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.

The clinic doctor did put my client on “no work” status, where he remained for two months.  However, during that two months, the employer/insurer did not start his weekly wage benefits (although they did authorize on-going medical care at the industrial clinic).

After two months of suffering intense pain and no weekly wage benefits, my client called me and hired my firm.  I immediately contacted the adjuster and demanded that the employer/insurer commence weekly wage benefits – my client got a check for past due benefits plus a penalty payment arising from the employer’s late payment of those benefits.

Next, I contacted the adjuster to demand better medical care.  The adjuster and I agreed on a more neutral doctor and we agreed that an MRI was necessary to properly evaluate my client’s ongoing back pain.

As I expected, the MRI showed significant damage to my client’s lower back.   Specifically, the MRI revealed:

• a central disc herniation at L3-4 and L4-5 with narrowing of signal canal and mass effect on thecal sac;
• bilateral neural foraminal narrowing  at L4-5 and on the left at L5-S1
• disc dessication at L3-4 and L4-5

My client was subsequently scheduled for surgery and is now recuperating.  Click on the link to view the actual X-ray report and the MRI report:

1. First, the employer/insurer was not looking out for my client’s best interest.  They were satisfied with the somewhat irrelevant X-ray result and would have been happy if my client has just gone away.   MRIs and CT scans are a lot more expensive than X-rays but that is what should have been ordered in this case.
2. Second, even though the employer/insurer authorized industrial clinic treatment and pain medication, they did not start weekly wage benefits.  Why?  I have no idea.  My client was on a “no work” status from one of their doctors but they just did not pay weekly wage benefits.  Perhaps the adjuster messed up or perhaps they were hoping my client would never notice.
3. Third, you have to be your own advocate and/or hire an advocate like me to represent your interests.  My client has no formal medical training but he knew instinctively that something was seriously wrong with his back despite what the X-ray said.   X-rays are not designed to show soft tissue (nerve and/or disc material) damage.  Further, the longer a spinal nerve is compressed the more likely that the patient will suffer permanent damage.  Hopefully, my client will not experience any permanent damage, but I know that he suffered two weeks of unnecessary pain because the employer/insurer was looking for the least expensive option.

“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.

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.

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

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.

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!

In this case, my client hurt his back badly about a year previously when he was lifting HVAC equipment.  For several months, the insurance company fought us in our attempt to get proper medical treatment but eventually I was able to get him to a good doctor who scheduled him for surgery to repair a large herniated disc in his lumbar spine.

Post surgery, my client developed complications when fluid began to build up in the spinal canal.  The surgeon prescribed a strong medication to help drain the fluid and prevent an infection.  Unfortunately this strong medication resulted in migraine headaches.

Although the migraine headaches were new, the law in Georgia is clear that medical treatment and medications necessary to treat a complication from a compensable injury is also compensable and must be paid for by the insurance company.  And, in fact, the insurance adjustor originally assigned this case, authorized my client’s pharmacy to dispense his migraine medication

Several weeks into the treatment regimen, a new adjustor was assigned to this claim.  The new adjustor decided that the migraine headaches were not related to the work injury and she canceled the pharmacy authorization.  Suddenly, my client was left without medication to treat his frequent and painful migraine headaches.

As you might imagine, this development left my client in a great deal of pain.  I immediately got on the phone with the adjustor but she would not change her position.  I then wrote the treating doctor to request a statement from him that “connected the dots” and related the migraine headaches to the original work injury.   I also got on the phone to the defense attorney representing the employer/insurer to demand that my client’s prescription be approved.  It took about 5 phone calls until I finally got the defense attorney to call me back – he acknowledged that our position was correct and he was able to convince the adjustor to start the medication authorization again.

This type of arbitrary action by workers’ comp insurance adjustors is all too common.  Adjustors come and go and a reasonable, knowledgeable insurance claims person can be replaced by someone new who is inexperienced, stubborn or even vindictive.  As a claimant’s lawyer, I make every effort to stay on top of problems like the one my client experienced and to take whatever steps are necessary to solve these problems.

