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Our offices are OPEN!

Posted on Monday, June 15th, 2020 at 5:18 pm    

We are excited to announce that our offices are now open!
We’re determined to succeed on behalf of every client who retains us, because we know what a difference it can make in their lives and the lives of their loved ones. When you need legal help, turn to a team that has the skill, experience, and resources necessary to win. Our consultations are always free, so contact a knowledgeable member of our team by calling (513) 351-5997, chatting with us live, or by filling out a contact form today.


Posted on Sunday, May 17th, 2020 at 10:00 am    

Ohio and Kentucky residents know their states are re-opening slowly, and the exact guidelines – Are restaurants open this week? How about bars? – can be really tough to pin down. Kentucky’s re-opening dates are published on the state’s official website with a handy poster explaining the guidelines here. Meanwhile, in Ohio there is a similar re-opening plan with dates that only vary from the Kentucky schedule by a few weeks at most.

Law firms are just one more industry that is trying to stay one step ahead while complying with all the state regulations. Since Lawrence & Associates Accident and Injury Lawyers, LLC has locations in both West Chester, Ohio and Fort Mitchell, Kentucky, we are combining both states’ re-opening guidelines into one plan to have both our offices physically reopen on June 15, 2020. We are waiting until June 15th because many of our employees are not able to get childcare earlier. Even where childcare facilities will be open, the restrictions on the number of children in a single room mean some employees might not be able to send their children in on the first day the facility opens. Until then, Lawrence & Associates Accident and Injury Lawyers, LLC will continue to represent our clients while working from home. We’ve made a few posts explaining how our focus on using the latest technology to achieve better results for our clients made the mandatory office shutdown very easy for us. You can see a video here explaining how our phones, email, and fax are all internet based and work normally even when the employees are working from home.

Our transition was so seamless, we even managed to achieve over $1,000,000.00 for our clients during the shutdown. In addition, we’ve been able to continue keeping our clients informed using video options such as Google Duo, Zoom, Microsoft Teams, and by telephone.

We know that your case is important and that work must continue. We recently produced another video talking about how we’ll manage our cases and personnel as we transition back into the West Chester and Fort Mitchell offices.

And while all this is going on, court systems are continuing to adjust and plan their own re-opening schedules. Here’s a little insight into how the court systems are planning for the next six weeks.

Personal Injury –The federal courthouse in Cincinnati recently re-opened. Kentucky is re-opening courthouses on a limited basis starting June 1, 2020. Despite that date, we expect that many routine motions and other issues will still have their hearings by video or teleconference due to restrictions on the number of people allowed in a courtroom. Lawrence & Associates Accident and Injury Lawyers, LLC’ attorneys have been attending or hosting depositions and mediations using Zoom. Important documents are being signed by Docusign so everyone can remain remote. Doctor’s offices’ re-opening has allowed us to get medical records in more quickly, and we are still asking clients if they’d prefer a medical records review by a doctor instead of an in-person exam, so your case can move forward despite your comfort level.

Workers’ Compensation – all workers’ compensation hearings are now moving forward normally, although mostly by telephone. Lawrence & Associates Accident and Injury Lawyers, LLC is seeing very little slowdown in the Workers’ Compensation system at this time, as both the Ohio hearing officers and Kentucky Administrative Law Judges have adapted to telephonic hearings. In fact, the telephone hearings have been so successful that we hope both systems continue to use them as a matter of course in the future. If you are in a workers’ compensation claim, you should see very little or no slow down at this time.

Bankruptcy– Much like the previous entry, there should be no slowdown in your ability to file bankruptcy cases. All hearings in federal court have been reset by video or telephone, and there was never a break in our ability to file bankruptcies. While this practice area requires client to produce a lot of documentation, Lawrence & Associates Accident and Injury Lawyers, LLC has a website set up where clients can upload all their documents with just the click of a button. There’s no more need to bring stacks of paperwork to an attorney’s office. If you need to file bankruptcy – and so many do because of the coronavirus-related layoffs – you should be able to hire an attorney and do so without leaving your home.

Social Security – although many social security hearings were remote even before the pandemic, this system has been slower to reset hearings than more. While Lawrence & Associates Accident and Injury Lawyers, LLC can still meet with clients by phone or video, and can get your claim filed, the hearings still haven’t been set at the same rate we saw before the COVID-19 pandemic. However, those first steps that can be done are still very important. Getting your initial application and follow-up motion for reconsideration filed are important pre-requisites to a hearing, so hiring an attorney and filing those documents still moves your case along the path of a successful disability claim. Lawrence & Associates Accident and Injury Lawyers, LLC’ social security disability attorneys expect to see many backlogged hearings set in the next month, but so far have not seen actual dates.

Tech-savvy Cincinnati lawyers

Our attorneys continued to be amazed and frustrated at the number of people who report that their current attorney is unreachable because the attorney’s office is closed, or who report that their cases are going nowhere because the courts are closed. This isn’t true, and if you’re being told these things you should find a new attorney. Good law firms with even a minimal grasp of modern technology should have no problem getting settlements or completing bankruptcies at this time. For those personal injury cases that can’t be settled, it is true that you cannot get a jury trial and that can be an impediment to moving a case forward. But ask your attorney about getting a bench trial done by video, because many courts are experimenting with this format to finalize cases without settlements. And above all, make sure you have an attorney that can keep you informed and move your case forward in case the COVID-19 cases start to rise again. While we all hope the quarantine is about to be over for good, no one knows. If businesses do shut their doors, will your case shut down or keep going? The decision you make today could affect you in the near future.

To get in touch with a tech-savvy Cincinnati law firm, call Lawrence & Associates Accident and Injury Lawyers, LLC at (513) 351-5997 or contact us online.

Limited Scope Representation: Can You Ethically Provide Better Service at Affordable Cost?

Posted on Wednesday, December 12th, 2018 at 8:32 am    

agreementAuthored by Justin Lawrence and Chris Rose

Limited scope representation is a relatively new and somewhat controversial idea in the legal profession. Some attorneys are hesitant to provide limited scope representation because they are concerned about the ethical ramifications of entering into an agreement that limits their representation of a client and leaves the untrained client to perform some (or even most) of the duties traditionally reserved for attorneys. Generally, the influx of limited representation has developed due to the growing costs of legal services many people cannot afford. Proponents of limited scope representation believe clients are better off with the limited representation they can afford, as opposed to attempting to face their legal hurdles entirely by themselves.

As limited representation becomes more common, attorneys turn to their state bar associations in search of guidance on how to enact this model of legal services.The Kentucky Bar Association has not issued specific guidance on limited scope of representation of unsophisticated clients in areas such as family law or defense of collection activities. Kentucky’s SCR 3.130(1.2)(c) does specifically allow that, “A lawyer may limit the scope of the representation if the limitation is reasonable under the circumstances and the client gives informed consent.” However, paragraphs six and seven of the Supreme Court’s 2009 commentary paint only the broadest outlines of what might be considered a reasonable limitation. For example, paragraph six states that when representing an insured, one’s representation of the insured may be limited to the issue of coverage, leaving the insured to determine appropriate damages on its own.

