Recently I had to handle a situation for a client when the workers' compensation insurance company denied treatment for migraine headaches caused by medication given to my client by an authorized physician.
In this case, my client hurt his back badly about a year previously when he was lifting HVAC equipment. For several months, the insurance company fought us in our attempt to get proper medical treatment but eventually I was able to get him to a good doctor who scheduled him for surgery to repair a large herniated disc in his lumbar spine.
Post surgery, my client developed complications when fluid began to build up in the spinal canal. The surgeon prescribed a strong medication to help drain the fluid and prevent an infection. Unfortunately this strong medication resulted in migraine headaches.
Although the migraine headaches were new, the law in Georgia is clear that medical treatment and medications necessary to treat a complication from a compensable injury is also compensable and must be paid for by the insurance company. And, in fact, the insurance adjustor originally assigned this case, authorized my client's pharmacy to dispense his migraine medication
Several weeks into the treatment regimen, a new adjustor was assigned to this claim. The new adjustor decided that the migraine headaches were not related to the work injury and she canceled the pharmacy authorization. Suddenly, my client was left without medication to treat his frequent and painful migraine headaches.
As you might imagine, this development left my client in a great deal of pain. I immediately got on the phone with the adjustor but she would not change her position. I then wrote the treating doctor to request a statement from him that "connected the dots" and related the migraine headaches to the original work injury. I also got on the phone to the defense attorney representing the employer/insurer to demand that my client's prescription be approved. It took about 5 phone calls until I finally got the defense attorney to call me back – he acknowledged that our position was correct and he was able to convince the adjustor to start the medication authorization again.
This type of arbitrary action by workers' comp insurance adjustors is all too common. Adjustors come and go and a reasonable, knowledgeable insurance claims person can be replaced by someone new who is inexperienced, stubborn or even vindictive. As a claimant's lawyer, I make every effort to stay on top of problems like the one my client experienced and to take whatever steps are necessary to solve these problems.
The economic downturn has led to an increase in companies that try to cut payroll costs by illegally classifying workers as independent contractors rather than employees. This practice costs the government billions in lost revenue and can leave workers with nothing when they are hurt on the job or are laid off. The Internal Revenue Service and 37 states are starting to crack down.
It can be a blurry line 
between employee and contractor status, but it is important to know which you fall into. These are some tips for determining your status to make sure you receive the benefits you deserve and to prevent yourself from being taken advantage of by companies engaging in unlawful practices.
Companies Worked For – A key indicator of independent contractor status is when the worker does the same work for multiple companies.
Expense Reimbursement – Independent contractors are more likely to have expenses that are not reimbursed. Employees are typically reimbursed for business-related expenses.
Workers’ Investment – Independent contractors most often have a significant investment in the services they use, most significantly an office or work space, and are not provided tools, equipment, or supplies by employers.
Pay Periods – Independent contractors are typically paid by the job, while employees are paid by the hour, week, or month.
Pay Rate – Independent contractors make a profit or loss on the job, while employees receive paychecks regardless of whether the company makes money.
Permanency – If a worker is hired with the expectation that the job will be permanent, or until further notice, they are generally an employee.
Benefits – Independent contractors are typically not provided benefits, while employees receive benefits such as insurance, pension plans, vacations, or sick days.
Have you been injured on the job and are not sure what category of worker you fall into? Feel free to use the Free Case Evaluation form on this website to discuss your particular circumstances with an experienced workers’ comp attorney.
Filed under Employee vs. independent contractor by 
Last July, I wrote a post on this blog about how your Facebook profile could be used against you in your case. The Georgia State Board of Workers' Compensation will allow defense counsel to introduce status updates and pictures to challenge your assertions that you are injured and cannot work. This is in addition to the surveillance and other investigation that defense counsel use to impugn your credibility.
More recently I have learned of a case where the insurance company's defense lawyer used a "request for the production of documents" to demand that an injured claimant turn over his personal computer to be examined by the lawyer. As you may know, when you file a workers' compensation claim in Georgia, both sides are allowed to demand information from the other per Georgia' "discovery rules."
Apparently, in this case, the insurance company believes that the claimant's hard drive will reveal damaging information – perhaps photos, evidence of work or physical activity, or it may be just a fishing expedition.
Now, this was not my case, and at this point, at least, this demand for the claimant's computer has not become a regular part of defense counsel's arsenal, but I think that this type of request sets a very bad precedent. I learned about this case in a monthly meeting I attend with a few other claimant's lawyers who get together to discuss current developments in the law and winning strategies. All of us in last month's meeting were somewhat taken aback by this discovery request as well as the presiding judge's approval of the request. We all agreed that if any of use are involved in a case and the insurance company asks to look at our clients' computers, we will fight this request vigorously.More on Judge Orders Injured Worker to Allow Insurance Company to Examine His Computer
The malpractice of a Georgia workers’ compensation company, which has been compared to the fraudulent actions of Enron, will ultimately have a large negative impact on innocent citizens.
