Who’s Incredible?

    School is back in full swing and it is officially Fall (though you would not know it from the 90 degree temps). My son (Sawyer) just started 3K, while the little one (Charlotte) is in 2K. It’s funny watching how fast they learn at this age. Sawyer is learning to draw numbers and letters while Charlotte now has the words and actions down to Baby Shark. Speaking of, that song/video has over 1.7 BILLION views on YouTube. While we are all grinding away at our desk jobs, some rich person is laughing all the way to the bank over a kid’s song that now just makes fun of the Ole Miss defense. Oh well.

    In addition to Baby Shark, my family is eaten up with The Incredibles, and by my family, I mean Sawyer. For those of you unfamiliar, The Incredibles is a movie about a family of super heroes who have been cast as villains by society. Sawyer is Dash, the son in the movie, and I, obviously, am Mr. Incredible, the dad. Several weeks ago, The Incredibles 2 came to theaters, and Sawyer could not contain his excitement to see it. I decided to take him one Saturday while my wife and daughter had a girl’s night. Below is picture evidence of our adventure.

    While I would never be mistaken as Mr. Incredible anywhere else, or by anyone else, it was fun to dress up and watch the movie in character. After the movie, there was even a crowd of kids (and two grandmothers) waiting to take pictures with us. Needless to say, we felt like super heroes that day too.

    For those of you who do not know, September is spinal cord awareness month. If a spinal cord injury is severe enough, then there could be some paralysis. These are not common, but for employers and carriers, these types of claims can easily exceed your policy amounts and necessitate coverage from your excess carrier.

    There are many aspects to a significant spinal cord injury, particularly where there is paralysis, which are expected. In some instances, you will pay all 450 weeks of indemnity benefits. Rather than paying out the benefits weekly, it is often in the best interest of everyone to pay on the front end, if the claimant returning to work is a practical impossibility. The claimant gets their money in one lump sum and you get a present value reduction, which is a small savings.

    Other than indemnity, it is also known that spinal injuries will require extensive medical treatment. However, there are other aspects to the claim that need to be considered on the front-end as well, for not only reserves, but so you can be prepared for what might come. For instance, you can expect there to be home modifications for those suffering from paralysis. Not only will the home need to be wheelchair accessible, but a van may be needed for transportation. If the claimant relies on certain medical devices necessary to sustain life in a normal manner, a generator may be needed as well.

    The final expense that is not always considered on the front end is nursing services. The Mississippi Fee Schedule sets forth that nursing services are to be paid, depending upon the skill level. If a treating provider issues an opinion that nursing services, or attendant care is needed, it will significantly increase the cost of the claim. What some people might not know is that the spouse is capable of providing said attendant care, and the Fee Schedule allows for payment to a spouse at a reduced rate of $8.00/hour, as compared to $15.00/hour for attendant care as contracted through a home health provider. If a treating provider orders attendant care and the spouse has provided said care, according to the Fee Schedule, they should be paid for the services rendered. Case law gets much more convoluted on what activities are to be performed for reimbursement, and I can address those separately if you have questions, but for the purposes of this blog, keep in mind the potential for the expense.

    For instance, a 50 year old man gets paralyzed in the course and scope of his employment. If the treating provider opines 5 hours of attendant care per day is necessary, if his life expectancy is 30 years, then your exposure, if the spouse provides said care, would be $436,800.00. If the attendant care is provided by a home health provider, your exposure would be $819,000.00. The exposure will obviously significantly increase with more skilled nursing or an increase in hours.

    Spinal injuries are some of the most difficult claims we deal with. They take special care from not only medical providers, but compassion from the employer and carrier as well. If you ever have questions about what is owed on a traumatic claim involving a spinal cord injury, whether it be with regard to indemnity, medical or expenses associated with reasonably accommodating a claimant, feel free to give me a call to discuss.