If you are injured on the job and you are a covered worker under the workers’ compensation law, your employer is required to provide you with medical care. However, as you may suspect, what you consider as reasonable and necessary care may not be the same thing as what your employer and its insurer want to provide.
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.
One of the issues that I sometimes face arises from my client’s initial report of his injury. When you are hurt on the job, you can help your case greatly by thoroughly and accurately reporting your injury.
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.
Filed under Back & neck injuries, Georgia Workers' Compensation, Medical benefits, Winning Strategies by 
I work at a job where I am using a computer keyboard all day long. Over the past few months, my right wrist started to hurt and get numb at times. I reported my injury on November 28, 2006 to the Human Resources Manager requesting for a keyboard tray from desk.
The HR Manager told me that it was out of his hands and that I should order a tray through my manager for approval. I asked on several occasions for the tray and my injury started to become more aggravated, so I went to his boss asking him about the status of a computer tray. He told me that the tray was too expensive and I now needed a doctors note in order for me to receive a keyboard tray.
I went to my doctor and told him the same story and he suggested that I file a workmen’s comp claim since it was a work related injury. It was filed the first week of February with the correct injury date of November 28th I am scheduled for surgery this Wednesday February 28th and they are now just informing me that I have to use my PTO to compensate my time off. Now, by law if I use the 21 days from the injury date (which it has been) shouldn’t I receive full compensation?
–Alyce
Jodi Ginsberg responds: Alyce, thanks for your question. The law requires that you file your workers compensation claim within 30 days of the injury. Here it looks like your date of injury was November 28, but you did not file your claim until the first of February. Is your employer acknowledging that you “reported” your injury in November?
For the benefit of anyone reading this blog, employers and insurance companies use these “reporting deficiencies” all the time to deny claims. If you get hurt on the job, you should always try to report the claim in writing and, if possible, file a report of on-the-job injury yourself with the State Board of Workers’ Compensation.
Assuming that your employer recognizes this as a workers comp injury, you ask about the 21 day rule. The 21 days runs not necessarily from date you reported it,but rather, from date of economic disability (when you stopped working). Did you continue working after the November, 2006 “injury date?”
By the way, if your injury did not “happen” on a specific day but was the result of months or years of overuse, then the injury date you choose is called a “fictitious injury date.” In cases involving these types of “overuse” injury, it is even more important for the injured claimant to file his own Form 14 notice on injury with the State Board.
Filed under Carpel Tunnel, Case studies, Georgia Workers' Compensation by
As I was loading a 400lb. piece of freight on an aircraft, my (L) knee twisted. I was sent to a clinic and evaluated that I might need a knee replacement. I have a history of several knee surgeries, my job function is loading and unloading airplanes for 30 years. My question is can I obtain my own Dr. in the state of Ga., under the workmans compensation laws………Thanks
–Andrew
Jodi Ginsberg responds: Andrew, thanks for your interesting question. Here is how I would analyze your situation. First, I would want to know if your potential need for a knee replacement is the result of your most recent injury or is it a combination of this injury and your past injuries/surgeries?
Your employer and its insurer may try to argue that your current problem is the result of past injuries as opposed to this incident, and they may try to deny coverage.
Even if your employer tries to deny coverage based on your old knee problems, your case may be winnable if a treating doctor will go on record that your most recent injury aggrevated your pre-existing condition, and if you did not misrepresent your knee problems at the time you were hired.
If your employer has accepted responsibility for covering your knee problem, then the next step would be to get you to a specialist. Under Georgia’s workers’ compensation law, an authorized treating doctor can refer you to a specialist and, generally, the insurer would be responsible for paying the specialist to treat you. If your employer has a valid "posted panel of physicians" there may be a specialist there that you could choose.
If the employer is denying coverage, you would need to request a hearing on the issue of whether your injury is compensable.
As you can see, the answer to your question depends on a number of factors. I do not think you can or should assume that your employer or its workers’ compensation carrier will act in your best interest.
Feel free to call me at 770-351-0801 if you wish to discuss further.
[tags] knee injury and georgia workers compensation, arising out of and in the course of employment, pre-existing condition and workers compensation [/tags]
Here is a question I received from a gentleman named Leon: Injured shoulder 11/16. Have seen Comp Dr. twice. Mentioned pain and ‘popping’ in shoulder. Diagnosis is a mussle or ligament tear. There was no mention of a possible rotator cup injury. Comp. insurance company has approved 2-3 weeks PT. Company has said they will pay me thru this period @full pay while on ‘light duty’. I have agreed to this. It was skilfully implied that this arrangement was in lieu of filing a claim. Can I wait to see if this PT is effective and file a claim at a later date?
Jodi Ginsberg responds: Leon, the thing you need to realize is that if you wait to file a claim you may be compromising your claim should you need to pursue it. There are many complications that can occur when you hold off on filing. For example, your employer may try to use your delay against you by contending that you hurt yourself at home or that you had a pre-existing claim. Some employers try to pursuade you not to file the claim so their premiums do not go up. If you agree and then find yourself with no claim, no coverage and no job and a denial of the claim.
