Adjuster X

An Unruly Student

By: | December 14, 2015

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. Michelle Kerr is the editor of this column and can be reached at [email protected]

My manager handed me a report and said, “You’re going to have your hands full with this claim.” The claim had the makings of an expensive case. A 59-year-old high school teacher was knocked down the stairs by a rushing crowd of students.

The municipality’s risk manager gave me an earful.

“You know that school is in a marginal neighborhood … some good kids, some rough ones,” he said.

I sensed he had more to say so I probed further. “Well, Gladys Romenko isn’t popular,” he said. “She’s demanding, inflexible and condescending.”

Without pause, he added, “And she’s culturally insensitive to students who don’t have English as their native language. We’d like to fire her but with tenure that would be almost impossible.”

While I was surprised by his candor, it was his next statement that shocked me.

Of the incident, she said, she was about halfway down a stairway when “the locust children descended and one of the brats knocked me over.”

“I can’t say for certain or prove it … but this may not have been an accident.”

I asked if there were non-student witnesses, but he said no.

Gladys fell down four steps, striking her head and back. She was “very woozy and quiet,” according to the risk manager. Paramedics took her to the hospital. She was admitted due to high blood pressure and the suspicion of fractures.

I assigned a nurse case manager and called her the next day.

Normally Elaine, one of our best, was unflappable, but as soon as I called, she blurted out, “Well, I met Gladys. She’s a teacher but she swears like a longshoreman! She was fit to be tied — and with her hypertension!”

Elaine said the X-rays showed a vertebral fracture, back contusion and right leg hematoma.

The next day I spoke with Gladys, who immediately began ranting about Elaine being intrusive and imperious. She later had an attorney request our nurse be removed

Of the incident, she said, she was about halfway down a stairway when “the locust children descended and one of the brats knocked me over.”

She didn’t know which one. She complained of severe back and leg pain, inability to sleep and fear of returning to the job and facing student ridicule.

Ongoing medical reports documented the need for continuing treatment. Copious amounts of narcotic pain killers were prescribed and Gladys began seeing a psychologist. It took eight weeks to schedule an independent orthopedic exam, and Gladys “howled and cried all the time I tried to examine her,” said the examiner.

The results were inconclusive but a psych evaluation was recommended. In due course, we obtained one, but by then Gladys had been out of work 49 weeks.

A claim petition had been filed formalizing the allegation of total disability with a psychological sequelae. The drug bills were amounting to about $950 a month, plus weekly physical therapy and psychologist visits.

A prescription drug review revealed the claimant was taking excessive opiods, sleeping pills and other medications for gastrointestinal problems due to the narcotics.

Counsel recommended a compromise settlement. Eventually this took the form of paying two years of future indemnity payments and then closing out that benefit. We were unable to close out future medical, however. The case of the unruly student proved to be a very costly lesson.

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