However, may a Kentucky attorney contract only to draft an Answer and conduct initial discovery, but no more? An ethics opinion from 1991, E-343, does give authority to draft only initial pleadings, so long as the attorney does not give the appearance that the claimant is entirely unrepresented, stating, “The overriding consideration should be the recognition and satisfaction of the legal needs of indigent persons. Artificial barriers should not be set up in the name of legal ethics.” In other words, drafting an answer is only ethical so long as the reservations in KBA Opinion E-343 are followed, but if discovery is also drafted, the attorney has entered an ethically gray area.

Bearing that in mind, may a Kentucky attorney agree to pursue a divorce by agreement, but cease representation if property settlement is disputed? And if a Kentucky attorney contracts only to represent in pre-trial litigation but not in trial, is withdrawing on the eve of trial unethical? Both the rule and commentary fail to provide the detail necessary to answer these questions.

The neighboring bar associations in Tennessee and Indiana have yet to address this issue and do not have information on the issue available on their websites. However, other states in the region, specifically Ohio and Missouri, have addressed the issue to provide guidance to their attorneys on how to competently serve their clients through limited representation, while protecting themselves from potential ethical hurdles that this model of legal representation may present.

Ohio Dipped Its Toe in the Limited Scope Representation Waters…

An article posted on the Ohio Bar Association’s website addresses the issue of limited scope representation, starting with the issue of ethics.When an attorney considers expanding his or her practice to include a new area or new service, one of the first concerns is how to ethically provide this service. Like Kentucky, the Ohio Rules of Professional Conduct do allow limited scope representation, pursuant to Prof. Conduct R. 1.2(c).This rule is an adoption of the Model Rules for Professional Conduct and a similar version of this rule appears in the rules governing attorney conduct in most states. Ohio’s rule allows limited representation of new and existing clients provided the limitation is reasonable and communicated to the client, preferably in writing (although written consent is not required).

According to Ohio Judge, Jeffrey Hooper, more than 50 percent of the cases in his court included an unrepresented party. Judge Hooper says it could be a “win/win” if more attorneys adopt the limited scope representation model because that allows clients to receive representation they can afford and attorneys may receive fees for providing this representation. No one is placed in a worse situation by the enactment of limited representation, according to Judge Cooper, if it is done correctly.

Ohio, which has a non-mandatory state bar association, adopted a piecemeal approach to incorporating limited scope representation. For example, the Sixth District Court of Appeals in Toledo has an official program for involving limited scope representation at the appellate mediation stage, while the First District in Cincinnati has not taken up limited scope representation at either the appellate court or bar association level. However, the Ohio State Bar Association (OSBA) adopted ABA findings that unbundling the following legal services can be permissible—and even desirable—if the client’s informed consent is obtained:

  • Advising on court procedures and courtroom behavior
  • Coaching on strategy or role playing
  • Collaborative lawyering
  • Conducting legal research
  • Reviewing documents
  • Drafting documents, contracts and agreements
  • Drafting pleadings, briefs, declarations or orders
  • Ghostwriting
  • Making limited appearances
  • Negotiating
  • Coaching for or participating in online, telephone or in person dispute resolution
  • Organizing discovery materials
  • Preparing exhibits
  • Providing legal guidance or options
  • Assisting with service
  • Appearing at a hearing
  • Negotiating on a client’s behalf.

The Ohio State Bar Association’s recommendation list gives much clearer boundaries for what a la carte offerings may be ethically made, which is a boon for both attorneys and judges encountering limited scope representation for the first time. If you want to know more—a lot more—about the ABA’s findings that were adopted by the OSBA, their 149-page Handbook on Limited Scope Legal Assistance on limited scope representation is available online.

… And Missouri Dove Right In

Of Kentucky’s neighbors, Missouri seems to be at the forefront of enabling its attorneys to provide limited representation, while also providing the guidance to enable them to do it competently and ethically. First, Missouri’s Rule 4-1.2(c) requires agreements to limit representation to be in writing and signed by the client, a brighter line rule than those of Ohio and Kentucky. The Supreme Court of Missouri and the Missouri Bar Association established a commission in 2002 to examine pro se litigation in the state. That committee released a report on limited scope representation that can be of great guidance to Missouri attorneys in implementing limited representation. This report addresses many issues Missouri attorneys face when providing limited scope representation and even provides an example of a limited representation contract for attorneys to use when unbundling their legal services. These are the most affirmative steps taken by a state Supreme Court and bar association to provide its attorneys with the information and resources they need to provide competent limited representation to clients who need it the most.

The Missouri Bar Association also provided guidance to attorneys to aid the determination of when limited scope representation is practical and ethical. The Missouri Bar Association advised that attorneys who deal in limited scope representation provide potential clients with questionnaires that will assess that individual’s ability to represent himself or herself to the degree the limited scope representation requires. Further, it set guidelines for the endpoint of limited scope representation, with specific requirements for how an attorney is to withdraw.

Finally, Missouri’s Rule of Civil Procedure 55.03 has a more detailed, more explicit list of activities expressly allowed under the rules, giving lawyers more guidance on whether a specific scope of limited representation is permissible. Attorneys in Missouri are expressly permitted: a) to draft documents to be filed in court without signing said documents; b) to appear and withdraw from representation at points of litigation expressly set forth in the contract, without fear of being held over into a trial without hope of payment from the client, and; c) to rely upon the self-represented party’s representation of the facts when drawing up legal documents or performing legal research. Missouri’s Rule 55 serves as a helpful list of dos and don’ts that give clear, logical guidance to attorneys seeking to engage in limited scope representation. We could find no other neighboring state with a better system in place.

The legal market, like any other, has an invisible hand. As market pressures such as rising tuition and the rising cost of litigation force attorney’s fees higher, new solutions emerge that resolve disparities between the cost of supplying legal services and the ability to pay by litigants demanding those services. Limited scope representation is the most relevant, prevalent and inevitable of those solutions. It is here to stay. Until the Kentucky Supreme Court modifies SCR 3.130(1.2)(c), or until appellate court rulings interpret how it is applied to the kind of limited scope representation described above, practitioners interested in providing such services should adhere to the ABA Handbook. Since SCR 3.130(1.2) (c) is modeled from the ABA rules of professional conduct), and review the specific programs created in Ohio and Missouri to see if they can adopt similar practices in their local Kentucky courts. By doing so, you should be able to help more people, stay ethically sound and grow your law practice.

Can a Lawsuit Settlement or Award Be Taxed By The Federal, Ohio, or Kentucky Governments?

Posted on Friday, August 24th, 2018 at 10:42 am    

The following post is part of our Law Student Blog Writing Project, and is authored by Jennifer Tressler, who is pursuing her Juris Doctorate at The Ohio State University Moritz College of Law.

