24 May, 2024

QPWB Associates Use Inconsistent Workers' Comp Claims to Dismiss Medical Benefits, Reducing Costs for Sanitation Company


In: Verdicts


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Lexington-Hub Associate Adrian Del Valle, Associate Amelia Kitchens, and Paralegal Melissa Candler's defense team achieved this win by thoroughly analyzing medical records to uncover inconsistencies, challenging the causal link between the alleged workplace injuries and the claimant's preexisting conditions. 

Overview of the Case

  •  A global hygiene and infection prevention corporation faced a workers' compensation claim from an employee alleging work-related injuries, including past and future treatments for hip and back issues.
  • The defense strategy focused on differentiating the claimant's chronic preexisting conditions from specific workplace injuries using medical evaluations and expert testimony.
  • The Administrative Law Judge ruled in favor of the corporation, dismissing the entire medical benefits portion of the case, highlighting the importance of distinguishing between chronic conditions and workplace injuries under Kentucky law.

Key Difference-Makers

  • Adrian Del Valle, Associate, orchestrated a comprehensive defense strategy, conducted meticulous legal analysis, and effectively presented evidence and expert testimony to achieve a favorable verdict.
  • Amelia L. Kitchens, Associate, provided invaluable assistance in developing the evidentiary record, uncovering a significant motor vehicle accident prior to the claimant's employment that resulted in an undetected concussion and L4/L5 back injury.
  • Melissa Candler, Paralegal, played a crucial role through her dedication and thorough handling of extensive documentation and logistical aspects of the case.

Claims Made Against Our Client

  • Medical Treatment Costs: Coverage for all necessary medical treatments related to the work injury, including back surgery (Percutaneous Vertebroplasty), physical therapy, and prescription medications.
  • Diagnostic Tests: Coverage for diagnostic procedures like X-rays, MRIs, and CT scans.
  • Medical Equipment and Supplies: Provision of necessary medical equipment and supplies.
  • Specialist Consultations: Expenses for consultations with relevant medical specialists.
  • Future Medical Treatment: Anticipated future medical expenses for ongoing treatment.
  • Travel Expenses: Reimbursement for travel expenses incurred while obtaining medical treatment.
  • Alternative Treatments: Coverage for non-traditional therapies like chiropractic care and acupuncture.
  • The financial exposure faced by our client was substantial, encompassing both past and future medical costs, ongoing care, and associated legal expenses.

Defensive Strategy

  • Thorough Case Analysis: Conducted an exhaustive analysis of the medical records, identifying inconsistencies in the claimant's narrative.
  • Expert Witness Selection: Engaged top-tier medical and vocational experts to provide evaluations and testimony.
  • Precedent Research: Conducted extensive research into relevant case law to craft nuanced legal arguments.
  • Strategic Depositions: Conducted depositions to uncover inconsistencies in the claimant's testimony and highlight preexisting injuries.
  • Evidence Presentation: Presented compelling evidence, including medical records and expert opinions, to illustrate the claimant's history of chronic conditions unrelated to the workplace.
  • Focus on Causation: Emphasized establishing causation, demonstrating that the claimant's injuries stemmed from preexisting conditions.
  • Alternative Explanations: Explored alternative explanations for the claimant's symptoms to challenge the causal link to the workplace incident.
  • Emphasis on Legal Standards: Articulated the legal standards required to establish compensability under Kentucky law.
  • Client Education and Collaboration: Worked closely with the client to gather key insights and ensure understanding of the defense strategy.
  • Flexibility and Adaptability: Maintained flexibility, adapting the strategy as new evidence emerged.
  • Medicare Considerations: Evaluated Medicare implications to ensure compliance and minimize future risks.

Impact on Final Outcome

  • Our comprehensive defense strategy, meticulous legal analysis, and compelling evidence effectively challenged the validity of the claimant's case, leading to a favorable verdict.
  • The Administrative Law Judge was persuaded by our expert testimony, resulting in a significant victory that safeguarded our client's interests and ensured long-term monetary savings.

Predicting the Future

  • This victory enhances the firm's reputation for delivering robust legal defense and achieving favorable outcomes in complex legal proceedings.
  • It solidifies our position as leaders in this practice area, instilling confidence in future clients and attracting those seeking superior legal representation.
  • The precedent set underscores our commitment to excellence and positions us as a go-to legal resource for clients facing similar legal battles in Kentucky and nationwide.

About QPWB

  • Quintairos, Prieto, Wood & Boyer, P.A., is the largest minority and women-owned law firm in the nation with jurisdiction in 45 states and territories in the U.S. allowing us to serve a broad spectrum of industries with over 100 areas of practice. Our lawyers provide representation for businesses and their leaders in litigation, regulatory, and corporate matters.

Discover the QPWB Difference

Learn More

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