Like many city and county governments, the City of Atlanta “self-insures” against workers’ compensation claims, meaning that weekly wage benefits and funds for medical treatment come directly out of the City’s budget.  The City does use a private claim’s administration service called NovaPro Risk Solutions out of San Diego.

The City is not denying responsibility for paying wage or medical claims, but it has been refusing to pay for various medical procedures and medical devices.

In one instance a police officer who had been rendered a parapalegic from a gunshot wound needed surgery on his Achilles tendon  because his feet kept slipping off his wheelchair footrests. His treating physician and a second opinion physician both documented the need for surgery, but the City refused to pay for the procedure, and requested a hearing, causing several months delay and forcing the paralyzed officer to retain an attorney.

Five months later and just days before the hearing, the City finally backed down and authorized the surgery, but not before the injured officer developed pressure sores as a complication from the delay.

The City of Atlanta has financial issues and workers’ compensation cases involving governmental entities give rise to special problems.  The plight of the injured officers serves as a lesson about the Georgia workers compensation system in general.  If the City of Atlanta will not stand behind herioc police officers injured in the line of duty where there is a powerful union and an outlet for publicity to shame the City into doing the right thing, what kind of treatment do you expect if you are hurt on your job?

By its nature, Georgia’s workers’ compensation system operates within an adversarial system.  Your dedication, loyalty and hard work on behalf of your employer mean nothing if you are hurt on the job.  Insurance companies that writer workers comp policies are looking to save money whenever and whereever they can.  Employers are looking to save money on premiums and claims – especially claims involving extensive medical treatment and weekly wage benefits – result in higher insurance coverage costs.

Let the experience of the paralyzed and brain damaged Atlanta police officers show you that injured workers need knowledgeable and aggressive counsel to help you obtain quality medical care from competant physicians in a timely manner.  It may not be pleasant to view your workers’ compensation claim as a fight but this is how you must see it.

The posted panel of physicians is the starting point for your claim for medical treatment. Under Georgia’s workers compensation law, employers are required to post a list or “panel” of doctors in a reasonably accessible place for employees to see.   A valid panel should have at least 6 indpendent medical providers on it and at least one of these doctors should be an orthopedist.

If your employer has a posted panel, you may select a doctor and schedule an appointment, with the cost borne by the ermployer/insurer.  Often, your employer will try to direct you to a particular doctor or clinic with whom the employer has an on-going relationship.  Under Georgia law, you as the injured worker have the right to select from any of the doctors on the panel.  You can do yourself a real favor by avoiding doctors who may not have your best interest at heart – Ginsberg Law’s extensive experience with physicians throughout the State can be a huge benefit to you if you become our client.

If you choose to select a doctor on the panel that is different from the doctor that your supervisor is “suggesting,” you would be wise to ask the doctor’s office to verify that the workers’ compensation insurer has agreed to pay for the appointment.  Some employers honestly do not understand that employees have the right to choose a physician, and sometimes employers and insurers will intentionally playing games with the payment of medical providers for unrepresented claimants even if those providers are authorized.

If there is no posted panel of doctors, or if there is a panel that is not accessible, or if you have never been given any explanation of how the panel works, Georgia law can provide you the right to select your own doctor.  As you might imagine, employers and their insurers will do everything in their power to retain control of the course of your medical treatment. You may hear things like “that doctor is not authorized,” or “that doctor is not on our panel,” or “that doctor is not in our network.”  Be aware that there have been dozens of litigated cases in Georgia relating to the posted panel, and factors that either validate or invalidate the panel.  Part of our job as your attorney is to identify whether the posted panel issue is something to pursue or not.

