Victory for Injured Mental Health Worker After Denied Claim
Background
A licensed mental health therapist was injured while breaking up a violent altercation at a treatment facility. She sustained serious injuries to her right shoulder and lower back while protecting others. Despite reporting the incident, her employer denied the claim entirely.
The Challenge
The Employer/Carrier admitted an “incident” occurred but denied any compensable injury. She was left to pay for her own surgery, therapy, and pain management. Legal challenges included:
- Proving her injuries were caused by the workplace incident
- Validating treatment she obtained without prior authorization
- Establishing her entitlement to lost wage benefits during recovery
Our Strategy
- Filed multiple Petitions for Benefits supported by medical documentation and expert opinions
- Presented testimony from an independent medical examiner (IME) confirming her injuries were work-related
- Proved the employer failed to provide timely medical care and misrepresented claim acceptance
- Successfully countered arguments that her injury was unrelated or preexisting
The Result
- Recognition of compensable workplace injuries to her right shoulder and lower back
- Approval and reimbursement for all past medical treatment, including:
- Shoulder arthroscopy surgery
- MRI imaging
- Physical therapy
- Pain management
- Prescribed medications
- Temporary wage loss benefits (TTD/TPD) awarded from July 2023 – May 2024, based on an AWW of $1,499.64
- Employer ordered to pay penalties, interest, and attorney’s fees
Why It Matters
This case shows how Touby, Chait & Sicking, PL relentlessly advocates for injured workers—even when employers deny responsibility. Our team ensured this worker was fully compensated and received the care she needed.
Need help with a denied workers’ comp claim? Call (305) 257-9472 to protect your rights.