You have been injured. You have no idea how you are going to pay for your medical bills. You are not able to work right now because of your injuries, so your family has lost your income and is struggling financially. It is such an overwhelming time that you file a lawsuit, and—great news—you win a settlement large enough to cover all of your medical bills and allow you to provide for your family until you are able to get back to work.

dollarHowever, now you have new worries. You have won this large amount of money—but will the money from your injury settlement be taxed and taken away from you? Does this money constitute income in the eyes of the IRS? The answers to these questions are dependent upon the facts and circumstances of your specific case.

Generally, though, the IRS will not interfere with the allocation of funds provided that they are consistent with the substance of the claims in your settlement. Different types of claims are treated differently by the IRS, however, and how you should deal with the settlement money from these different types of claims will be briefly outlined here. If your settlement included multiple claims, the amounts pertaining to each claim will be treated accordingly with the rules for that individual amount. This means that if you receive $50,000 for personal physical injury and $50,000 for emotional distress, $50,000 will be regarded under the rules for personal physical injury or physical sickness and $50,000 will be regarded under the rules for emotional distress or mental anguish.

Personal Injury and Emotional Distress Lawsuits

If your settlement is for personal physical injuries or physical sickness and you did not take an itemized deduction for medical expenses related to the injury or sickness in the past, the full amount is non-taxable. You should not include this money in your income reporting. You must, however, include any portion of the settlement that is for medical expenses that you deducted in the past that resulted in a tax benefit. If part of the proceeds is for medical expenses you paid over more than one year, it must be allocated on a “pro rata” basis, or in proportion to the amounts paid each year. Talking to an experienced lawyer at Lawrence & Associates Accident and Injury Lawyers, LLC can help you figure out how to calculate the amount to report and fill out the correct forms.

If your settlement is for emotional distress or mental anguish originating from a personal physical injury or physical sickness, it is treated in the same way as a settlement for personal physical injury or physical sickness, which is listed above. If the emotional distress or mental anguish settlement you receive does not originate from personal physical injury or physical sickness from the accident, it must be included in your income reporting. This amount reported is reduced by the amount paid for medical expenses attributable to emotional distress or mental anguish not previously reported and by previously deducted medical expenses for emotional distress or mental anguish that did not provide any tax benefit. A lawyer can help you attach a statement showing these deductions to your return and fill out the necessary forms to document this.

Employment or Property Damage Lawsuits

If you receive your settlement in an employment-related lawsuit, the portion of your proceeds that are for lost wages is taxable and subject to the social security wage base, as well as the social security and Medicare tax rates in effect for the year the settlement is paid. They are subject to employment tax withholding, and a lawyer can help you report these in the appropriate places on your returns. If you run your own business and your settlement is for lost profits for your own trade or business, those proceeds are considered net earnings subject to self-employment tax and must be reported. A lawyer can help you navigate this more complex reporting and help you select the correct IRS forms.

If your settlement is for loss in value of property and is less than the adjusted basis of your property, it is not taxable and generally does not need to be reported on your tax return, although you must still reduce your basis in the property by the amount on the settlement. If your property settlement exceeds your basis in the property, the excess is considered income. A lawyer can help you determine if this applies to you and, if so, how much excess you must report. In addition, any interest on any settlement is generally taxable and needs to be reported.

The Different Treatment for Compensatory and Punitive Damages

Most of the money awarded to you in your settlement is considered compensatory damages, meaning that the money is intended to pay you back for your injuries. Compensatory damages compensate the injured party for their direct suffering (i.e. medical bills, lost wages, resulting health problems, etc.), and you had to prove that you suffered some type of monetary loss, how much the loss was, and that the other party was the cause of this loss. In contrast, punitive damages are intended to punish the wrongdoer, as well as serve as a warning or lesson to the rest of society. They exceed simple compensation. Punitive damages are only available in cases where the defendant is considered reckless or negligent. For example, in a car accident, punitive damages could be available if the defendant was driving drunk at the time of the crash. Punitive damages are always taxable and must be reported as income, even if they were received in a personal physical injury claim. Some settlements containing punitive damages require the recipient to make estimated tax payments on said settlement. A lawyer can help you determine if this applies to you, and if so, how much your estimated tax payments should be.

If you have questions about how your settlement will be taxed, please call Lawrence & Associates Accident and Injury Lawyers, LLC today for a free consultation at (859) 371.5997. We’re Working Hard for the Working Class, and we want to help you!

Cincinnati Area Tips and Tricks for Dealing with Insurance Companies After A Car Accident

Posted on Thursday, August 16th, 2018 at 4:07 pm    

The following post is part of our Law Student Blog Writing Project, and is authored by Dayna Wilson, a law clerk at Lawrence and Associates, who is pursuing her Juris Doctorate at Chase College of Law.

Getting into an accident is frightening. You may feel alone and unsure how to proceed after such a terrifying event. Who should you talk to? What should you say? Who is on your side? All these questions may be scattered in your head as you question who you should turn to. The first call you might get is from an insurance adjuster who wants to question you about your accident. At this point, you need an experienced attorney who can help you handle communications with the insurance adjuster to protect your rights. Insurance adjusters for liability insurance policies get annual training on the best ways to interrogate people in car accidents to avoid or minimize damages payable under the policy. Don’t be one of their statistics!

Should You Talk To Your Insurance Company After an Accident?

crashThe goal of your insurance company is to make the other driver’s insurance pay for damages to the vehicle. Although your insurance company is on your side, they are not paid or trained to pursue your claim against the at-fault driver the same way an attorney will. Your retained attorney will work on your behalf with your insurance company and the other driver’s insurance company to maximize your settlement. This is why it is important after an accident to contact an attorney so your rights can remain protected.

In addition, your insurance company has an obligation to pay for related medical bills after a car accident. These payments are called PIP payments in Kentucky, and Med Pay payments in Ohio. However, the adjuster often lives outside the Cincinnati area, and therefore doesn’t have the expertise to help you choose a doctor from the confusing army of medical professionals in the Tri-State area. In a similar vein, many primary care physicians are part of hospital networks that are pressured to refer within the hospital’s network, rather than to the doctor best equipped to treat your injury. One benefit of retaining an attorney early on is that an experienced personal injury attorney knows every doctor in the area, and has seen the outcome of their treatment on hundreds of patients. We know who to refer you to, and take pride in referring to the best medical professional for your condition!

Can An Insurance Adjuster Trick You Into Saying Something To Hurt Your Case?

When you are injured in an automobile accident, one of the first things that will happen is an insurance adjuster will contact you about the car accident. The adjuster may begin with some simple or innocent questions. Although the questions may seem innocent, the adjuster’s motives are not in your favor. Adjusters questions often include:

“Have you been involved in a previous car accident or other accident?”
“Are you the registered owner of the vehicle?”
“Was the weather a factor in the accident?”
“What happened?”
“Were you using a cell phone or any other electronic devices?”

