CASE STUDY: Eden Rafferty Gets Knee Replacement Settlement in Workers’ Compensation Case

Background:

The firm’s client was a well-respected, hard-working nurse case manager who was self-employed and handled catastrophic injury workers’ compensation cases. Her job required her to drive all over the state, do a lot of walking, and stand for long periods of time during her visits to hospitals.

In 2009, she had a minor workplace injury when she tripped over a power cord in her home office, injuring her right knee. She had arthroscopic surgery and missed just a few days of work. A couple of years later, she started having problems with the knee.

As the knee got progressively worse, a doctor determined in 2013 that she needed a total knee replacement. The insurance company paid for it immediately.

Showing dedication and commitment to her work, the client continued to work part-time, working on her computer, talking to people, and trying to coordinate care for her clients. Still experiencing discomfort in the knee and still getting treatment, she learned that the replacement knee did not fit as expected.

A year and a half later, she had a second total knee replacement for the same knee. Again, the insurance company paid for the operation, knowing she was not missing much time at work.
After the operation, she returned to work, but since she was still impaired, she started to lose business. The client was dedicated and trying to work hard while in demand by the highly qualified nurses who worked with her. However, she just couldn’t handle the full-time workload and could only do 20 hours per week.

Approach:

That hard work and determination led to overcompensating with her other knee, and that led to the need for a total knee replacement of the left knee. That’s when the insurance company starting fighting, claiming that since she was over 60, arthritis was a strong contributing factor to both knee injuries and that this latest injury was not related to overcompensation for the other knee.

The insurance company sent the client to an IME (Independent Medical Examination) and the doctor agreed with the insurance company that the two injuries were not related. But the client’s own surgeon said they were related. So, Attorney Eden filed a workers’ compensation claim.

Attorney Eden went in front of an administrative judge at the industrial accident board. The judge ordered the insurance company to pay for the surgery. Three weeks later, the client had the surgery. She also had to have home health care because she lived alone and needed help with meals, and other daily tasks.

In workers’ compensation cases, whenever there is a dispute over the judge’s order, the plaintiff is sent to a doctor chosen by the judge. This doctor is understood to be impartial and gives his own medical testimony – which the judge is supposed to accept.

In this case, the impartial doctor said the injuries were not related and the insurer should not have been held responsible. This decision caused a real dilemma for Attorney Eden. The surgery on the left knee was already done. But further challenging the ruling could result in having to pay back the medical costs. And so, it was a significant risk for the client.

Result:

The client was still partially disabled from the injury to the right knee and the insurance company realized they would have to pay for that. Attorney Eden agreed to settle the case, obtaining future indemnity benefits in exchange for agreeing that the two knee conditions were not related.

The workers’ compensation settlement for partial future liability allowed the client to keep working as much as she was able and to go to school to further her career. The surgeries were paid for. The home healthcare was for three-plus years when the insurer wanted to pay only for six months for each surgery.

There was one more benefit. The client was given peace of mind. She knew she had an advocate who cared about her and would go to battle for her. Attorney Eden represented her as she does all her clients—with honesty, integrity, and the same work ethic regardless of the amount of money involved. To her, it’s not about the money. It’s more about the life-changing outcome for her clients.