An overview of DeQuervain’s Syndrome and Lateral CTS

DeQuervain Syndrome is also nicknamed Mother’s Wrist or Washerwoman’s Sprain. In more medical, technical terms it is known as de Quervain's tenosynovitis, de Quervain's stenosing tenosynovitis, or Radial styloid tenosynovitis. DeQuervain’s syndrome is an inflammation (or tendinosis) that occurs in the sheath or the tunnel which surround the two tendons which are responsible for the thumb’s movement.

Carpal Tunnel Syndrome or CTS is also referred to as median neuropathy at the wrist and is a condition that results from a compressing or pinching of median nerve in the wrist area. It typically leads to extreme pain, muscle weakness, and numbness of the hand. Night symptoms and waking up off and on are characteristics of CTS as well. The definitive or standard treatment of the condition is a surgical procedure known as carpal tunnel release.

It should be noted that although this surgical procedure effectively relieves the symptoms of CTS, established nerve dysfunction in the form of atrophy, constant or “static” numbness, and weakness are all permanent. Ironically, most CTS cases do not have a specific cause, and some individuals are predisposed at developing the condition based on genetics.

Workers’ Compensation case involving repetitive motion injury: The case of “Ms. C”

Our client, Ms. C, was diagnosed with bilateral CTS as a result of her repetitious work in cake decorating. According to Dr. D, she was diagnosed with “bilateral DeQuervains tenosynovitis and ulnar nerve injury.” As a result of Ms. C’s injuries, she underwent surgeries on both wrists. About 6 weeks later, she went through surgical procedures on the left wrist – carpal tunnel and DeQuervains release surgery.

Ms. C continues living in pain today, even after the different surgeries were performed. Pain is prevalent especially in the hand, at the incision, and in the wrist area. She is currently undergoing physical therapy and has limited range of movement (ROM) as well as the pain mentioned in the above areas. It is evident that she will continue to remain under medical care as well as receiving TTD for quite some time.

Given the residual problems that exist and her surgeries, the PPD (Permanent Partial Disability) rating of each wrist is 10%. Additionally, due to the repetitive nature of Ms. C’s work, it is very obvious that her capacity to perform her job has been severely limited and she will experience continued levels of pain. As a result of her case, we have demanded “X” amount in her Workers’ Compensation case and are awaiting settlement

• if your employer does not provide a valid "posted panel" of physicians you may be able to seek care with any physician and your employer and its insurer must pay for this care
• you can switch between one posted panel physician to another without prior permission
• you can request  a change in authorized treating physician
• you can request a claimant's IME

The claimant's IME is a very interested feature of Georgia law.  First enacted in 1990, Section 34-9-201(e) provides that an injured worker can demand an independent medical exam with a physician of his choice, paid for by the workers' comp. insurance carrier.  In my practice I use this "claimant's IME" frequently to get a second opinion about questionable existing care or as evidence to support a request for permanent change in authorized treating physician.

Of course your right to a claimant's IME under Georgia law is not absolute – I recently wrote an article about this topic on one of my web sites.   Take a look if you are not happy with the quality of medical care you are receiving – and let me know what you think.

Worker’s compensation, or more colloquially worker’s comp, refers to a type of insurance which provides certain benefits to employees that are injured on the job such as income due to lost wages and medical treatment. Additionally, the employee relinquishes their right to sue the employer for negligence once they file a worker’s compensation claim. Oftentimes, the trade-off between the assured, limited coverage versus the relinquishing of legal recourse is referred to as “the compensation bargain.”

What is covered and not covered?

While there are some differences between state worker’s compensation laws, the underlying intention and premise of worker’s comp benefits is the same. For instance, in the state of Georgia, any employer who employs three or more individuals, regardless of full-time or part-time status, must provide worker’s compensation insurance. They must also provide the injured employee, at their expense, proper medical care for the on-the-job injury.

Additionally, in cases involving the loss of a limb or the death of the employee is the case, worker’s compensation benefits are also provided. For instance, if you lose an arm or a leg and this causes you to take a lower paying job or position, you are entitled to benefits to cover the loss of wages. Similarly, if you die as a result of the industry, your spouse and children are entitled to benefits.

Other benefits that may be necessary

In addition to the above, not all of the benefits provided by Worker’s Compensation Insurance involve lost wages and medical care. Sometimes it is necessary to provide the injured employee with either rehabilitation benefits or vocational benefits. If this is the case, you will receive these benefits should there be an injury rehabilitation period involved, or if you need vocational training in order to perform a different job or have to take on a new position in the company where you were injured.

