School workers comp cases can drag through many dollars and years

The pain in Sendy Wilburn’s back won’t go away. A spinal cord stimulator implant embedded by doctors is the only reason she’s able to use her left leg.

Both are the byproducts of a student from DeKalb County’s Stephenson Middle School, where Wilburn worked, pushing her down bleachers during a school assembly.

Nearly 16 years after she was injured, she’s still waging a battle against the school district, so it remains on the hook for her ongoing medical care. For years, she’s pushed to get the district to settle. If it established a trust to cover medical expenses, Wilburn could return to work without worrying how to pay for her next procedure. Many more are inevitable, she said.

Metro Atlanta school districts are responsible for more than 2,500 active workers compensation claims, with some going back as far as 1977. They could be anything from paid medical treatment for an incident that occurred while working, or a case like Wilburn’s, where recovery is ongoing and continues to affect a person’s ability to work, Susan Setterstrom, the district’s director of risk management, said through emails.

“I don’t want to spend the next 15 years of my life like this,” Wilburn, 50, said recently. “And I want my life back. They need to come up with a solution so I can move on.”

Wilburn said she’s been offered jobs in the school district, but is afraid to take them. She receives $400 a week from the district that could be taken away if she takes a job and has her workers compensation status changed for returning to work. With the open workers compensation case, she said other potential employers see her as a liability.

“When you look at it overall, if it was them, they wouldn’t be OK settling with this,” she said of officials handling her case. “I’m sure they wouldn’t be OK with going through what I’ve gone through and being OK with that.”

In DeKalb County, there are about 500 active workers comp cases. Of those, approximately 90 are more than five years old, some going as far back as 1984. Setterstrom said a claim is opened when a person notifies the district he or she could seek medical coverage for an on-the-job injury. The claim closes when the worker no longer needs medical treatment, recovers and returns to work or receives the available benefits. Medical benefits are typically paid up to 400 weeks. Others, like Wilburn, receive benefits for much longer.

“Once a person who is receiving medical care from workers compensation … (reaches) a baseline of health, they’re taken off workers compensation,” Setterstrom said by email.

About 140,000 workers compensation claims were filed in 2014, according to the Georgia State Board of Workers’ Compensation. That year, nearly $1.3 billion was paid out on workers compensation claims. The majority, about $1.05 billion, was spent on indemnity claims, where a person is injured or becomes ill because of the job and his or her employer compensates for lost wages. The information is reported to the state from insurers, self-insurers and group funds.

The longer a case sits open, the more the possibility for a settlement diminishes, said attorney Tracee R. Benzo, who worked as a workers compensation adjuster after college, but has dedicated her law practice to representing injured workers across the state for nearly 10 years.

“Cases don’t get better with time,” she said. “They’re not like fine wine.”

A lot of cases remain open for extended periods because of some school districts’ status, like DeKalb, as a self-insurer. The district may believe it’s more cost-efficient for them to keep a case open and pay weekly checks in lieu of lump-sum settlements, she said. Some districts find self-insuring a better route, having benefited from reforms limiting payouts. Only catastrophic cases — where a person is no longer able to work or suffered life-long debilitating injuries that won’t go away — are paid income and medical benefits for life.

Benzo said several of her clients have workers compensation cases open since the 1990s, and many long-term cases are beneficial to the client. Should they settle, she said, “they have to be the responsible stewards for that money for income and long-term care.” Otherwise, the employer remains responsible for those payments.

Benzo said she settled a case with a school district last year before her client’s status was deemed catastrophic. The process — getting all sides to agree on the payout, and having it approved by the school board — is long and, often fruitless. Another client of Benzo’s who recently settled her case joined a water a aerobics class and lost a significant amount of weight, which improved her medical condition.

“She would never have attempted the activities while in the workers’ compensation system,” Benzo said. “There is significant psychological impairment that goes into being disabled and feeling hopeless. Injured workers’ lives are turned upside down. Sometimes resolving a case allows an injured worker to begin to feel that they are back in control of their life and can transition to a better place and move forward.”

Wilburn’s case, Benzo said, is unique in the sense that she’s receiving catastrophic benefits but is able to return to work.

“There’s a lot of benefit to having a closed file,” she said. Wilburn “may have found a way to improve her life outside of the system. But (the school district) would probably never settle her case. It’s too expensive to use taxpayers money to pay for a large lump sum settlement at one time.”