$127,000 Plus Future Medicals and Social Security Disability Payments to Mechanic Who Suffered a Several Back Injury

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Myron knew that there was something seriously wrong with this back, but he thought since he worked at his family’s business, he would be taken care of.  Unfortunately, that was not the case.  Myron needed the help of the Joye Law firm to get him the workers compensation and disability payments he desperately needed.

When it came to automotive body work, Marlon Roberts thought he had found his life’s calling. Before his ability to do this work was ended by a severe back injury he sustained on July 2, 2003, Marlon had specialized in doing frame repair for severely damaged cars for most of his adult life.

“I was never all that good at school but there was something about working on cars that just came natural for me,” said Marlon. “I always figured I would do that work up until the day I retired.”

For most of the 25 years that Marlon did body work, he felt fortunate to work for a business owned by one of his brothers. Unfortunately, the nature of his relationship with his brother would also be permanently altered as a result of his severe work injury.

When July 2, 2003 began, Marlon felt like everything was going well in his life.

His wife and he had just purchased a few acres in the country and he had finished having his home moved to this location the week before. Marlon was looking forward to a cookout at his new home and enjoying the 4th of July holiday weekend.

Marlon’s holiday plans changed with one missed step. While working on a damaged car, Marlon was standing on the framing tower approximately three feet off of the ground. While reaching to adjust a chain on the car, Marlon mis-stepped and fell from the tower, striking a steel column as he fell to the concrete floor. Immediately after he fell, Marlon dusted himself off and felt that he was not seriously injured.

“Those types of things happen all the time when you’re doing framing work,” said Marlon. “If I had a dollar for every scrape or bruise I had all the years I did the job, I would have a good bit of money.”

As the workday went on, Marlon had some lingering pain in his right hip and he mentioned this to another brother who worked with him (but who was not the brother who owned the body shop). During the days after the accident, Marlon began to realize that he may have sustained more injuries than just a couple of bruises. He began to have persistent pain running down into his right leg, which was unlike any pain he had ever experienced before.

Concerned about the continuing problems, Marlon went to his sister-in-law, who ran the front office for her husband’s body shop. Marlon began to sense from the outset that he may have some problems getting assistance for his work injuries and he was told that she would discuss the situation with her husband (who worked a full-time job at another location), and then get back to him. A few weeks later, Marlon figured he could not go any longer without medical care and he went into the front office insisting that medical treatment be lined up for him. This encounter quickly escalated into a shouting and cursing match. Not sure what he should do next, Marlon then went to his family doctor, who immediately recommended that he be seen by a back specialist.

Marlon was still hopeful that he would be able to reason with his brother about getting treatment started for him. However, when he went to his brother to ask him if he could help get workers’ compensation lined up for him, his brother told him that he did not believe that Marlon had been hurt on the job and that Marlon should just work through any pain he was having.

At this time, Marlon made the decision to call the Joye Law Firm for assistance with his claim and the long legal battle over his entitlement to workers’ compensation benefits began.

After meeting with Marlon and gathering the limited medical records that were available, attorney Ken Harrell of the Joye Law Firm filed a hearing request on Marlon’s behalf on August 14, 2003. To prepare for the eventual trial in the case, Mr. Harrell took numerous depositions (sworn statements before a court reporter), including taking statements from Marlon’s brother who owned the body shop, Marlon’s sister-in- law, and several co-workers.

The case eventually proceeded to a hearing in April of 2004. (Unfortunately for Marlon and his family, this case was filed at a time when it was taking considerably longer for the Workers’ Compensation Commission to schedule evidentiary hearings. Fortunately, changes have been made to the system which now result in an injured employee typically getting a hearing set three to four months after the hearing request is filed.)

The trial of the case was every bit as contentious as the months leading up to it. Both sides presented multiple witnesses, with the owners of the body shop making accusations that Marlon had injured his back while moving his mobile home (Mr. Harrell was able to submit documentation confirming that Marlon had hired a moving service to do this work) and that Marlon had had back problems for several years (there was no medical evidence to support this).

Shortly after the trial of the case, the hearing commissioner issued a decision that was fully favorable to Marlon. The hearing commissioner ordered that Marlon was entitled to back-owed weekly benefits from the end of July, 2003 through the day of the hearing and continuing, and that the workers’ compensation insurance company was to provide Marlon with medical treatment for his severe back injury.

This did not end the fight for Marlon on his claim. The workers’ compensation insurance company filed an appeal of this decision to the Workers’ Compensation Commission’s Appellate Panel. An appellate hearing was held before the Commission’s Appellate Panel on November 29, 2004. One month later, this panel issued a decision fully affirming the hearing commissioner’s decision in Marlon’s favor.

There was still concern about whether the workers’ compensation insurance company would file yet another appeal. (There are potentially three appellate levels for a workers’ compensation case, including possible appeals to the Circuit Court level and to the Court of Appeals or the Supreme Court following the commission’s appellate panel hearing.)

Fortunately for Marlon and his wife, the insurance company decided to stop fighting his claim, to pay him back-owed benefits of nearly $35,000, to place him on a weekly payments status, and to provide him with medical care.

