A significant number of work injuries in Georgia involve back injuries. Unfortunately if you are being treated by a “posted panel” doctor, your treatment may be delayed or not taken seriously. In this video, I discuss certain “red flag” issues that demand immediate treatment with a spine specialist whose focus is your well being.
Filed under Back & neck injuries, Case studies, Medical benefits, Medical Care, Understanding the Law by 
Often, when a worker injures his back on the job, the human resources manager will take down a claim and refer the worker to an industrial clinic for evaluation and treatment. All too often, the industrial clinic or other posted panel doctor will take X-rays, perform some basic neurological tests, then release the worker back to full duty work after a day or two of rest.
I often get these cases four to six weeks later when the injured worker finds himself unable to work because of severe back pain and limited mobility. In some instances the injured worker faces pressure and even harassment from his employer due to his decreased productivity, and when I get the case, the employer/insurer may try to argue that any serious injury to the employee may have happened at home instead of at work.
Recently I represented a very nice young man in a back injury case that clearly demonstrates why X-rays are insufficient to evaluate back pain.
My client is a 31 year old man whose job involved installing and reinstalling fence posts. Starting at 8 AM, my client, using a sledge hammer, loosened fence posts by breaking up their cement foundations, cleaned the post base, then reinstalle the post with fresh cement. Beside using the sledge hammer, my client had to carry heavy buckets of cement and pour them in to holes in the ground.
By 2 PM that day, my client felt a “pop” in his back when he tried to lift the sledge hammer and he felt radiating pain in both legs. He reported the injury to his supervisor, who referred him to an industrial clinic. The clinic doctor took X-rays which described “mild disc space narrowing at L4-5″ but no other impairment. More on Company Doctor Uses X-Rays Instead of MRI and Misses Herniated Disc
Case Study: Private investigator sustains 2 separate injuries while on the job
“Mr. L,” a private investigator, received significant injuries when he was working a case in bad weather. He was involved in a serious automobile accident when he lost control of his vehicle and crashed into a large pine tree. His airbags deployed and his vehicle was damaged on both sides. As a result, he incurred injuries to his cervical spine, chest, left arm, right elbow, and right shoulder.
He would be treated for his injuries in the local ER and then released into the care of two doctors (Doctors M and N) where he would receive necessary follow-up care. The condition of his cervical spine could not be treated by Doctors M and N, so he was referred to Dr. S for specialized care and further testing. Dr. S performed a CT scan and an EMG. During this time, Mr. L continued to work his PI job when he was confronted by a police officer, arrested, and then handcuffed in the process.
As the arresting officer handcuffed him, he forced the man’s neck and shoulder into a position which resulted in further injury to Mr. L, therefore creating further problems for him! At this time, Mr. L went into the care and treatment of Dr. P, an orthopedist. Dr. P immediately discovered the injuries that Mr. L received during the arrest and diagnosed them as “a right C 6-7 radiculopathy; herniated disc and stenosis at C5-6; as well as a partial rotator cuff tear of the right shoulder.”
In September of 2005, he was referred to a surgeon who would perform “anterior cervical discectomy and fusion with plating.” The surgeon also placed him on what is called a “no work” status. In other words, he was forbidden from working since he was always in pain and movements that were typically performed on the job could no longer be made. He began receiving regular TTD payments of $394.52. Additionally, he was treated with a bone stimulator to assist with the fusion part of his treatment.
In addition to the bone stimulator, Mr. L was also being treated by having to wear a hard neck brace for the ensuing several months. Additionally, he was prescribed numerous medications including Celebrex, Reglan, and Ultracet because of his intense pain and his limited ROM or Range of Motion. To this day, Mr. L continues to live with neck pain and according to Dr. D, the extent of the damage to the man’s cervical spine is now a source for the chronic pain he has been diagnosed with.
Mr. L continued living in pain and a restricted ROM because of the torn rotator cuff in his right shoulder. He continues to be under the care of Doctors A and P. At that time, arthroscopic surgery was performed on the injured shoulder which didn’t relieve his pain or his symptoms. Despite the fact that Mr. L attempted to go back to work as a PI, it was immediately apparent that the injuries to his right arm and shoulder would cause significant pain so he could not properly perform his job any longer.
At this time, Dr. P also performed another surgical procedure wherein Mr. L was anesthetized and the doctor tried to manipulate his shoulder in order to relieve his pain. To this date, he still encounters pain and discomfort when driving. Everything to this point had failed to ease Mr. L’s symptoms despite his continued medication and therapy. He was then referred (again) to Dr. A for a consult and then a decided-upon treatment. At that point in time, a post-surgical MRI revealed the full extent of Mr. L’s injuries.
