Perhaps no other element of a workers compensation case gives rise to as many questions as the subject of when and how to settle your case. In my opinion the timing of settlement negotiations can greatly influence the outcome of your case. Settle too soon and you may end up paying out of pocket for expensive medical services. Wait too late and your case can grow stale if the insurance company can calculate with certainty its exposure on your case.
Generally the best time to settle your case is when significant uncertainty remains regarding your future medical and lost wage eligibility. Remember – insurance companies are in the business of risk management. If we can show them that your future medical costs could soar into the tens of thousand and that your return to full duty work could be far into the future, they will be more likely to offer more money to eliminate that risk.
I tell my clients that identifying that “sweet spot” is more art than science. Sometimes a single line in a medical record, or a brief comment from my client will tell me that we are entering the zone where my client’s medical condition is stabilizing but enough unknowns remain for me to put forth a settlement demand that will result in a fair and generous settlement.
Filed under Maximizing your settlement, Winning Strategies by 
Would you be surprised if I told you that those photos you uploaded to Facebook, or that video of your child’s basketball game now playing on YouTube, or even your restaurant “check-in” on Yelp could cost you thousands of dollars and seriously undermine your workers’ compensation case? Unfortunately all of these things have happened to men and women pursuing work injury claims in Georgia.
If you did not realize this already, understand that privacy in the United States is pretty much dead. If you participate in social media like:
- My Space
- Yelp
- Tumblr
- Wordress (blogging)
- Blogger
- YouTube
- and many more
information about your life can be available to anyone who is looking. And you can bet that insurance adjusters and insurance defense lawyers are looking. While private eye surveillance is still used, insurance defense adjusters also run searches for you on various social media platforms. If they see you running, jumping, lifting or doing anything inconsistent with your claimed injury, they will use that video, photograph or post as grounds to cut off your benefits.
A colleague of mine tells the story of a client of his who decided to video her son’s high school wrestling match and thereafter uploaded to YouTube. At one point the video shows the claimant climbing bleachers, then jumping up and down to cheer her son. Unfortunately this woman was asserting a job injury to her hips and lower back that she claimed was disabling. When confronted with the video, she insisted that the wrestling match was a one-time event and that she ended up in bed for a week thereafter. The workers’ compensation judge did not accept this argument and upheld the insurance company’s termination of benefits. A case that could have settled for $50,000 to $75,000 ended up settling for nuisance value of less than $5,000.
Don’t let this happen to you. If you are pursuing Georgia workers’ compensation benefits, close or suspend your social media activities until your case is over.
Filed under Georgia Workers' Compensation by
Have you ever wondered how an insurance adjuster can influence your authorized workers’ compensation doctor? If you work in an industry where employees often get hurt, or where work injuries are likely to be serious, you can be certain that your employer’s insurance company has directed the human resource director at your company to include specific doctors on your company’s posted panel. Insurance adjusters know that physicians who derive most or all of their income from workers’ compensation referrals will be much less likely to keep you off work or order expensive tests.
The problem, of course, is that delays in needed tests, or delays in needed treatment can result in permanent injury to you. Further, if a panel doctor returns you to work and you are unable to perform your duties, you are likely to be fired putting you in a difficult financial situation and psychologically deterring you from pursuing your rightful benefits.
In this video I discuss a case where the authorized doctor flat out ignored his own physical therapist’s conclusions about my client’s very limited use of her arms, and issued a full duty return to work. I won’t let the insurer get away with this, of course, but I wanted you to see how broken the workers’ compensation medical system has become. I’d be willing to bet that this doctor knows that he was not living up to his oath to offer full and complete treatment to his patients, but his interest in making money and seeing those referrals seems to override his conscience.
Filed under Arms & Hands, Case studies, Medical Care, Understanding the Law by
A significant number of work injuries in Georgia involve back injuries. Unfortunately if you are being treated by a “posted panel” doctor, your treatment may be delayed or not taken seriously. In this video, I discuss certain “red flag” issues that demand immediate treatment with a spine specialist whose focus is your well being.
Filed under Back & neck injuries, Case studies, Medical benefits, Medical Care, Understanding the Law by
Often the problem that drives clients to call me relates to lost wage checks. Specifically, you may have been hurt a week or two ago, you are getting letters and State Board forms in the mail, but no lost wage check. What exactly are the rules regarding when you are supposed to get that first check?
the insurance company has 21 days after the date of your first missed day from work to issue your first lost wage check. You do not count your last day of work in this calculation
- you will not receive payment for the first 7 days of missed work unless you miss 21 consecutive days
- once you miss 21 consecutive days, the insurance company must pay you for the first 7 days of missed work
- if you do not miss 21 consecutive days, you should receive 2 weeks’ worth of benefits by day 21 after your first day of missed work
Confused? You are not alone. The law seeks to balance the needs of workers for money to pay their bills and the needs of the insurance company to conduct its investigation and set up a payment schedule. Personally, I think that an employee’s suffering when he is hurt and broke for 3 weeks outweighs an inconvenience to an insurance company, but this is the law as it exists currently. More on When Do I Get my First Lost Wage Check?
Filed under Income benefits, Returning to work by
I understand how important it is that you receive your weekly temporary total disability benefits on time. If you are like many of my clients, when you lose your regular paycheck and you are depending on workers’ compensation, you may be living week to week and you may face significant and dire consequences when your checks are late. Here is what you need to know about late payments, the penalties that the insurance company must pay and what you can do to force the insurance company to issue your check.
Assuming that your claim has been accepted and you are not currently working, your employer’s insurance company must pay your weekly benefit checks on time.
Your first weekly benefit check must be mailed on day 21 after the accident if that check is mailed within Georgia, and it must mailed on the 18th day after the accident if it is mailed from an address outside the state of Georgia. The day of the accident does not count when calculating dates.
Subsequent checks mailed from within Georgia must be postmarked as of the last day of the week (i.e. Saturday) in order for payment to be considered timely.
Subsequent checks mailed from outside of Georgia must be postmarked by the Thursday of the week it is due in order for the payment to be considered timely. More on What Happens if my Weekly Benefit Checks are Late?
Filed under Income benefits, Miscellaneous information, Understanding the Law by
Under Georgia’s workers’ compensation law, your employer gets to direct where you get medical care if your employer provides you with a valid “posted panel of physicians.” Not surprisingly, posted panel doctors sometimes bring a pro-employer bias to their treatment of you. I regularly see – and you have no doubt heard stories about – cases in which a seriously injured man or woman is given a regular duty return to work, only to end up in surgery a few weeks later.
In 1990, the Georgia legislature gave injured workers an important new right, the “claimant’s IME (independent medical exam). Under this law, an injured worker can request an independent medical examination with a doctor of his choosing, paid for by the employer’s insurance company.
When properly used as part of a effective claim strategy, your claimant’s IME can be used to:
- refute the unfair and biased claim of industrial clinic doctors
- contest a premature return to work demand by the insurance adjuster
- support a request for a change in authorized treating physician
- support a reasonable settlement demand
However, as important and valuable as your claimant’s IME rights may be, this right is not open ended and it can be wasted if not used properly. More on Am I Entitled to More than One Independent Medical Exam if I have Multiple Work Injuries?
Filed under Medical benefits, Medical Care by