The purpose of an insurance adjuster is to investigate and evaluate insurance claims. Adjusters decide whether an insurance company must pay and if so, how much. They conduct interviews, inspect property, and review police reports. The goal of the adjuster is to obtain valuable information to use during the claims process. While the information may seem reasonable, often any data collected is used against you to lower the value of your claim.

There are good reasons to limit your phone conversations with insurance adjusters when an adjuster calls you after an accident. Many adjusters will call frequently in an attempt to get you to settle quickly. In this case, if your injuries are minimal or nonexistent, it is permissible to talk to the other driver’s insurance company. The police report may place liability on the other driver. If this has occurred, communication with the other side may speed the claims process along.

Often, insurance adjusters will ask the victim to make a recorded statement. Remember an important rule: you should not provide an insurance company a recorded statement concerning the motor vehicle accident without having an attorney present. Simply put, the other side’s insurance company is not on your side, no matter how friendly or approachable they may seem. You can be completely honest about everything. However, later at trial, the insurance company may attempt to use any inconsistent statements between the recorded statement and the testimony at trial against you. Often, such inconsistent statements occur because your memory will fade between the recorded statement and trial, or because you won’t have known an important fact at the time of the recorded statement that you later learn before trial. Despite such reasonable explanations, the lawyer representing the insurance company many attempt to use this contradiction to make the jury question your credibility so that the jury will find for the defendant and not the victim. Having adequate representation will help prevent you from accidentally saying the wrong thing, or speaking about facts that haven’t been adequately investigated.

In addition to attempting to extract information to use against the victim and to get a recorded statement, the insurance company may also try to get the victim to sign a medical release form. These medical release forms allow an adjuster to get all of your medical records from every provider you have ever had. That is an enormous invasion of your privacy, and unjustified by any provision of Kentucky or Ohio law! It is important to keep the goal of an adjuster in the back of your head. They are there to reduce or eliminate your claim and protect their profits. If you provide recorded statements or sign medical releases prior to consulting with an attorney, there is a high chance that your claim will be significantly decreased.

How Can I Protect Myself If an Adjuster Wants to Take My Recorded Statement?

Individuals who have been injured in an automotive accident cases may choose to consult with personal injury lawyer. If you are seriously injured in an accident you should consult an attorney. An attorney can also help you if your own insurance company denies payment of your PIP or Med Pay benefits. Here at Lawrence & Associates Accident and Injury Lawyers, LLC we can handle the process of communicating with insurance companies so that you will not make a mistake that will negatively impact your case. We will handle the proper negotiations with the insurance company in order to pursue just compensation. If there’s even a small chance you could have significant injuries or damages, or the question of who caused the accident is in dispute, it’s probably smart to not speak with the other driver’s insurance company without legal representation.

Call our attorneys today for a free, confidential consultation if you need help. We’re Working Hard for the Working Class, and we want to help you!

How Can a Local, Cincinnati Attorney Help Get Social Security Disability Approved?

Posted on Thursday, June 28th, 2018 at 11:53 am    

The following post is part of our Law Student Blog Writing Project, and is authored by Jennifer Tressler, who is pursuing her Juris Doctorate at The Ohio State University Moritz College of Law.

Social security disability attorneys can help make an overwhelming process seem much more manageable. While hiring a lawyer specializing in social security disability cases is not required, it will likely be extremely beneficial during a difficult time when your health is suffering. Social security disability attorneys have experience dealing with the Social Security Administration (SSA) and, as such, will be able to handle any of the various issues that could arise during the application process. You can expect your social security disability benefits attorney to review your case with you and ask you a variety of questions, both to gather information on your case and to prepare you for questions you may be asked should a hearing be necessary in the future. Your social security disability attorney will function as the liaison and communicator between you and the SSA. This is just one of the duties that you can expect your social security disability attorney to carry out on your behalf. But it is an important one, as the language and application process of social security disability is complex and often foreign to the average person. At Lawrence & Associates Accident and Injury Lawyers, LLC, Kelsey Westermeyer  handles the vast majority of social security claims and consistently achieves high approval ratings.

How Can My Attorney Help Get Approval for SSDI Through the Cincinnati, Ohio or Florence, Kentucky Social Security Offices?

Another one of the duties of your social security disability attorney is to complete an initial review of your case. This will happen no matter at which stage of the application process you are. After this initial review, your social security disability attorney will determine the best strategy for you moving forward. He or she will assist you in crafting a compelling story around your case and develop some strategies for how your case will be won.

One of the most common (and significant!) mistakes made by individuals applying for social security disability benefits is filing with an incomplete claim. The majority of applicants for social security disability benefits are denied during the initial stages, mostly due to incomplete applications. Having your social security disability attorney review your application and ensure its completeness is one of the best ways to ensure your application will go undo review in the proper channels.

Your social security disability attorney will collect and sort medical evidence on your behalf. Many social security disability cases are won and lost on medical evidence. After obtaining proper medical release forms, your social security disability attorney will help you gather the relevant medical evidence needed for your application. He or she will review your medical records and work alongside you to collect any missing medical information or tests. Most importantly, he or she will sort through the hundreds of pages of medical documents to determine which information is the most important. Many social security disability attorneys will work directly with your medical provider, physician, or other healthcare provider to gather supportive opinion statements and letters. Having this evidence strengthens your case and makes it more likely that you will be granted social security disability benefits. Additionally, if your social security disability attorney determines that additional testing is necessary to bolster your application, he or she can request a consultative examination from the Social Security Administration doctors or ask that you get the additional testing completed on your own.

Your social security disability attorney is responsible for staying in communication with the Social Security Administration. The Social Security office is enormous and has an immense volume of claims pass through it. The application process of social security disability benefits is complex, filled with multiple deadlines and various formalities that must be adhered to. Your social security disability attorney will communicate directly with the SSA on your behalf, so that you have less to worry about regarding your application and more time to work on your health. Having a middleman communicate with the SSA on your behalf protects your best interests during this already stressful time. Your social security disability attorney will work to push your social security disability benefits application through the system with minimum effort and work from you.

How Can My Attorney Help Represent Me in Front of a Social Security Administrative Law Judge at a Hearing?

If needed, your social security disability attorney will file the necessary appeals for you. According to the Social Security Administration, less than forty percent of social security disability applications are approved at the initial application level. If your case is one that receives an initial denial, you are entitled to appeal the decision. The appeals process contains several specific and distinct steps that much each be completed within a certain amount of time. Hiring and retaining a social security disability attorney can help you navigate the appeals process, should your initial application be denied. To that end, your social security disability attorney will represent you at disability hearings, if necessary. The majority of successful disability claims are won at the hearing level. If you are originally denied disability benefits and you and your attorney appeal the decision, you are offered a hearing in front of an administrative law judge.

The hearing process is stressful, and having adequate preparation is critical to your success. Having a social security disability attorney will ensure that you are adequately prepared for your hearing. Though you will still need to speak for yourself, your social security disability attorney will represent you during the process and prepare you to testify. Your social security disability attorney will ask questions of your witnesses and address any expert witnesses, such as medical or vocational experts. If you have already been granted social security disability benefits but feel that you are not receiving adequate compensation, your social security disability attorney can help you request additional financial aid in the form of SSI benefits.