Dr. A performed three different procedures including surgery to repair his torn rotator cuff. After this time, Mr. L went to Dr. M for an IME (independent medical examination) where several things were documented such as:
- constantly aching shoulder
- pain encountered with movement overhead
- rotator cuff issues
Mr. L continues to need medication and ongoing pain management. Neither post-surgery medications nor therapies have helped Mr. L live without pain or limited ROM. He is restricted with the amount of hours that he can perform functions including:
- standing
- walking
- sitting
- reaching overhead
- lifting
- pushing
- pulling
He can occasionally bend, crouch, kneel, or stoop; drive no more than 30 minutes at one time; and cannot operate dangerous machinery because of his pain medications.
Since his last surgery, Mr. L’s medical condition has not changed very much and after reading through the medical records I discussed with Mr. L the advisability of settlement. Mr. L had indicated to me that while he would not be resuming his career as a private investigator, he was exploring other avenues to earn money. Because he had been a private investigator, he readily understood that the insurance company would likely put him under surveillance and that if he was seen engaging in any significant activity, the insurer would move to cut off his benefits. We decided that this was a good time to settle and after several weeks of negotiation the insurance company agree to pay well over six figures.
Filed under Arms & Hands, Back & neck injuries, Case studies, Georgia Workers' Compensation, Winning Strategies 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
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 4rd installment of my summer long series on Georgia Workers’ comp case studies. In the following case study, I discuss a case involving a long-term employee who sustained multiple job injuries.
The case of “Mr. F,” a long-term employee with multiple injuries
“Mr. F” has been employed by his company for 26 years as a machine operator and is required to maintain, repair, and run the machinery he is responsible for. He also operates a forklift in order to stock supplies. As a result of his job responsibilities, Mr. F sustained significant cervical and lumbar spine injuries as well as significant knee damage. His medical records indicate that he has continued to encounter pain and problems in these physical areas.
Mr. F’s treating physician (Dr. V) firmly believes that knee surgery is inevitable and that cervical and lumbar spine pain will be ongoing. To date, Dr. V continues to provide Mr. F with treatment in the hopes of relieving his pain. Due to the fact that the TTD has been reduced, Dr. V placed the man on “no-work” status so he did not lose the original amount of compensation for being unable to work due to his injuries. PPD ratings were also assessed which will be due and payable in the future.
Given the nature of Mr. F’s injuries and the residual problems which resulted from performing his job and will continue for years into the future, it is evident that his employer and insurer are responsible for compensating the man. As a result from the aforementioned circumstances, we have demanded a settlement in the amount of “X” and are awaiting a favorable settlement of our client’s case.
Filed under Back & neck injuries, Case studies, Shoulder & Knee injuries by
Case Study: Injured worker’s employer illegally discourages him from pursuing workers’ comp benefits
Throughout this summer, I plan on posting several Georgia workers’ compensation case studies. These case studies involve actual cases I have managed in recent years, and they often touch on many issues people may face when going through the workers’ compensation system in Georgia. All names of clients, employers and physicians will be changed so as to protect the privacy of my clients. Today, we will discuss the case of “Mr. B,” an injured worker whose employer tried to pull an illegal move and direct him to pursue an insurance claim with his own insurer rather than pursue workers’ comp benefits.
The Workers’ Compensation case of “Mr. B”
Mr. B was injured on the job when he lifted roughly 100 pounds of rubber materials. He injured his back as a result of the accident, and he also reported pain radiating down into his legs. He was referred to Dr. G for immediate conservative care, and soon after initial treatment, the client was referred by Dr. G to Dr. C for lumbar spine surgery. The goal if surgery was to repair a herniated disc and relieve his continual radiating leg pain. Once Mr. B successfully completed the rehab phase of his treatment, he returned to his place of work roughly 3 months after the surgery was performed.
Unfortunately, Mr. B was only able to work for 2 weeks; his back and leg pain flared up again, preventing him from working. Dr. C placed him on “off-work” status, and the client stayed out of work accordingly. According to medical records, both doctors G and C agreed that his injuries were work related, and both persisted in obtaining authorization from Workers’ Compensation.
However, a problem occurred in this case. The employer discouraged our client from pursuing workers’ comp benefits based on his job accident. Rather, the employer insisted that the employee take the issue to his own insurance carrier and file it as an LTD (Long Term Disability)/STD (Short Term Disability). This is highly illegal, especially since there was clear evidence that our client had been injured on the job. Even early paperwork from the employer indicated that this was a job injury. Therefore, according to Georgia workers’ comp law, out client was clearly entitled to workers’ comp benefits.
When we stepped in, we helped our client realize that he indeed needed to pursue his workers’ comp claim and then started looking at the specifics of his case so that we could prepare a settlement demand. We helped our client settle the case for a fair amount, and he now receives TTD benefits and will be aptly covered for any future medical costs.
The point here is that if your employer tries to discourage you from pursuing workers’ comp benefits and instead suggests that you pursue your own insurance claim, then you should realize that this is illegal and that you should probably speak with an attorney who can help you better understand your claim. A workers’ comp attorney’s job is to make sure you get the benefits you deserve and need, as well as to make sure your employer doesn’t pull any illegal moves.
Stay tuned for additional case studies!
Filed under Back & neck injuries, Case studies by
