LOIS Subrogation Team Secures 100% Loss Transfer Award Despite Prior Finding of No Liability

In a case where two claimants were injured in the same motor vehicle accident and the adverse automobile liability insurance carrier denied both loss transfer claims on the basis of a prior arbitration award, Lois Law Firm Partner Christopher Major, Esq. and Senior Paralegal Jenifer Andrews were able to obtain full reimbursement via intercompany loss transfer arbitration on both claims. There was a prior third-party settlement with the at-fault driver that was inadequate to compensate the claimant’s damages, resulting in the claimant making an application for underinsured motorist benefits (SUM/UIM) against the UIM carrier. While that claim was pending, the UIM carrier sought intercompany loss transfer against the adverse carrier for property damage sustained in the accident. In that arbitration, the arbitrator ruled that the case was “word vs. word” and, therefore, there was inadequate evidence of liability on the part of the adverse carrier’s insured.

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LOIS Obtains Labor Market Attachment Win Despite Non-Payment of Awards

LOIS Partner Christian Sison was asked to defend a self-insured employer in a difficult case (K.S. v R.G., Inc.), wherein the claimant sustained burns after a pilot light on a grill malfunctioned. As the claimant’s rehabilitation progressed, LOIS secured a judicial ruling that the claimant had a temporary partial disability that required the claimant to mitigate the damages by looking for work within those restrictions or pursuing vocational rehabilitation. However, LOIS also was able to suspend indemnity benefits because of the claimant’s separate failure to produce medical evidence to substantiate wage loss benefits.

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LOIS Wins on Intoxication Defense in New York

The claimant alleged having sustained a work injury when he fell while carrying a large pot of boiling hot ingredients, resulting in burns to his chest, legs, left arm, back, bilateral legs, left knee and left ankle. The claim was denied on the basis that the claimant was visibly intoxicated when he came in to work.

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LOIS Wins on Challenging Additional Body Parts

The claimant was injured on January 31, 2022, while pushing a stretcher in a driveway, slipping, and falling on ice. At the hearing on August 1, 2022, the claim was established to the left shoulder with an AWW of $1,050.39 without prejudice. At a hearing on December 6, 2022, the Law Judge found PFME for left-hand carpal tunnel syndrome.

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LOIS Client Wins by Proving Claimant’s Testimony as to Loss Facts Was Not Credible

The Claimant alleged that he sustained various injuries to the left leg, right knee, left knee, neck, left shoulder, entire back, left wrist, right wrist, and right elbow while loading cargo into a truck. The Board found the neck, back and left shoulder as established sites by prima facie evidence. The Claimant failed to report prior injuries to the established sites during his medical examinations addressing his alleged injuries resulting from his instant claim.

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LOIS Wins Reclassification Argument

In a case where a 7-year-old decision found a claimant to have a permanent total disability, LOIS Partner Christian Sison requested a reclassification of the claimant based on covert surveillance that discovered the claimant’s ability to perform activities that were initially deemed impossible. The claimant was previously found to have an exertional ability that limited her to perform sedentary work. However, evidence produced after the permanent disability finding indicated otherwise, with the claimant seen performing various household activities without the use of the assistive device previously alleged to have been necessary.

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