Your chances of success when applying for social security disability benefits dramatically improve if you are working with a social security disability attorney. Even if you are struggling financially due to your illness, hiring and working with a social security disability benefits attorney is well worth your time, energy, and money when you consider that without their help, winning your case can be exponentially more difficult. If you are overwhelmed by the social security disability benefits application process and would like some assistance from qualified, experienced individuals, contact Lawrence & Associates Accident and Injury Lawyers, LLC today. We can help you obtain that fresh start that you deserve! Call today for a free consultation at (859) 371.5997. We’re Working Hard for the Working Class, and we want to help you!

Social Security Disability: Five FAQs and Facts

Posted on Tuesday, June 19th, 2018 at 2:59 pm    

Enduring the process of applying for Social Security Benefits can be extremely stressful to any person. Fortunately, we are here to help ease your mind and speed up the process. In this blog, we are going to cover five frequently asked questions and other facts about Social Security Disability Income.

ONE: What Conditions Qualify for Disability Benefits?

One of the most common questions we hear when talking to social security disability candidates is this: “What disabilities qualify for benefits?” One way that the Social Security Administration answers that question is by using a Listing of Impairments (Part A) also known as the “Blue Book.” The Blue Book has several categories and is then broken down to sub categories.

The main categories for adults are listed below:

  • Musculoskeletal System
  • Special Senses and Speech
  • Respiratory Disorders
  • Cardiovascular System
  • Digestive System
  • Genitourinary Disorders
  • Hematological Disorders
  • Skin Disorders
  • Endocrine Disorders
  • Congenital Disorders that Affect Multiple Body Systems
  • Neurological Disorders
  • Mental Disorders
  • Cancer (Malignant Neoplastic Diseases)
  • Immune System Disorders

The Blue Book also has a Listing of Impairments for Children (Part B). The children’s Listing of Impairments is broken down into main categories and sub categories as well.

The main categories for children are listed below:

  • Low Birth Weight and Failure to Thrive
  • Musculoskeletal System
  • Special Senses and Speech
  • Respiratory Disorders
  • Cardiovascular System
  • Digestive System
  • Genitourinary Disorders
  • Hematological Disorders
  • Skin Disorders
  • Endocrine Disorders
  • Congenital Disorders that Affect Multiple Body Systems
  • Neurological Disorders
  • Mental Disorders
  • Cancer (Malignant Neoplastic Diseases)
  • Immune System Disorders

The Social Security Administration describes the Listing of Impairments as: “Impairments considered severe enough to prevent an individual from doing any gainful activity (or in the case of children under age 18 applying for SSI, severe enough to cause marked and severe functional limitations).”

TWO: My Disability is listed in the Blue Book. Do I Still Need an Attorney?

You may have a disability that is displayed on the Listing of Impairments, but may not be seen as “severe enough” by the SSA to fulfill eligibility requirements. Your disability must then be proved “severe enough” to qualify.

Even if your disability is listed, your benefits are not automatic. By hiring an experienced Social Security Attorney, you are letting go of the reins and letting a professional take over. So many people have had applications denied because of mistakes on their applications. Don’t let this happen to you.

THREE: My Doctor Says I am Disabled. Why do I Keep Getting Denied by the SSA?

The SSA may have denied you for medical reasons. In order to prove you have an impairment that is found in the Blue Book, you will need to obtain proper medical evidence that supports what you have claimed to be disabled for. Your attorney can obtain this medical evidence by requesting medical records, reports and more from your doctor(s).

FOUR: What is the Importance of My Attorney Getting Medical Records for My Case?

Claims for Disability benefits are approved or denied based on medical evidence. Medical records establish the severity of your impairment and helps the SSA understand your disability.

According to The Code of Federal Regulations, medical evidence that can be used or submitted with your claim include:

    • Objective Medical Evidence
      • Medical Signs
      • Laboratory Findings
    • Medical Opinion
      • This can be a report from your doctor stating things that you CAN do, despite your impairment.
    • Other Medical Evidence
      • Medical History
      • Clinical Findings
      • Diagnosis and more

If your application lacks these key evidence types, your claim could be denied. An attorney can request these medical records for your claim and help your claim get approved.

FIVE: Can I Work While Getting Disability Benefits?

SSDI recipients generally can’t do Substantial Gainful Activity (SGA) while receiving full benefits. The SSA describes SGA as “A term used to describe a level of work activity and earnings. Work is “substantial” if it involves doing significant physical or mental activities or a combination of both.” They describe “Gainful” Work activity as “Work performed for pay or profit, work of a nature generally performed for pay or profit, or work intended for profit, whether or not a profit is realized.” Your eligibility for SSDI benefits depends on whether or not you are able to do SGA.

SGA has two parts. Hours worked and income earned. If you work more than 20 hours per week that is SGA and will cause you to be ineligible to received benefits. According to the SSA the income portion of SGA for 2018 “for statutorily blind individuals for 2018 is $1970. For non-blind individuals, the monthly SGA amount for 2018 is $1180. SGA for the blind does not apply to Supplemental Security Income (SSI) benefits, while SGA for the non-blind disabled applies to Social Security and SSI benefits.” In other words, if you are a non-blind individual, you can make up to $1,180 per month while receiving benefits and for blind individuals, you can receive up to $1,970 per month while receiving benefits. According to the history of SGA amounts, they have slightly increased almost every year since 1975. This is because the amounts change based on the National Average Wage Index.

If you are concerned about your application to the Social Security Administration for SSI or SSDI, call Lawrence & Associates Accident and Injury Lawyers, LLC to talk to one of our trained intake specialists about setting up a completely free consultation to talk to one of our Social Security Attorneys. Lawrence & Associates Accident and Injury Lawyers, LLC will be with you every step of the way and will help you fight for your benefits. We practice Social Security in the states of Ohio and Kentucky.

Call us today to find out how we can help you now!

Warnings to Injured Workers in the Ohio Workers’ Compensation System

Posted on Monday, June 11th, 2018 at 11:31 am    

Compensation: When most people hear the word “compensation” they think of monetary recovery. While there is monetary recovery involved in Ohio Worker’s Compensation, it is only one of several benefits available to injured workers. In fact, Ohio Workers’ Compensation provides many forms of recovery that are valuable, but do not come in the form of a check or monetary award. These valuable benefits are unique to Workers’ Compensation and are often times not available in civil lawsuits. However, these added benefits do come as somewhat of a “tradeoff” as some of the monetary recovery received via the Ohio Bureau of Worker’s Compensation is smaller in amount or may seem less significant at first glance when compared to the monetary recovery that can be common in civil litigation. This blog discusses some of the unique aspects of the Ohio Worker’s Compensation system; pointing out both the positives and the negatives for injured workers as compared to more typical civil litigation lawsuits.

