Welcome to the 5th installment of my summer long series on Georgia Workers’ comp case studies. In the following case study, I discuss a workers’ comp case involving outstanding medical bills.
Outstanding medical bills and your credit
One of the most common sources of damage to a person’s credit is outstanding (unpaid) medical bills. If you are injured on the job, your medical bills should be covered by your employer’s workers comp insurance company. Not surprisingly workers’ compensation insurers can be slow in paying medical bills and your credit may be the casualty in such a situation. I have been retained by several clients to handle this issue because of the frustration and anger they feel when bill collectors start calling about medical debt that should have been paid weeks or months earlier by the insurance company.
Group Health vs. Workers’ Compensation: a Recipe for Confusion
Under Georgia workers’ compensation law, bills relating to your treatment from authorized treating physicians must be paid timely. The law also provides that workers’ compensation insurance is “primary” – meaning that group health does not come into play when there is valid workers’ comp coverage. Sometimes injured workers submit bills to a group insurance company because a supervisor instructs them to do so or because they do not realize that workers’ compensation is the primary insurance source.
If the group health carrier identifies your claim as a workers’ comp. claim, it will deny coverage. If the physician’s office has coded the claim incorrectly it may send your account to a collection agency. You may be caught in the middle trying to explain to a disinterested bill collector that your bill is covered by insurance, or you may find that the “authorized” treating doctor will refuse to treat you because of “unpaid” bills.
Recently, I represented an injured worker who found himself facing both collection and a refusal by his doctor to treat because of the outstanding balance. When we settled this case, I insisted that a provision for future medical care must be included in the settlement. Our settlement provided for:
- monetary compensation for my client in the amount of “X” dollars
- a confirmation that the health carrier has paid for all the current bills and will pay for any future bills from Dr. “W”
- Dr. “W” must confirm with the group carrier that he does not need any further reimbursement until further services are rendered
- medical payments and TTD continue being paid to my client pending approval of the settlement by the State Board
Please feel free to call me at 770-351-0801 if you are getting the run-around with regard to your medical bills or medical treatment.
Filed under Case studies by 
Welcome to the 6th installment of my summer long series on Georgia Workers’ comp case studies. In the following case study, I discuss a case in which a client’s neck injury was made worse by a return to work.
Cervical injuries made worse by returning to the job
Mrs. B is a 20-year employee of a medical practice. As the office manager, she was involved in all facets of managing the practice, including patient care, insurance submission, and handling other patient paperwork. Mrs. B is also a licensed practical nurse and she also served as a nurse, frequently making rounds with doctors at the hospital during her work shift. Mrs. B was injured when she felt a “pop” in her neck while assisting two co-workers move office furniture and other office equipment.
After moving the furniture and equipment, Mrs. B started to experience severe pain in the arms and neck. Additionally, she noticed that she had numbness and pain in her right leg. Despite her pain and numbness, Mrs. B. returned to work the next day and continued working for 9 full months until the pain and discomfort became so intense at she could not function. Finally, Mrs. B returned to the panel physician who took her out of work and prescribed pain pills and physical therapy.
Perhaps because Mrs. B has a medical background, she sensed that the care she was receiving under workers’ compensation was not sufficient, so she decided to seek counsel, even though she was receiving her weekly income benefits of $500 per week and the employer/insurer was not denying her claim.
When I got involved in this case, I recognized that Mrs. B’s injury was most likely a surgical problem. After reviewing literally thousands of pages of medical records, I have a fairly good sense of which doctors I like my clients to see for various medical problems and I wanted Mrs. B to see a particular surgeon. The insurance adjuster would not agree to my preferred doctor so I directed my client to return to her panel physician and request a referral to this particular doctor, which he agreed to do. Under Georgia law, this referral from an authorized treating physician to another physician must be honored by the insurance carrier and the adjuster reluctantly agreed to authorize my preferred surgeon. In my view, all parties – my client and the insurance company will benefit from this surgical referral as my preferred surgeon is one of the best specialists in the state for neck surgery.
Mrs. B underwent a multi-level cervical fusion and followup rehabilitation. Mrs. B had expressed a desire to return to her job but, as I expected, the insurance carrier demanded a resignation as part of any settlement. Mrs. B recognized that she would not be able to return to her past work and she authorized me to enter in to settlement negotiations. Our final settlement consisted of cash and 24 months of “open medical” care with the surgeon
Filed under Back & neck injuries, Posted panel of physicians, Settlements, Stipulated settlements by
Welcome to the 7th installment of my summer long series on Georgia Workers’ comp case studies. In the following case study, I discuss a recent workers compensation case involving a severe ankle and foot injury.
Severe ankle and foot injury Workers’ Compensation case
This case involved an ankle injury incurred by woman (Mrs. K) who worked in a warehouse environment. While moving a bulky 250-pound steel panel, Mrs. K and her co-workers paused to rest after moving the steel panel only about 10 feet. The panel became extremely unsteady and fell on her Mrs. K’s foot, snapping and breaking the ankle and foot. Mrs. K was immediately rushed to her local hospital’s ER where she would undergo surgery to stabilize and immobilize the fracture.
After her surgery, Mrs. K was referred to a physician from the posted panel of physicians who saw her 3 days after her surgery. Despite the severity of her fracture, the panel physician did not take X-rays to evaluate the union of the bones, nor did he conduct any nerve function tests to evaluate any possible loss of function. Instead he left the cast on and prescribed pain medications.
