Adjuster X

Trade Show Flip-Flop

A failed attempt at flattery results in injury. There’s a lot to be said for learning how to take “no” for an answer.
By: | June 1, 2015

I received an incident report about a meeting planner who had sustained neck and back injuries while attending a trade show. It seemed she had been picked up, hoisted in the air, shaken and placed back on the ground. Not your typical claim.

I spoke with the insured’s marketing director. He explained that one of their male sales managers invited the petite meeting planner to the stage during the trade show. After thanking her for an outstanding job and calling her a “star,” he picked her up, twirled her in the air over his head, and then quickly put her back on the ground. She complained of back and neck pain immediately afterward.

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The thoughtless manager was fired and the planner remained out of work. The director felt the injury wasn’t compensable since it didn’t occur on their premises and it was the result of “fooling around.” The workers’ comp report, he said, was simply procedural. The company had submitted a short-term disability claim.

An ISO search request came back noting two prior injuries: a left arm fracture after falling on an icy mall parking lot and a cervical strain after an auto accident.

I called the meeting planner, Sheila Wilmot, but no one picked up. I was already running out of time to make my first indemnity payment, so I tried to call the manager who hoisted her at the trade show but he refused to cooperate.

Fortunately, since it happened at a trade show, there were plenty of other witnesses.

The three co-workers I spoke with were pretty consistent with what they reported. However, one of them mentioned, off the record, that the sales manager was rumored to have tried to date the meeting planner but was rebuffed. His impression was that the sales manager attempted flattery by bringing the planner to the stage but then got carried away.

The director felt the injury wasn’t compensable since it didn’t occur on their premises and it was the result of “fooling around.” The workers’ comp report, he said, was simply procedural.

Based on the customer’s request, I didn’t initiate compensation benefits. A few months later I received an attorney representation letter, a formal claim hearing request and medical bills totaling $30,000. I called Sheila Wilmot’s attorney and requested permission to speak with her but the lawyer denied that request.

Before requesting a conciliation meeting, I spoke with defense counsel, who felt that the causal relationship was pretty solid. After all, the employee coordinated the trade show for the insured, attended it and sustained the injury in the course of her employment. Incidents resulting from horseplay had successful statutory precedent cases. The potential for an unfair claim practice act litigation also existed.

At the conciliation meeting, Sheila’s attorney said she had a vertebral fracture, cervical strain and a stress condition. Her short-term disability claim was denied. Her doctor indicated the injury was work related. By now, the lost time was 10 weeks with medical bills totaling $30,000.

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We were permitted to schedule an exam, which confirmed the diagnosis. The examiner felt the pre-existing cervical condition was aggravated by the trauma. Sheila was on a physical therapy regimen, taking very high doses of narcotic analgesic pain medications. With the insured’s concurrence, the claim was settled.

So Sheila suffered, her employer paid the consequences, and the sales manager lost his job. There’s a lot to be said for learning how to take “no” for an answer.

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]

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The R&I Editorial Team can be reached at [email protected]