In order to receive any Ohio Workers’ Compensation benefits, monetary or otherwise, a claim must first be allowed by the Ohio Bureau of Workers’ Compensation. Before wasting your time, energy, and resources spinning your wheels to see if your claim is allowed you will want to consult with an attorney who specializes in Ohio Workers’ Compensation. What they tell you may surprise you. For example – did you know that Ohio is a “no fault” state? This means that no showing of breach of duty on the part of the employer is required for the allowance of a claim. Unlike commonplace civil litigation the defendant need not do anything wrong, careless, or negligent. If an employee is hurt in the course of, and arising out of, the injured employee’s employment they are covered! The actions the employer took, or failed to take to prevent such an accident are most times irrelevant.

While this no fault system may lead an injured worker to believe it is easy to get their claim allowed and compensation awarded, there are many other hurtles the injured worker may be unaware of that will cause their claim to be denied if not handled correctly. For example, if an employee legitimately gets hurt at work, but hurts a part of their body that has been hurt previously, or may not be perfect to begin with due to the natural aging process, the allowance of such claim may be fought by several other parties at several levels on the basis that it was a preexisting condition. Another situation in which it is nearly impossible to get a claim allowed is for a psychological condition. While Ohio does recognize psychological conditions in certain situations, there are particular procedures and requirements which must be met to receive benefits for psychological injuries. Another quite common scenario is for a claim to be initially allowed for a very minor injury, such as a sprain or strain, but then to not be recognized for the true, but more expensive condition suffered such as radiculopathy or torn muscles and ligaments which will require surgery. Only an experienced Ohio Worker’s Compensation attorney can help overcome these common obstacles in receiving the benefits an Injured Worker may be entitled to.

Where’s the money?

Generally speaking there is a lot less monetary compensation paid to plaintiffs in Ohio Workers’ Compensation than would be recovered for the exact same injury in a Personal Injury lawsuit. The reason for this is twofold: First, there are benefits for plaintiffs hurt at the work place that are not available to plaintiffs in Personal Injury lawsuits; these benefits will be spelled out later on in this blog article. Secondly, as a counter balance to some of those benefits to the injured worker, there are no punitive damages (in other words no pain and suffering) imposed on the employers of a Workers’ Compensation claim, unless there is a special circumstance known as a VSSR.

So, now that we’ve established that plaintiffs tend to recover significantly less money through Workers’ Compensation as compared to other civil litigation, let’s talk about how much money is involved and when an injured worker can expect to receive it. There are usually two situations in which an injured worker can expect to receive monetary compensation in a typical Ohio Workers’ Compensation Claim. The first is known as Temporary Total Disability, or TTD for short. An Injured Worker becomes eligible for TTD when they miss eight or more consecutive days of work and a Doctor has taken them off of work via a form called a MEDCO14. Therefore, plaintiffs who have missed less than eight consecutive days or do not have a MEDCO14 completely filled out and clearly stating that they have work restrictions that prevent them from returning to work will not be eligible for TTD. This is one reason why it pays to have an attorney in your corner. Oftentimes Doctors who are unfamiliar with such required forms will fail to fill them out or fill these forms out riddled with errors. These mistakes can cost injured workers thousands of dollars in TTD, so you will want someone who is familiar with these requirements to advocate on your behalf to your doctor.

The next question you may have is, “how much TTD can I expect to get?”

This number is calculated by statute and is dependent on the wage you were earning prior to your workplace injury. This calculation is set out by the Ohio Revised Code and can be complex and confusing to understand. Therefore it is important to consult with an attorney to ensure you are not being shortchanged on the TTD you receive. One aspect of this type of wage loss recovery that differs from its civil litigation counterparts is that TTD is capped every year by state statute. For example, injured workers receiving TTD in 2018, can receive no more than 902 dollars per week, regardless of what they were earning prior to their injury.

The second major situation an injured worker is typically eligible for monetary compensation is much later on in their claim when they have been determined by a doctor to have reached Maximum Medical Improvement, or MMI. MMI is defined by Ohio statute as “a treatment plateau (static or well-stabilized) at which no fundamental functional or physiological change can be expected within reasonable medical probability in spite of continuing medical or rehabilitative procedures.” However, reaching MMI does not necessarily mean the injured worker is %100 recovered. Again the monetary compensation is set out by the Ohio Revised Code, which provides a calculation that is based on the Permanent Partial Disability the injured worker has sustained. By way of example, if an injured worker reaches MMI, but is determined to only be 90% recovered, their compensation will be based on the remaining 10% Permanent Partial Disability. Much like TTD, this calculation is confusing and the process for obtaining this award is complex. This is another component of Workers’ Compensation in which an attorney who specializes in Ohio Workers’ Compensation will add tremendous value to your claim.

Other possible, but far less common Workers’ Compensation monetary benefits can include: working wage loss, VSSR, death benefits, and living maintenance. Only an attorney with experience in Ohio Workers’ Compensation will be able to identify if these special benefits are entitled to a particular injury or claim.

Other than monetary compensation, Ohio Workers’ Compensation provides injured workers with medical treatment and rehabilitation that can often times far outweigh the value of compensation paid via TTD and Permanent Partial Disability. The Ohio Workers’ Compensation system is designed to enable Injured Workers to be treated and get back to work as soon as possible. Therefore if an injury or disease is determined to be work related, treatment for such aliment is covered through the Workers’ Compensation System. Such treatment can include, but is not limited to surgeries, diagnostic tests such as MRIs and x-rays, physical therapy, chiropractic treatment, and pain management. However, for this valuable treatment to be covered through your Workers’ Compensation claim, the treatment must be deemed reasonable and necessary to treat a condition that has been formally allowed in the claim. Again, getting both conditions and treatments allowed is confusing and time consuming. If a condition or treatment is denied an injured worker may only have a short amount of time to figure out how to appeal it. This is when an attorney with Ohio Workers’ Compensation experience can make a remarkable difference in your claim.

Due to the fact that so many of these benefits are received by the injured worker before the end of their claim, the payout at the end in the form of Permanent Partial Disability, is much less than what would be recovered for the same injury in civil litigation. In other words, if a person were to recover for an accident through a personal injury lawsuit, that person would have to front all of their own medical treatment, and come up with income during time missed from work, then at the end of their treatment they would recover all of the money spent on medical bills, lost on missed wages, and even be compensated for their pain and suffering. In Ohio Workers’ Compensation however, the Injured Worker will be receiving most of these benefits as they work through the claim, and because the Ohio Workers’ Compensation system is set up to get workers back to work rather than to punish employers the monetary sum at the end will almost always be quite less than the same injury would result in through a Personal Injury claim.

Many injured workers are surprised to find out that even after reaching MMI and getting a Permanent Partial Disability award, there may be further benefits an injured worker is entitled to, that only an attorney with Ohio Workers’ Compensation experience will be able to identify. These can include maintenance treatment, vocational rehabilitation, and even future increases in Permanent Partial Disability.