After just over a week living in intense pain, Mrs. K. found me through my web site and retained me to represent her. After reviewing the medical record, it was obvious to me that Mrs. K needed additional surgery and she needed a surgical consult quickly. I contacted the insurance adjuster and persuaded the adjuster to refer my client to a foot and ankle specialist. The foot and ankle specialist diagnosed the foot fracture as a “displaced” fracture, meaning that another surgery was needed and that plates and screws would have to be used to stabilize the foot. This, of course, means that a third surgery likely would be necessary to fully or partially remove this hardware.
Because of the delay in getting Mrs. K to the appropriate physician, she suffered complications – ecchymosis (skin discoloration) up the leg to her knee and neuropraxia (loss of nerve function) throughout her foot. In my opinion, these complications would not have occurred, or would have been less severe had the 2nd surgery been performed earlier than it was.
Mrs. K is still recovering from surgery. Her job had required her to stand, squat, lift and stand, and she cannot perform the duties of her past job. Rehabilitation is proceeding slowly and I estimate that she will be out of work for at least 6 to 8 months.
Mrs. K has not yet had her second surgery and it is not clear to me how invasive that second surgery will be. I expect that we will make a settlement demand either before or after the second surgery.
In my view, this is a case in which the insurance company’s delay and their reluctance to get Mrs. K to the right doctor quickly on what was clearly a surgical case will dramatically increase the settlement value of this case. More importantly, I am of the opinion that my client’s health was compromised by the insurer’s delay, not to mention the unnecessary suffering she experienced. I further suspect that had she waited 3 or 4 weeks before hiring me, a second surgery would not have been scheduled as the initial panel doctor seemed oblivious to the severity of this injury.
This case illustrates the importance of recognizing that medical treatment under workers’ compensation can be substandard and inadequate. The panel doctor’s motivation and loyalty was not to his patient, but to the insurance company. Ironically, the panel doctor’s failure to act will end up costing the insurance company more money.
Filed under Case studies, Foot/crush injuries, Medical Care by
Filed under Georgia Workers' Compensation, Medical Care by
The prevalence of on-the-job back injuries
According to government statistics, nearly 20% of all the work-related injuries involve back injuries and back pain, especially lower the back area. The cost of these work injuries continues to soar – currently estimates put the cost of treatment and lost productivity at nearly $20 billion annually. Not surprisingly many of the cases I see involve some form of back injury – ranging from cervical (neck) damage to lumbar and thoracic (mid to lower back) injuries. In my experience, quick diagnosis and treatment can greatly improve the chances of a more complete recovery.
General causes of back injuries
Back injuries can result from numerous causes including:
- Heavy lifting
- Remaining in the same position for too long and too often
- Repetitious activities and movements
- Stressful lifestyles
Back braces and modified lifting techniques can help but not prevent back injuries.
The back injury case of Mr. S
Mr. S worked for a company that owned several large trucks. The company was selling several of its trucks and Mr. S’s supervisor directed him to show the truck to a potential customer. Mr. S was attempting to push open the hood of the truck when the hood (weighing 300 lbs.) detached and fell on him, pinning him to the floor. Mr. S began experiencing pain in his lower back as well as radiating pain in his leg.
This accident was witnessed by both the potential truck buyer and Mr. S’s supervisor, who instructed Mr. S to go to one of the posted panel doctors. Upon arriving at the doctor’s office, Mr. S noted that the line of patients was out the door and since he did not want to sit around and wait, he decided to return to work and took pain medication before returning to the job. Mr. S continued working for the next 4 months, relying on over the counter pain pills to reduce his pain. At no point did he ever actually meet with a doctor.
Around 4 months later, Mr. S again injured his back while working on a truck. This time, he felt a definite “pop” and his legs went numb. The supervisor again sent Mr. S to a posted panel doctor who took Mr. S off work and began conservative treatment (prescription pain pills and physical therapy) When Ms. S was unable to perform the exercises during physical therapy, the panel doctor ordered an MRI. The MRI revealed several bulging discs as well as 2 herniations with impingement on the spinal cord.
The panel doctor then referred Mr. S to an orthopedist for surgery. Mr. S was not impressed with the surgeon and he emailed me with his story to ask if he had any options. I suggested to him that if I was dealing with the same injury I would want to be evaluated by a specific neurosurgeon, and I also explained what Mr. S could expect in terms of rehab and case settlement. At that point, Mr. S retained me to serve as his lawyer.
Once I was retained I contacted the insurance adjuster and suggested that we agree that Mr. S should be seen by a neurosurgeon who I know to be very capable. The adjuster agreed (to my surprise) and my client underwent a multi-level fusion, which my client underwent.
There was one other interesting twist to this case – at the time my client was seen by the original panel doctor for the second time, the adjuster assigned a nurse case manager to assist with my client’s care. For those of you who are not familiar with the role of the nurse case manager, she is a nurse who works on behalf of the insurance company to facilitate care. Sometimes, nurse case managers can be helpful in cutting through red tape – such as getting diagnostic reports like MRI films to a doctor. In other instances, the nurse case manager can interfere with treatment by advocating on behalf of the insurance company – for example I have seen cases where a nurse case manager attempted to influence a treating doctor to return a claimant to work too early.
Years ago, the insurance company had a right to assign a nurse case manager. Under current law that right exists only in catastrophic cases. Otherwise the claimant (usually through counsel) can terminate the involvement of the nurse case manager.
In this case, we had to do just that. The nurse case manager was attending my client’s medical exams and she was pressuring the surgeon to speed up the rehabilitation process. I felt that her motivation and value were in question and I advised the adjuster that we no longer needed her services.
Filed under Back & neck injuries, Case studies by
