October 20, 2017

Delay in Treatment of Your Back Pain May be Hazardous to Your Health

low back painIn my Georgia workers’ compensation law practice I interact with dozens of insurance companies each week and I frequently find that claims adjusters take a very short sighted approach towards medical treatment for back injuries.

At least half of the clients I represent are suffering from some form of back injury. Low back pain (often disc herniations at L5/S1) is the most common problem I see but I also represent clients with damage to the spine at all regions: cervical, lumbar, sacral and thoracic.

Regardless of where the injury is localized, a common argument I have with insurance adjusters has to do with the need for fast treatment.

Despite dozens of research studies which show that fast diagnosis and treatment of any type of back injury results in faster and more complete recovery, I almost always find that insurance companies work to limit access to care and slow down the course of treatment.

Even in cases where an MRI shows a herniated disc that will require surgery, I inevitably find myself fighting to get the insurance company to agree to a surgeon, authorize surgery, approve post-surgical physical therapy or agree to pay for even short term prescriptions for beds, home modifications or even medications. [Read more…]

How Insurance Companies Try to Cut You Off

aggressive insurance companyYou might think that if your employer is paying weekly benefits and has paid for medical care, you are not likely to have any significant disputes in your work injury case. As the case I am about to discuss shows, however, challenges from the insurance company may be right around the corner.

The case I want to highlight is not one of my cases. The decision in this case is part of the public record in that it is published on the web site of the Georgia State Board of Workers’ Compensation. I bring this case to your attention for several reasons:

  • first, I want you to see how a State Board judge analyzes evidence
  • second, there are certain elements of this case that are not discussed in the decision, but we can assume they are there because the insurance company did not raise the issue and the judge did not mention the issue. We’ll read between the lines to reveal these issues.
  • third, this is a case that shows how insurance companies operate to cut off the benefits of a deserving claimant and to force a below market settlement.

The case I am discussing was decided in 2013 in south Georgia. Because State Board files are confidential, neither the name of the claimant nor the name of the employer is disclosed.  Here is a link to the written decision.

The employee is a female who worked as the manager of a restaurant. In December, 2006 the employee hurt herself and developed neck pain which radiated into both hands and lower back pain that radiated into both legs. The employer accepted the claim and began paying her TTD (weekly wage) benefits. The employer also paid for medical care that include surgery on her cervical spine and surgery on her lumbar spine. [Read more…]

Unrepresented Claimant with Rotator Cuff Injury Denied Necessary Rehab

post surgery rehabI want to talk with you today about rotator cuff injuries and the importance of both proper medical care and appropriate rehabilitation and followup.

In many respects the right kind of rehabilitation and follow-up medical care can make the difference between a return to full function and long term (and sometimes permanent) restriction of movement, stiffness and pain.

Recently I received a call from a prospective client who tore her right rotator cuff and underwent surgery, but was seeking legal advice because she sensed, correctly, that her workers’ comp doctor was not providing appropriate follow-up 1.

The prospective client told me that she hurt herself attempting to move a heavy box over her head and that shortly thereafter her right shoulder became painful, swollen and weak.  The industrial clinic doctor was unable to do much (other than waste a couple of weeks) and she was referred to a local orthopedist for consultation. [Read more…]

  1. I have changed the details of this case to preserve confidentiality, but the underlying principles are real.

Poultry Plant Worker Injuries Likely to Increase Under New USDA Regulations

chicken processing plant work injuriesWhen I first started practicing law back in 1988, I worked as an associate attorney for a well established insurance defense law firm.  I stayed at that firm for about 7 years before leaving to start my own practice, representing injured workers.

My days as an insurance defense lawyer were invaluable, however, because I learned a great deal about workers’ comp. law from some very good lawyers and I litigated hundreds of cases.   I also traveled throughout the state and got to see numerous job sites in person.

I remember distinctly visiting several poultry processing plants north of Atlanta near Gainesville.  I will never forget watching poultry workers “popping blisters” on conveyor lines of chickens moving quickly overhead.

It is no surprise that poultry plant workers experience a high number of work injuries.  The most obvious type of injuries are repetitive motion injuries such as carpel tunnel, but I also see shoulder injuries, crush injuries and puncture wounds.

Now, I am reading that the U.S. Department of Agriculture has proposed a rule change that will reduce federal oversight of poultry processing plants while allowing processors to speed up their kill lines. 1.

The federal government will save $90 over three years by eliminating the fourth inspector.  At the same time, large processing companies will save over $250 million by increasing the speed of the lines. [Read more…]

  1. Currently USDA regulations required processors to allow four inspectors per line with the lines producing 140 chickens per minute.  The new regulations would only call for three inspectors per line, while allowing the lines to turn 25% faster – 175 birds per minute.

Sell Your Thumb for $30,000 and Other Strange Provisions of Georgia’s Workers’ Compensation Law

value of human thumbWould you be willing to sell your thumb for $30,000.  How about your right eye for $75,000, your big toe for $15,000 or your pinkie finger $12,500?

Sound crazy?  Well, welcome to the world of the Georgia workers’ compensation permanent partial disability payment schedules.

Because you cannot recover anything for pain and suffering in a Georgia work injury case, every type of injury has been boiled down to a number.  The permanent partial disability payment schedules sets out precisely how much you can recover if you incur a loss or loss of use to part of your body.

In the case of an amputated or permanently damaged thumb, for example, the payment schedule says that your thumb is valued at 60 weeks of work.  If your average weekly wage is $500 per week (the current maximum), then you multiply $500 x 60 to get $30,000.  The loss of an eye is equal to 150 weeks, the big toe is worth 30 weeks and your pinkie finger is worth 25 weeks, and so forth.

When you hear workers’ compensation lawyers talk about a PPD rating, we are referring specifically to Code Section 34-9-263 which sets out a value for various impairments. [Read more…]

Body Parts and Insurance Companies

authorized treating physician refusal to treatI recently had a long and somewhat heated conversation with an insurance adjuster about body parts.  Specifically, I wanted the adjuster to authorize medical treatment for my client’s neck and back , but the adjuster only wanted to authorize the treating physician to provide care for my client’s back.

As ridiculous as this may sound, this type of negotiation happens all the time in a workers compensation.  Though common sense would tell you that an employee who injures his low back falling from an 8 foot ladder might reasonably be expected to suffer neck injuries as well (such as when his head hits a concrete floor), insurance companies are very careful not to assume anything.

The problem in my case arose from my client’s first conversation with the posted panel doctor.  My client’s low back was in spasm and he was absolutely miserable, and he did not specifically mention any pain in his neck to the treating doctor.

I am thinking that my client had probably incurred a concussion and was not thinking straight in the first place so who knows what he told the company doctor.  By the time I was retained, almost two months had passed and now my client is receiving epidurals for his lower back – although he may need surgery soon – but no treatment at all for his neck.

When my client goes to the workers’ comp. doctor and tries to talk about his neck pain, the doctor tells him that the insurance adjuster has not authorized treatment for the neck so the doctor will not treat the neck.

Imaging a doctor’s appointment where the physician tells you “I’m sorry you’re in pain but I am not allowed to treat that part of your body!” [Read more…]

How do Workers’ Compensation Adjusters Pressure Authorized Doctors?

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.