The State Insurance Commissioner's office has begun a criminal investigation into SEUS, an insurance company that provided workers’ compensation insurance to dozens of Georgia communities.
Suspicions of SEUS, short for Southeastern U.S. Insurance Inc., began when department analysts learned that the company had engaged in questionable business practices with a hunting club it owned in Seminole County. SEUS had invested $10 million in the hunting club when the company was in no financial condition to make such an investment. Upon investigation, the department also discovered that SEUS was inflating company assets while drastically understating liabilities.
In October 2009, Fulton County Superior Court Judge Thomas R. Campbell, Jr., ordered SEUS, which at the time held over 200 workers’ compensation policies and provided coverage to dozens of towns and school boards in Southern Georgia, into liquidation.
Georgia Insurance Commissioner John Oxendine was named as the liquidator. Following investigations into the company’s financial transactions, Oxendine compared the bookkeeping methods of SEUS’s former chief executive, M. Clark Fain III, to those of Enron.
Companies like Enron and SEUS, which are motivated by corporate greed, inexcusably disregard the large negative affect their misconduct will have on innocent citizens. Oxendine’s office has taken over the operation of the workers compensation insurer and is now authorized to sell off its assets to pay claims. SEUS has also been banned from involvement in further business.
Filed under Blogs, Recent developments, Workers' Comp Fraud by
Although Georgia's workers' compensation system is supposed to foster an environment where legitimately injured workers can get needed treatment and then return to work, the reality is much different. It has been my experience that workers' compensation practice is just about as adversarial as divorce practice. Often justice and fair play take a back seat to "winning" and efforts by employers insurance companies to avoid paying benefits.
Case in point. This week I received the following email from a young woman who works at a factory in north Georgia:
Where I work I have been told that carpel tunnel is not recognized as a workman's comp injury if I wasn't having problems with numbness before. Is this correct?
The short answer is "no, this is not correct." Repetitive motion injury (often resulting in a diagnosis of carpel tunnel syndrome) is a very common work injury, especially for factory workers performing manual labor with their hands.
Any employer who tells an employee that "carpel tunnel is not recognized as a workers' comp. injury" is either very misinformed or downright dishonest.More on Employee Gets Bad Information About Legitimate Job Injury
If you have a computer and enjoy sufing the web, there is a good chance that you have a profile on Facebook, mySpace, Twitter or any of more than a hundred social media sites. These sites exist to help you connect with others – often for social purposes, and sometimes for business purposes.
How can an account at Facebook or many of these other sites hurt your workers' compensation case? When you create a profile on Facebook, your account has a default privacy setting that offers no privacy. Anyone who has a Facebook account anywhere in the world can find your profile and read what you have posted, what others have posted on your "wall" and view photos that have been "tagged" with your name.
Insurance defense lawyers are well aware of Facebook, and they are aware that many Facebook users may not be very savvy about changing privacy settings. Perhaps there is a photo of you attending a ball game or a family gathering. Maybe you listed yourself as the CEO of ABC Enterprises. Thanks to New York workers' compensation lawyer Jim Reed who posted about this issue on his New York InjuryLaw blog.
Photos and updates can easily be taken out of context. Even your frequency of posting can be used as evidence that you have the capacity to perform clerical type of work. Posts on Facebook and other social media sites can be used against you to put you on the defensive and as leverage to reduce the value of your case.
So, if you enjoy using Facebook or similar sites, take a few minutes to learn about the privacy settings. Block your profile to all but known friends and avoid "friending" someone that you don't really know.
If you were not already aware that there is no real privacy in the world, now you know. Take steps to protect yourself.
Filed under Maximizing your settlement, Miscellaneous information by
A front page story in the Sunday, May 24, 2009 edition of the Atlanta Journal-Constitution details the struggle of five catastrophically injured Atlanta police officers to obtain needed medical help from the City of Atlanta's workers' compensation office. Each of these police officers was injured in the line of duty – with injuries ranging from brain damage to paralysis arising from gunshot wounds to the spinal cord.
Like many city and county governments, the City of Atlanta "self-insures" against workers' compensation claims, meaning that weekly wage benefits and funds for medical treatment come directly out of the City's budget. The City does use a private claim's administration service called NovaPro Risk Solutions out of San Diego.
The City is not denying responsibility for paying wage or medical claims, but it has been refusing to pay for various medical procedures and medical devices.
In one instance a police officer who had been rendered a parapalegic from a gunshot wound needed surgery on his Achilles tendon because his feet kept slipping off his wheelchair footrests.More on Injured Atlanta Cops Fight Workers Comp System