“The day that Ken called me to tell me that the insurance company was going to stop fighting us is a day I’ll never forget,” said Marlon. “I can’t tell you how low my wife and I had gotten while my claim was being denied – I don’t know how we made it through. I know one thing. I never could have made it without Ken’s help. Whenever things were at their darkest, he kept telling me to hang in there and that he would keep fighting to try to make things right for me. He was certainly true to his word.”

While the initial legal battle was over, Marlon still faced a dark road ahead because of his severe back injury, which had gone largely untreated while the case was being tried and appealed. Marlon had consulted with orthopedic surgeons in Florence but they had understandably advised him that they would not be able to perform a surgery without some guarantee that the hospital and the surgery charges would be paid. Once the insurance company stopped its appeals and medical coverage was available to Marlon, he was able to undergo a surgery to remove a portion of his herniated disc in June of 2005. Marlon had little improvement after this surgery and his treating doctor advised him that this was due to the fact that he had severe permanent nerve damage because of the long delay in his having the surgery done from the time that he was injured.

“I don’t have any doubt that I would have been 100% better if I could have gotten my surgery done a few months after I got hurt,” said Marlon. “If that had been done, I feel like I would have been back to work and I would be working today.”

Concerned about his lack of improvement, Marlon asked Mr. Harrell if he could get the insurance company to set up a second opinion evaluation for him with another medical specialist. Eventually, Mr. Harrell was able to get the carrier to agree to have Marlon evaluated by Dr. Don Johnson at the Southeastern Spine Institute. Following his initial evaluation, Dr. Johnson recommended that Marlon undergo a fusion surgery because of the severe damage he had at several disc levels in his low back. This fusion surgery was performed in January of 2006. While the fusion surgery did not take away most of Marlon’s pain in his low back and in his legs, it did provide enough pain relief that Marlon felt that he could better cope with it.

“I’ll always be thankful to Ken for helping me get to Dr. Johnson,” stated Marlon. “Dr. Johnson did the best he could with a bad situation. I live with severe pain in my back every day, but I didn’t know if I could go on living with the type of pain I was having before the fusion surgery.”

The end result of Marlon’s treatments were that he was left with chronic pain which require him to take narcotic medications and he was assigned permanent physical restrictions, including not lifting more than 15 pounds and his avoiding bending, twisting, prolonged sitting and standing. Dr. Johnson recommended that he apply for Social Security disability benefits, noting that he would never be able to return to doing any type of manual labor.

After Marlon was released by Dr. Johnson, Mr. Harrell filed another hearing request on Marlon’s behalf seeking a hearing to address Marlon’s entitlement to disability benefits. Mr. Harrell hired a vocational consultant to examine Marlon and this consultant was of the opinion that Marlon was totally and permanently disabled. Shortly before a second trial to address Marlon’s entitlement to permanent disability benefits, the workers’ compensation disability portion of the case was settled for over $127,000, which figure was only slightly below the maximum amount that Marlon could have recovered under South Carolina law given his weekly compensation rate.

The insurance company also agreed to pay a separate amount to set up a Medicare set-aside account to cover Marlon’s future medical costs causally related to his work injury. As part of the settlement agreement, Mr. Harrell had language included in the settlement agreement to protect Marlon’s entitlement to possible Social Security disability benefits. At Mr. Harrell’s urging, Marlon had applied for Social Security disability benefits while his workers’ compensation case was pending.

Once the workers’ compensation case was settled, Mr. Harrell turned the file over to attorney Matt Jackson, the head of the Joye Law Firm’s Social Security disability practice. Mr. Jackson had already been working to prepare Marlon’s file for an eventual Social Security disability hearing. This hearing was held in November of 2006 and the Social Security Administration judge issued a decision shortly thereafter ruling that Marlon was totally disabled and entitled to receive monthly Social Security disability benefits. Once again, Marlon felt like he could not find the words to express how grateful he was to the Joye Law Firm.

“I really don’t know what I would have done or where I would be if it had not been for Ken and Matt,” said Marlon. “Unless you have been as down as I got, you can’t understand it, but those guys really saved my life. There is no way I can say enough to thank them for what they did for me.”

For Mr. Harrell, the situation that Marlon faced is indicative of the benefits of having a law firm that provides a variety of services.

“It seems like this situation comes up all the time where we have a client who we can help more than once because of the different areas of practice our firm has,” he said. “This is especially true when it comes to severely injured workers who are disabled from going back to work. The biggest mistake a lot of workers who are in this situation make is trying to handle their workers’ compensation claim on their own, and not including the necessary language in their workers’ compensation settlement to protect their future Social Security disability benefits. In doing this, they can cost their family and themselves tens of thousands of dollars. I really am amazed at how people who have to fight on their claim for years and months like Marlon did can survive, but the fighting spirit of the American working man is an amazing thing to behold.”

While Marlon’s legal dilemma ended on successful terms, he feels that it is unlikely that he will ever be able to repair the broken relationship with his brother.

“I still can’t believe I got treated the way I did by my own flesh and blood, all because they were trying to save money on insurance premiums,” said Marlon. “It is a crying shame that I feel like I lost a brother on top of everything else I went through, but on the plus side, I also feel like I picked up two life-long friends in Ken and Matt.”

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