So the next question you might be asking yourself is, “Yes I can see that having an attorney who understands the complexities of the Ohio Workers’ Compensation system is important. But I am out of work and how am I supposed to pay an attorney?”

The good news is that most Workers’ Compensation Attorneys work on a contingency basis. Meaning, the attorney only gets paid a percentage of money they recover for you. Therefore, just as most injured workers are eligible for monetary awards twice during their claim, so also attorneys get paid for their work most commonly at these two junctures as well: when back due TTD is awarded, and at the resolution of the case upon reaching MMI. “What about when my attorney wins additional conditions, diagnostic tests, or treatment for me?” You might ask. Most attorneys will only charge a very small and nominal fee for this type of service if that attorney feels that the Injured Worker is not likely eligible for any of the monetary compensation to which they would collect a typical fee for. If the attorney is certain that there is lost time at issue in the claim, or a Permanent Partial Disability has been suffered by the injured worker, any work done to get treatment allowed will be done at no additional charge.

Last, but certainly not least are some time frames that injured workers should be well aware of. The first is that of a short 14 day appeal deadline. Oftentimes when an aspect of a claim, or a claim in its entirety is not allowed an Injured Worker may have only 14 days to appeal such a decision. Additionally, disputes over the allowance of benefits necessitate Injured Workers to appear at various hearings and medical exams on quite little notice. Thus, an injured worker does not want to delay in getting an attorney. In order to make sure you have representation at such hearings, and to ensure you do not miss appeal deadlines, it is in your own best interest to retain an attorney as early as possible.

In sum, Ohio Workers’ Compensation is a complex area of the law. Attorneys and non-attorneys alike may has some understanding of what to expect in a run of the mill civil lawsuit, but these understandings and expectations cannot be applied in the same way to Ohio Workers’ Compensation claims. Before you find yourself in over your head, or facing a deadline that you do not understand come in for a free consultation with one of our attorneys who specializes in Ohio Workers’ Compensation.

Why You Shouldn’t Feel Bad for Filing a Personal Injury Lawsuit

Posted on Thursday, May 31st, 2018 at 8:28 am    

At the time I’m writing this, I’ve been in practice for over 13 years, and I’ve filed thousands of personal injury lawsuits in Ohio and Kentucky for everything from car accidents and slip-and-falls to products liability and boating accidents. I’m proud of what I do. I get a lot of injured people medical treatment that they’d never have gotten otherwise. I help widows keep their homes. I help hard working men and women get the money to pay back the debts they incur while they’re off work and recuperating from surgeries. But no matter whether I’m in Kentucky or Ohio, no matter who is across the desk from me at a consultation, there is one comment I hear more than any other: “I’m not the kind of person that normally sues people.”

This comment never fails to amaze me. There isn’t a kind of person that sues people. Personal injury lawyers don’t get repeat customers. On the rare occasion that I have seen the same person back in my office, I don’t think I’ve ever seen more than two lawsuits. But more than that, “I’m not the kind of person that normally sues people” speaks to a kind of shame associated with the civil justice system. 
“I’m not the kind of person that normally sues people” means that nearly everyone who walks into my office thinks only bad people sue other people. We all know that doesn’t hold water. We’ve all driven past accidents where the ambulance is already removing a driver that was rear ended or t-boned; do we really believe the guy in the ambulance is a bad person for suing the one who put him there?

But really, the ridiculousness of “I’m not the kind of person that normally sues people” goes deeper than that. There are a lot of reasons that lawsuits are good things, so long as they are handled by good lawyers. That so many people don’t understand that speaks to a long history of disinformation about the civil justice system, including things like the myth of the McDonald’s Hot Coffee and a series of widely believed email forwards from the early 1990s. When you set aside falsehoods and think about it, there are many reasons you should file a personal injury lawsuit if someone else hurts you.

It’s Your Constitutional Right, and It’s Better Than Any Alternatives

Today, many politically minded people swear by the founding fathers. The original meaning behind the Constitution, both federal and state, is the cornerstone of Libertarian and most Conservative political theories, and in the Greater Cincinnati area where I practice, a large percentage of registered voters identify as Libertarian, Republican, or Conservative. On top of that, in this area it is typically Democratic elected representatives that are the staunchest defenders of the jury trial system. With that in mind, it is worth remembering that the Seventh Amendment in the Bill of Rights to our federal Constitution states:

“In Suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury, shall be otherwise re-examined in any Court of the United States, than according to the rules of the common law.”

Section Seven of Kentucky’s Constitution goes further, saying:

“The ancient mode of trial by jury shall be held sacred, and the right thereof remain inviolate, subject to such modifications as may be authorized by this Constitution.”

Section Five of the Ohio Constitution states:

“The right of trial by jury shall be inviolate, except that, in civil cases, laws may be passed to authorize the rendering of a verdict by the concurrence of not less than three-fourths of the jury.”

There is a reason the founding fathers of every state, and of the federal government, made sure to enshrine the jury trial system: it provides for a peaceful resolution of conflicts while making sure the wrongdoer – the one that hurts, the one that takes, the one that breaks – is brought to justice. Prior to the jury trial system, it was common for people to fight duels, or for might to make right. Today, lawsuits are common and duels don’t exist. No one dies over defamation, or for being an inattentive driver. And no one should get away with it either. The beauty of the lawsuit is that it brings peaceful justice for men and women that have been wronged. Without it, we’d be back to the kind of 18th century justice our forefathers fought to prevent.

Everyone Is Insured (and If They Aren’t They’re Breaking the Law)

That was all well and good for the 1700s, you might say, but does it really apply today? Yes, and even more so than it did when the Constitution was written. Back then, a defendant losing a lawsuit might have to pay a princely sum of money; maybe enough to have to mortgage the family farm, or lose a business. Today, that fear doesn’t apply because almost everyone and everything is insured.

The most familiar form of insurance is auto insurance, which all Americans are required by law to get, but it isn’t the only kind. There is property insurance, general liability insurance, homeowner’s policies, farmowner’s policies, malpractice insurance, umbrella policies; you name it, and the insurance industry already thought of it thirty years ago. All those insurance policies not only mean that no one has to sell their house because they lost a lawsuit, but they also change the very nature of filing a lawsuit.

Let’s take automobile insurance as an example. An insurance policy is a contract. The insurance company says they will cover a driver for a specific amount of money if he or she causes an accident, and in exchange they want a certain amount each month as a premium. Let’s say that driver pays the premiums, and a few months down the line, rear ends you while you’re driving your car. You’re taken away by ambulance, and later file a lawsuit to cover your medical bills and the wages you missed while being off work.

When you file that lawsuit, you aren’t saying you want the other driver to pay you. You’re saying you want the insurance company to honor its contract. The money doesn’t come from the other driver’s pocket. It comes from the insurance company. The insurance company took the premiums, and they are supposed to pay for the damages. The lawsuit only happens if they don’t honor their contractual obligations. Feeling guilty for forcing an automobile insurance company to honor its contractual obligations makes no more sense that feeling guiling for forcing your health insurance company to pay for medical bills.