There is a 30 day notice requirement to report the injury to a supervisor and a one year filing requirement with the State Board of Workers’ Compensation to perfect the claim.
Although workers’ compensation is supposed to be a "no fault" system that covers you if you are injured while on the clock, over the years it has become a very adversarial system. In some instances, employers will turn on loyal employees with a long work history and solid performance history. Often the employer will demand a resignation as part of settlement negotiations.
On the other hand, I do not necessarily think you would be acting wisely to trust your employer to do the right thing. Although I would want to speak with you further about your claim, I generally advise anyone who is injured on the job to report that injury as a workers compensation injury sooner rather than later. I also think you need to get a better idea of exactly what is wrong with your shoulder and what your likely course of treatment would be. You did not specify what you do at work so it is difficult to give you any specifics. Feel free to call me at 770-351-0801 and I would be happy to discuss your case with you further.
[tags] shoulder injury on the job, georgia workers compensation, State Board of Workers’ Compensation, rotator cuff injury [/tags]
Filed under Case studies, Georgia Workers' Compensation by
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 am frequently called upon by my clients to explain the difference between settling their workers’ comp cases and agreeing to a “no-liability” stipulation.
If the insurance company has paid benefits, paid for medical care and accepted the on-the-job injury claim as compensible, then the only type of settlement permitted is a standard settlement.
On the other hand, if the insurance company has denied (controverted) the claim and not paid benefits, then the case can be settled with either a standard settlement or with a no-liability stipulation. In a no-liability stipulation, the parties agree to disagree. The employer/insurer denies that a compensible accident happened but agrees to pay a lump sum to settle the worker’s outstanding claim for benefits.
Often, my client (the injured worker has a hard) with the concept of a no-liability stipulation. Frequently, the language of the stipulation contains assertions by the employer that the accident did not happen at all. Even if a substantial sum of money is involved, many injured workers have a hard time signing off on a document that essentially says that they are lying.
In my role as the claimant’s lawyer, my focus is on getting my clients enough money and sufficient medical care so that my client can live his life with dignity. Sometimes, as a matter of business, a no-liability stipulation is the best alternative.
A few weeks ago, I settled a case with a no-liability stipulation and I believe that my client is better off with this solution than if we had taken the case to the State Board of Workers’ Compensation and won.
At the time of his accident, my client was a 30 year old man who worked for a poultry processing plant. He was told by his supervisor to clean out a large machine that made filets out of chicken breasts. This machine was a large tube (large enough for a man to fit inside) with sharp blades rotating alongside a conveyor belt that carried the chicken breasts.
My client crawled onto the conveyor belt and started to clean the blades when someone turned the machine on. He tried to pull a manual cut-off rope but the manual cut off did not work. He tried to yell for a co-worker, but the person on watch did not speak English. My client was cut all through his midsection by the sharp blades and suffered a crushed pelvis.
Although there were numerous witnesses to this accident, the insurance company denied coverage on the grounds that my client was engaged in “wilful misconduct.” The insurance company’s adjustor advised me that my client’s supervisor would testify that my client failed to use a magnetic card to turn off the machine himself.
My client and several of his co-workers advised me that no one had ever trained them in the use of the magnetic cards and that the employees were told to sign forms verifying their training – despite the absence of actual training – if they wanted to get paid. So, every month, the employees of this poultry plant signed forms verifying their completion of training courses when no such courses were ever given.
As you might imagine, my client was extremely hurt and upset that his employer was trying to put the blame on him for this horrible accident. His problem, however was that he needed immediate medical care if he hoped to recovery.
I recognized that part of what was motivating the company was a fear of huge liability – not just this workers’ compensation case, but perhaps an OSHA investigation and even criminal negligence charges.
I suggested to the adjustor that rather than firing my client, they keep him on as an employee and cover the cost of his group medical insurance. I pointed out that if they totally cut him off and we ended up winning at a hearing 6 months down the road, they would have a much more disabled person requiring much more intensive and expensive rehabilitation.
The adjustor agreed and the company allowed my client to continue to receive medical care. Six months later, when we went to a mediation, my client was recovering from his injuries and was ready to move on. Our “no-liability” stipulation included $80,000 in cash plus the insurance company agreed to reimburse the health insurance carrier for all medical costs. In addition, the employer agreed to provide COBRA medical coverage to my client at a discounted rate of less than $100 per month.
Was my client made totally whole? No, of course not. His injuries are pemanent and he will never be able to perform certain types of physical activities. He also carries with him some resentment against his former employer for trying to shift the blame for his accident on to him.
However, in this case, the no-liability stip solution made sense for everyone. My client got the medical treatment he needed and avoided the stress of extended litigation. He also got a lump sum of money that will help him cover his bills until his recovery is more complete. Had we taken this case to a hearing we might have won – but then again, the employer was prepared to present testimony and written documentation supporting its position.
After laying out the possiblities, my client decided that the no-liability stipulation was the way to go and I agree with his decision. What do you think?
[tags] no liabilty stipulation, Georgia workers compensation on-the-job injury-georgia workers’ comp mediation [/tags]
