A bright 23-year-old, Matthews took a painting job while trying to sort out his post-college plans. His manager asked that Ronald (his name has been changed) repaint the company's shed. Shortly thereafter, Ronald lay motionless, with a blue tint to his lips and burns on his hands and bottom of his pants. He had been electrocuted when he touched a metal ladder to a power line obscured by a tree.
He was still alive but slipped into a coma due to anoxic brain injury. Additional injuries included a fractured rib, hematomas, contusions, and burns on his face and foot. During hospitalization, he developed high fevers, respiratory infections, restlessness and poor appetite. Doctors amputated two toes due to poor circulation and gangrene.
I recommended a provisional reserve of 26 weeks of temporary total disability, an initial medical reserve of $250,000 and a 30-day plan with referrals to a subrogation specialist, catastrophic claim director, and calls to the insurance carrier.
After coming out of the coma, he was able to make eye contact but his speech was poor, his gait was unsteady and cognition was still quite impaired.
But there was another significant obstacle to his recovery: his parents. They were divorced and I could tell these two wouldn't play nice. Plus, they thought their son was on his way to reclaiming his normal life, even though doctors repeatedly told them otherwise. When I recommended that Ronald be transferred to Southern States, a premier hospital for neurological care, they said 'no' because the facility was 500 miles from their homes. Yikes. I recommended an increase of the indemnity to 52 weeks and the medical reserve to $750,000.
Back at the painting company, an investigation showed that the power lines were in compliance and Ronald did not have a legal right to sue the utility company.
Within six weeks, Ronald's infections subsided and he stabilized. His family transferred him to a level-one trauma center near his mother's home. I was pleased to see that he was moving better and was able to speak more clearly. His parents were thrilled. Upon discharge, he moved in with his mom, but she soon became exhausted and he moved in with his father.
After being evaluated by a neurologist and speech pathologist, it was determined that return-to-work was unlikely, but the carrier was not yet ready to concede permanent total disability. Indemnity reserves increased to 500 weeks, the statutory maximum and future medical for five years. Ongoing outpatient medical care would require an additional medical reserve of $500,000.
Despite the claimant's positive attitude, his father said his son could no longer live with him because it caused disharmony with his new wife. With neither parent willing to take care of him full time, Ronald fell into a downward spiral.
With nothing to lose, I urged the family and case manager to let him do an inpatient stay at Southern States. They finally agreed. After a 30-day stay, he lived at an apartment complex affiliated with the facility, where nurses visit daily. Ronald's therapists spoke glowingly of his progress. He even surprised everyone by saying that he wanted to stay in the apartment after treatment.
Ronald continues to reside at the Southern State's apartment. He's functioning as best he can and may even work again.
JARED SHELLY is the editor of this column and can be reached at firstname.lastname@example.org. This column is based on the experiences of a group of long-time claims adjusters. The situations they describe are real, but the names and key details are kept confidential.
May 1, 2013
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