Lawsuits Help Your Doctor and Health Insurance Company Get Paid, Too

It’s worth bringing up another common myth about lawsuits: the money doesn’t really all go to the injured person. Yes, they take some home and yes, the attorney gets paid. But most people don’t realize that doctors often receive money as a result of a successful Workers’ Compensation lawsuit by an injured person against an insurance company. Also, every successful lawsuit against an automobile insurance company like Statefarm means a health insurance company like Humana gets reimbursed for the bills they paid. The logic is simple: one person or company caused the harm, and that person or company should pay for the harm. A doctor should not bear the burden of medical bills that cannot be paid, any more than the injured man or woman should bear the burden of being unable to put food on the table while they recover from surgery. A lawsuit against someone that is liable for negligence helps many people, not just the person hurt by the negligence.

Lawsuits Make Everyone Safer

We’ve all seen warnings that you can’t believe had to be printed, like a ridiculous commercial that tells you not try some obviously stupid act at home. It’s all the lawsuits, people think, that made that dumb warning appear. This is a part of the myth of the lawsuit too – do a little research and you’ll usually find that no one ever tried to sue over whatever dumb warning you saw. Generally, they are a part of an overabundance of caution on the part of companies that never bothered to ask a lawyer if they could be sued in the first place.

But some warnings do appear because of lawsuits. Like the warning that cigarettes can cause cancer, or that taking too much Tylenol can be fatal. Lawsuits also brought us the fire escape, the seatbelt, and the safety stop on saw blades. When used properly, the lawsuit is a force for good and drives the creation of new technology and new processes that make all Americans safer for decades to come.

It isn’t that there aren’t bad lawsuits. There are. Sometimes unhappy people file lawsuits on their own without a lawyer, which is generally a recipe for disaster. Sometimes bad lawyers with bad goals file bad lawsuits. But those lawsuits are the rare headline grabbers that cast a shadow on the good lawsuits, good lawyers, and good people who have been hurt through no fault of their own. If you have been hurt, and know someone else is at fault, don’t let the myth of the bad lawsuit cause you to deny yourself your right of recovery. If you’re a good person, get a good lawyer and get the justice you deserve.

If you have any other questions about Personal Injury or Workers’ Compensation lawsuits, please call our Fort Mitchell, Kentucky office at 859-371-5997 or our West Chester, Ohio office at 513-351-5997. We have helped over 3,000 clients and help a new, deserving person every day. We’re Working Hard for the Working Class, and we want to help you!

Why Is a Treating Doctor an Important Part of a Worker’s Compensation Case?

Posted on Tuesday, May 22nd, 2018 at 12:39 pm    

When a worker gets injured at work, they aren’t thinking about which doctor to go to. They are hurt and want medical attention and that’s about as far as the thought process goes. In contrast, the insurance company has already given the subject a lot of thought. Often insurance companies have pre-selected the doctor’s office they want an injured worker to treat with. While their medical treatment is not controlled by the insurance company directly, these offices are in long-standing relationships with the workers’ compensation carrier.

Under Kentucky workers’ compensation law, medical treatment is controlled by a “designated physician” this is a doctor the injured worker selects on what is known as a “Form 113”. Sometimes an insurance company will fill in the Form 113 with a physician’s office of their choosing. However, the injured worker has the right to pick their own doctor.

The selection of a Form 113 doctor is crucially important. This doctor is the “quarterback” of the injured worker’s medical team. They are the physician who calls the medical plays, so to speak. This doctor determines whether a referral to a specialist is necessary, and they often make a recommendation as to which specialist to see. This in turn determines whether an injured worker gets diagnostic testing such as MRIs and whether the injured worker gets surgical care.

For the selected doctor, the decision on medical care is actually twofold, not only are they determining whether they think there is a medical need for treatment, they are deciding whether or not the treatment is work-related. For example, let’s say you twisted your knee at work. If your doctor is of the mindset that you need surgery now but consider that part of that surgery is to treat an arthritic condition, they might determine that you cannot have the surgery under workers’ compensation coverage. This might be the case even though you 1) got hurt at work, 2) there were witnesses 3) you had never once received any kind of medical care for arthritis or for your knees in your entire life!

When a doctor makes this decision they are not necessarily following the law. In Kentucky it is well-established that if a worker has some kind of condition that pre-existed the work injury, but was dormant i.e. it never bothered them before the work injury so they weren’t under medical care for it and then the condition becomes problematic after the work injury then both the work injury itself AND the prior dormant condition can be treated under the workers compensation carrier coverage. If the injured worker is off work while this treatment is undertaken, they may qualify for income benefits.

This makes the doctor’s decision very important. If a doctor does not agree with the law, say, due to their political stance, or if the doctor simply is unaware of the law, the treatment and income benefits the injured worker is entitled to may get denied. As you can see, it is extremely important that an injured worker gets a treating physician that either already has an understanding of the legal ramifications of the decisions they make or is at least willing to listen and learn. Sadly, not all doctors are.

An understanding of the workers’ compensation system is not the only requirement for the right treating physician. An insurance company is in business to make money. They do not make money by paying for medical care or paying an injured worker income benefits. Therefore, they will do things to try and minimize the amount they pay out. One of the things the insurance company will do is challenge the medical treatment through a process called utilization review, or peer review. In these scenarios the insurance company has hired a doctor, or often a nurse, to review the records to see if they believe the injured worker should get the medical care their doctor asked for. The reviewer will not see the patient, not even once, they will often refer to what are called the Official Disability Guidelines, and commonly they will determine that the treatment is not compensable. In the denial they will often state that they attempted to call the treating doctor but could not get through. The treating doctor has the right to appeal the decision of the reviewer, but they have a limited amount of time. It is very important that the injured worker has a doctor who is willing to answer the call and to respond to the denial when it comes. If the doctor simply doesn’t bother, the injured worker may have to litigate just to get their medical care, and this can take months. If the injured worker gives up, then the insurance company saves a bunch of money.

The treating doctor has an important role to play in the amount of income benefits an injured worker receives. This is because these benefits are calculated using an impairment rating provided by the physician. Many times, a hired expert will give an opinion on the percentage of impairment, and a good attorney will know which experts to use. However, the Administrative Law Judges often consider the view of the treating physician to be very significant. If your treating doctor is unwilling to figure out your impairment, or if they are unfamiliar with the process, they will not be assisting your case.

The treating doctor will be the one who assesses work restrictions, in other words they determine whether an injured worker can go back to work. Often the insurance company will employ a nurse case manager who will question the doctor on this issue. The injured worker will want a physician that is willing and able to justify their decision on work restrictions under this kind of challenge.

At Lawrence & Associates Accident and Injury Lawyers, LLC we describe the physicians that do these things as “patient advocates”. While proper medical care is essential, patient advocacy is always very important too.

Last Updated : May 22, 2018
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