget. (I’ve put us on the waiting list for the public mental health counseling service, but it’s at least a six-month wait to get non-crisis counseling. But it’s a sliding scale payment, so maybe we can get some service there.)

15

If your family’s whole income is $2000 a month, you may qualify for free or reduced-cost child care, freeing you up to work.

https://dfcs.dhs.georgia.gov/caps-income-requirements

You should also consider pursuing disability benefits for your husband. This can only help your lawsuits, and can get you some much-needed income, plus Medicaid. It isn’t a fast process, so the sooner you start it, the better.
No doubt these are both unpleasant options to consider, but your husband’s medical needs should be addressed as soon as possible for the best possible outcome, and your stress over your financial situation deserves relief. This could give you the breathing room you need to get you through this period. Hopefully soon you won’t need it any more because your case will be settled, but meanwhile there is no shame in seeking out and taking any assistance you can to get your family through this difficult time.