To illustrate the importance of asserting your rights under workers compensation law, I would like to relate to you the story of a recent client of mine who suffered permanent nerve damage in his spine because of delays caused by the insurance company.  As any reputable doctor will tell you, time is of the essence if you have a serious injury. If you have a serious injury to your back, neck, arm, knee, foot, head or hand a delay in diagnosis can result in permanent injury and inability to return to work.

Our case involved a situation where a client hired us after enduring almost a year of frustrating delays in medical care. The client had a significant back injury after falling off the back of a truck. He hit the ground and had sharp, shooting pains in his back and radiating down his leg, with numbness in his toes. He was ordered by his employer to see the clinic down the road from his job. For several months, he stayed under the care of this clinic – taking medication and undergoing therapy that did not help, and actually made him worse.
When this injured worker (not yet represented by our firm) asked for a referral to a specialist he was ignored and offered more therapy. The clinic doctors released him to “light duty,” which he tried to do with very limited success. Finally, after many months the clinic doctor ordered an MRI scan, which revealed herniated discs at 2 levels impinging on a nerve in the spine.

Again, the injured worker asked for a referral to a spine specialist and after another full month of delay, he finally got the referral. The specialist confirmed the diagnosis of disc and nerve injury and ultimately the injured worker (now our client) underwent a fusion of his spine. Unfortunately, the surgery did not relieve his pain, because our client had incurred permanent nerve damage due to the delay in care.

Don’t just talk about the one injury that is hurting you right now.  Instead, take an “inventory” of every part of your body that was involved.  Don’t exaggerate, but don’t minimize problems either.  For example, if you fell off a ladder, you might have immediate back pain.  But, you might also have:

• concussion
• headaches from the hard landing or from hitting your head
• neck pain from sudden impact
• foot problems from landing on your foot ackwardly
• knee problems from landing on or twisting your knee
• hand problems from falling hard on your hands

Your employer may send you to a doctor.  When you meet with the doctor, you want to begin creating an accurate paper trail.  Report each and every body part that is affected, even if the doctor does not seem interested.  Most doctors ask you to fill out an intake form – that form will become part of your case record.  Use it to identify all problems.

If you fail to list all problems at the outset, the insurance company may use this gap to deny coverage and to limit treatment.  If the insurance company identifies your case as a low back/hip case, they may not authorize your doctor to treat your knees or feet.  You could literally find yourself being treated for one part of your leg, but not another part because the doctor is specifically not authorized to treat that other part.

It may sound crazy to you that your doctor will only treat part of your problems, but this is a common situation in workers compensation.  The insurance companies put very specific limits on what they will pay the doctors to treat.

Now, what happens if you did not give your supervisor or your initial treating doctor an accurate description of your injury?  It may not be too late.  You may still be able to update your report of your injury and preserve your rights.  I would advise you to speak to an attorney before trying to do this on your own. 

Here is an example from one of my recent cases that demonstrates the importance of accurately reporting your injury.

My client was a carpenter who was carrying a 2×4 board on his left shoulder.  His right hand was in his apron  He fell down and landed on his left shoulder, leaving him in severe pain.  The employer sent him to a local emergency room where he complained about his left shoulder.  An MRI was done, showing a torn left rotator cuff that required surgery.

Following surgery and physical therapy, my client remained in severe pain.  At this point, the injured carpenter called me.  My first question – are you having headaches?  I asked this because I know that headaches are a common symptom of cervical (neck) disc problems.  I used the “employee’s second opinion” to have my client seen by an orthopedist who specializes in neck injuries.  Sure enough, my client had a herniated disc in his cervical spine. 

This cervical spine issue necessitated additional surgery and rehabilitation.  Because the injury was more severe than originally thought, this case had significantly more settlement value as well.  My client did have any medical background and there is no reason for him to know about the anatomy of the neck and shoulder.  I do have an understanding of this anatomy because I have represented dozens of claimants with similar issues.  This is a case where I was able to use my experience and knowledge for the benefit of my client.