My question is that, I’ve been out hurt for a year and 3 monthswith a crushed heel. I’ve seen 2 workers comp doctors and just saw a independent doctor. The independent doctor said that he could heal me,and do surgery but the workers comp doctor disputes his opinion. Now the insurance company says that their not going to let me see him nor pay for the surgery. If the workers comp doctor would have x-rayed my foot he would’ve saw that its still broke but he hasn’t x-rayed it in 6months or hasn’t seen me in 3 months and refuses to give me anything for pain. Isn’t that refusing me treatment? Please give me some advise???
-John
Jodi Ginsberg responds: John, thanks for your question. I am going to assume that you are not yet represented. If you are, you should speak with your lawyer to discuss the reasons for the denial and what you can do about it.
There are a number of approaches I would consider in your case. First, I would evaluate whether you have a good argument to ask for a change in your authorized treating physician. If you are not getting better and the independent medical exam doctor states that surgery is indicated, I think that the State Board would consider a request for change in treating physician. The law provides for such a change if the current doctor demonstrates a "failure to effect a cure or give relief."
I would also discuss with you whether you might consider a settlement of your claim. Sometimes, when there is uncertainty in a claim (differing opinions by the doctors), you have an opportunity to maximize your settlement dollars since the insurance company faces an unknown risk in future surgeries and wage benefits. Settlement would only be appropriate if you feel comfortable that you could pursue medical treatment on your own and are prepared to assume that risk.
[tags] independent medical examination, workers compensation doctor, company doctor, georgia workers compensation [/tags]
Filed under Case studies, Foot/crush injuries, Georgia Workers' Compensation, Medical benefits by 
I was in Savannah, GA. attending a seminar at my employer’s request. On Thursday, 9/21/06, I slipped in the bathtub and suffered a spiral fracture of the fifth metatarsal bone in my left foot. As a result of that injury, I had to undergo a four-hour surgery on 10/11/06 to repair the fracture. I have not been able to return to work due to doctor’s orders. Last Friday I got a phone call from my supervisor who told me I was being terminated. Jodi Ginsberg responds: I am happy to speak with you about your case; your injury; rights to benefits; specialized medical care; potential lump sum settlment and reason for termination. I am curious why your employer called you to terminate you. Is it due to the time missed from your injury? Are you on TTD (temporary total disability) benefits while on the no work status? If so and there is no reason to fire you other than injury then this termination may actually help your case. If you are being terminated because of an on-the-job injury, you may be gaining additional leverage to obtain more weeks of TTD benefits, and perhaps a larger lump sum settlement. Assuming that your doctor releases you to either light duty or full duty work, the question becomes whether your employer has a job for you. If you have been terminated, this question is more difficult to answer and you can use this uncertainty to argue for a larger settlement. In addition, when you settle, your claims under the Americans With Disabilities Act might be part of the negotiations. As in any workers’ compensation case, timing and leverage are all important. Knowing when to push for settlement and knowing how to use the circumstances of termination for the benefit of our clients are part of what workers’ compensation lawyers like me do on a day to day basis. [tags] employee terminated after suffering on-the-job injury, workers compensation settlements [/tags]
Filed under Georgia Workers' Compensation, Maximizing your settlement, Winning Strategies by
