I am pleased to introduce the Georgia workers’ compensation blog. In the days and months to come, I will be posting case studies, observations about the Georgia workers’ compensation system and answers to your questions about Georgia workers’ compensation. Please let me know what you think and what you want to know.
–Jodi
[tags] georgia workers compensation, workman’s compensation georgia, jodi ginsberg, georgia workers’ comp information [/tags]
Yesterday, I settled a very intense closed head injury case for almost $200,000. In looking back over this case, it strikes me that there are several important lessons here for anyone pursuing Georgia workers’ comp benefits.
This case involved a 47 year old construction worker who was struck in the head by a 100 lb. beam that fell on top of him from a height of over 14 feet. Although my client was wearing a hard hat, the impact from the steel beam knocked him unconscious and resulted in a fractured vertebrae in his neck.
Over the next 12 months, my client, acting without a lawyer, looked to his employer’s workers’ compensation insurance carrier to provide medical care. During that time he visited six different doctors on referral from the worker’s comp adjustor. Each time, he had to fill out an extensive new client questionnaire and he had to explain, as best he could, what had happened to him. This repeated new client intake process was very difficult for my client because he was in pain, suffering from memory loss and depression as well as severe emotional turmoil resulting from his accident. Despite all of these doctor visits, my client had not been referred for surgery and his condition was not signficantly improved.
Approximately 12 months after the accident, this gentleman called me to ask for help with his workers’ compensation case. Because the medical treatment so far had not helped much, I was able to convince the adjustor to approve as treating physician a top orthopedic surgeon here in the Atlanta area. My client subsequently underwent a two level fusion in his cervical spine (neck). We were then able to get a pain management physician approved as well as a psychiatrist to help with my client’s depression. And, after deciding that the timing was right to settle, we engaged in arbitration with the insurance company and agreed to settle the case for $195,000.
This was not a case where the insurance company denied the claim – there was no dispute that my client’s injuries arose out of and in the course of employment. When I was retained, my client was receiving his weekly wage benefits. The problem I had to deal with here was the insurance company’s unwillingness or inability to offer my client needed medical care.
Because my client was in pain, emotionally distraught and, most of all, unfamiliar with the Georgia workers’ comp system, he was not able to formulate a “big picture” strategy for his case.
The lessons you can learn from this case:
- you need to have a case strategy to follow and you need to demand that the insurance company fulfil its responsibilities to you
- do not assume that because the insurance adjustors are polite and cooperative that they are also working in your best interest. The adjustor’s primary goal is to minimize the insurance company’s financial exposure
- physicians on the “posted panel of physicians” or who are referred by the adjustor may have divided loyalties. You and your attorney are entitled to participate in the choice of physicians who treat you
- delay in getting appropriate medical treatment can result in longer recovery times and less satisfactory results
[tags] georgia workers’ compensation, posted panel of physicians, workers comp settlement [/tags]
I am frequently called upon by my clients to explain the difference between settling their workers’ comp cases and agreeing to a “no-liability” stipulation.
If the insurance company has paid benefits, paid for medical care and accepted the on-the-job injury claim as compensible, then the only type of settlement permitted is a standard settlement.
On the other hand, if the insurance company has denied (controverted) the claim and not paid benefits, then the case can be settled with either a standard settlement or with a no-liability stipulation. In a no-liability stipulation, the parties agree to disagree. The employer/insurer denies that a compensible accident happened but agrees to pay a lump sum to settle the worker’s outstanding claim for benefits.
Often, my client (the injured worker has a hard) with the concept of a no-liability stipulation. Frequently, the language of the stipulation contains assertions by the employer that the accident did not happen at all. Even if a substantial sum of money is involved, many injured workers have a hard time signing off on a document that essentially says that they are lying.
In my role as the claimant’s lawyer, my focus is on getting my clients enough money and sufficient medical care so that my client can live his life with dignity. Sometimes, as a matter of business, a no-liability stipulation is the best alternative.
A few weeks ago, I settled a case with a no-liability stipulation and I believe that my client is better off with this solution than if we had taken the case to the State Board of Workers’ Compensation and won.
At the time of his accident, my client was a 30 year old man who worked for a poultry processing plant. He was told by his supervisor to clean out a large machine that made filets out of chicken breasts. This machine was a large tube (large enough for a man to fit inside) with sharp blades rotating alongside a conveyor belt that carried the chicken breasts.
My client crawled onto the conveyor belt and started to clean the blades when someone turned the machine on. He tried to pull a manual cut-off rope but the manual cut off did not work. He tried to yell for a co-worker, but the person on watch did not speak English. My client was cut all through his midsection by the sharp blades and suffered a crushed pelvis.
Although there were numerous witnesses to this accident, the insurance company denied coverage on the grounds that my client was engaged in “wilful misconduct.” The insurance company’s adjustor advised me that my client’s supervisor would testify that my client failed to use a magnetic card to turn off the machine himself.
My client and several of his co-workers advised me that no one had ever trained them in the use of the magnetic cards and that the employees were told to sign forms verifying their training – despite the absence of actual training – if they wanted to get paid. So, every month, the employees of this poultry plant signed forms verifying their completion of training courses when no such courses were ever given.
As you might imagine, my client was extremely hurt and upset that his employer was trying to put the blame on him for this horrible accident. His problem, however was that he needed immediate medical care if he hoped to recovery.
I recognized that part of what was motivating the company was a fear of huge liability – not just this workers’ compensation case, but perhaps an OSHA investigation and even criminal negligence charges.
I suggested to the adjustor that rather than firing my client, they keep him on as an employee and cover the cost of his group medical insurance. I pointed out that if they totally cut him off and we ended up winning at a hearing 6 months down the road, they would have a much more disabled person requiring much more intensive and expensive rehabilitation.
The adjustor agreed and the company allowed my client to continue to receive medical care. Six months later, when we went to a mediation, my client was recovering from his injuries and was ready to move on. Our “no-liability” stipulation included $80,000 in cash plus the insurance company agreed to reimburse the health insurance carrier for all medical costs. In addition, the employer agreed to provide COBRA medical coverage to my client at a discounted rate of less than $100 per month.
Was my client made totally whole? No, of course not. His injuries are pemanent and he will never be able to perform certain types of physical activities. He also carries with him some resentment against his former employer for trying to shift the blame for his accident on to him.
However, in this case, the no-liability stip solution made sense for everyone. My client got the medical treatment he needed and avoided the stress of extended litigation. He also got a lump sum of money that will help him cover his bills until his recovery is more complete. Had we taken this case to a hearing we might have won – but then again, the employer was prepared to present testimony and written documentation supporting its position.
After laying out the possiblities, my client decided that the no-liability stipulation was the way to go and I agree with his decision. What do you think?
[tags] no liabilty stipulation, Georgia workers compensation on-the-job injury-georgia workers’ comp mediation [/tags]
If you have never filed an on-the-job injury claim before, prepare yourself for a rude shock once you file your workers’ compensation claim. In theory, Georgia’s workers’ comp. law is designed to reduce disputes between employers and employees – in fact, I believe that workers’ compensation is just as adversarial as divorce or any other hotly contested litigation.
In theory, the Georgia’s workers’ comp statute reduces conflict by eliminating fault from the claim equation. If a worker is injured, he need only prove that he was on the clock performing a duty of his employment. Negligence is not an issue. Bad judgment, if honest and unintentional, is compensible.
By comparison, you cannot recover damages in a car accident if you were at fault. For example, if you are driving a company vehicle on a delivery and you run off the road and hit a tree, workers’ comp will cover you. If you had this same accident on the weekend, you would have no source of recovery in negligence.
There is a tradeoff for not having to prove fault. In workers compensation, you cannot recover money damages for pain and suffering. Instead, the Georgia comp statute provides that you can recover for your economic loss (temporary total disbability) and for your permanent medical impairment (total or partial permanent disability). Typically, recoveries for injuries in worker’s comp are less than the same injuries in a negligence case.
Because negligence is not an issue, the “battleground” in a workers’ comp case often arises from a dispute about the severity of your injury. Often, I spend a lot of my time fighting with the insurance company over who the treating doctor ought to be.
It should come as no surprise that the insurance companies who process workers’ compensation claims in Georgia have identified dozens of doctors who take a very conservative approach to on-the-job injury claims. These doctors are likely to minimize the significance of your injury and will release you back to work quickly.
Having been in practice for over 15 years, I have met, deposed and reviewed the work of most of the doctors who you will likely see in your workers’ comp claim.
By contrast, my job is to secure for you medical care that is focused on your well being. I will also expect that your treating doctor’s loyalty is directed towards you, not to an insurance company that sends him work.
[tags] georgia workers’ comp law, workers’ comp vs. car accident, company doctor [/tags]
Filed under Georgia Workers' Compensation, Medical benefits by 
One of the most important parts of your workers’ comp case relates to who will be your “authorized treating physician.” The opinion of your treating doctor is very important to the development of your case – if your doctor downplays your injuries and releases you back to work, you may lose your benefits, you may lose your job, and you may lose important leverage in your case.
The Georgia workers’ compensation statute gives the employer/insurer the first opportunity to direct your medical care. Code Section 34-9-201 provides that at a minimum that covered employers – any employer with more than 3 employees – must make available to employees a posted panel of physicians containing at least four independent medical providers. The Code Section also provides for something called a “conformed panel” containing ten physicians or a managed care organization approved by the Georgia State Board of Workers’ Compensation.
In addition to maintaining a properly set out panel of physicians, the employer must make the panel accessible to employees and must explain how the panel works and the procedure for filing a claim.
If the panel does not exist, or if it is not accessible or if it is not explained, then the employer forfeits the right to control the medical care and you can go to any doctor for treatment and the employer will have to pay for the treatment.
An employer who does not have a panel can still controvert the claim but, as you might imagine, that is an uphill battle if the only on-going medical treatment in the case is from a friendly physician.
Posted panels are usually, but not always, printed on bright pink paper and may be posted in break rooms or near restrooms. The insurance defense bar recognizes the significance of the posted panel of physicians. One of the insurance defense firms that I frequently litigate against has published a paper presented to employers at a seminar – the subheading of the paper is “Solutions Which Will Keep Even the Most Atypical Claimant at Work!” Although this paper is written for the benefit of employers and their insurers, you as the claimant can learn a lot from it and I recommend it to you.
I frequently see examples of improper panels in many types of businesses. My dry cleaner, for example, has a pristine pink posted panel – with no physicians’ names printed on it. A local pizzeria near my house has a posted panel with two hospitals and one doctor – improper because it contains only three choices.
If you think that your employer did not have a proper posted panel at the time you were hurt, you can help your case by asking a co-worker to photocopy the panel or snap a digital picture of it.
[tags] posted panel of physicians, georgia workers compensation, O.C.G.A. Section 34-9-201 [/tags]
Filed under Georgia Workers' Compensation, Posted panel of physicians by