Worker’s comp rehab benefits apply to a variety of circumstances when they become necessary due to the on-the-job injury you have incurred. These include:

• Prosthesis and learning how to perform your job with the artificial limb
• Physical therapy required in order so that you can function and perform your job normally
• Speech therapy
• Vocational therapy (learning how to perform a different job)

If you need further information regarding any of the above or have any questions, please call contact us by visiting our website or sending us a comment using the form below.

Any business, corporation, or individual that provides products or services to a business entity and is specified contractually or by verbal agreement is referred to as an “independent contractor.” According to the IRS tax codes, they are not defined or recognized as an employee of that business or corporation. They typically work as they are required to and are usually subject to what is called the Law of Agency.

Additionally, independent contractors (hereinafter referred to as IC’s) are responsible for paying their own federal and state taxes; this is not the responsibility of the business, corporation, or individual who has contractually procured the IC’s products or services. Compensation is normally made on a freelance basis and the IC may be working through a limited company which they own themselves or via what is called an “umbrella company,” a company that acts as the agent for the IC.

Does worker’s comp cover the independent contractor?

Under the worker’s compensation laws of the state of Georgia, independent contractors are not covered for any injury sustained while performing their work. However, the definition of an independent contractor under state statutes has very specific guidelines in order to determine if the individual is an employee or an IC. Employers do not always use this definition correctly or properly. Additionally, the IRS’ guidelines regarding IC’s are not followed by worker’s compensation law.

For these reasons, this is a very problematic area. However, it is extremely ironic that an individual who has opted for being an independent contractor and who engage in dangerous or high risk occupations are not covered by Worker’s Compensation Insurance based on their independence or freedom from an employer. But the fact that employers would love to classify employees as independent contractor is what leads some to cheat and do exactly that so they are not responsible for worker’s comp benefits.

The bottom line is that if a business owner or corporate entity has 3 or more individuals working for them and they require a method, manner, time, and the type of work that the individuals are expected perform, they cannot classify the individual as an IC. Any business owner who employs 3 or more individuals is required to carry Worker’s Compensation Insurance. It is not surprising then that some employers try to “cheat the system” in order to avoid purchasing this type of coverage.

If you would like more information regarding the independent contractor/worker’s compensation issue, please feel free to contact us at our website. We will be happy to answer any questions you may have and provide you with additional information.

More recently I have learned of a case where the insurance company's defense lawyer used a "request for the production of documents" to demand that an injured claimant turn over his personal computer to be examined by the lawyer.  As you may know, when you file a workers' compensation claim in Georgia, both sides are allowed to demand information from the other per Georgia' "discovery rules."

Apparently, in this case, the insurance company believes that the claimant's hard drive will reveal damaging information – perhaps photos, evidence of work or physical activity, or it may be just a fishing expedition.

Now, this was not my case, and at this point, at least, this demand for the claimant's computer has not become a regular part of defense counsel's arsenal, but I think that this type of request sets a very bad precedent.  I learned about this case in a monthly meeting I attend with a few other claimant's lawyers who get together to discuss current developments in the law and winning strategies.  All of us in last month's meeting were somewhat taken aback by this discovery request as well as the presiding judge's approval of the request.  We all agreed that if any of use are involved in a case and the insurance company asks to look at our clients' computers, we will fight this request vigorously.

However, I would be remiss if I did not let you know about this troubling development.  It is certainly possible that a Georgia appellate court could sanction this type of discovery under certain circumstances.  Therefore, I will be telling my clients to not only be aware that their outside activities could be videotaped by an insurance company private investigator, but that their emails, photographs and other computer activities could be examined by a hostile adversary in a workers' compensation case.

And for those of you who say "let them look – I have nothing to hide" I would respond by saying that clever defense counsel can take photos, videos and correspondence out of context that will make you look deceitful.

Case in point.  This week I received the following email from a young woman who works at a factory in north Georgia:

Where I work I have been told that carpel tunnel is not recognized as a workman's comp injury if I wasn't having problems with numbness before.  Is this correct?

The short answer is "no, this is not correct."  Repetitive motion injury (often resulting in a diagnosis of carpel tunnel syndrome) is a very common work injury, especially for factory workers performing manual labor with their hands.

Any employer who tells an employee that "carpel tunnel is not recognized as a workers' comp. injury" is either very misinformed or downright dishonest.

The point here – if you are injured on the job, you should not rely on your supervisor or the HR person at your job to advise you regarding your rights.  The employer (and its insurer) have a decided interest in avoiding claims.  And they know that if delay reporting an injury or if you do not report an injury accurately to your doctor they stand a better chance at minimizing your settlement or even convincing a judge that you did not really get hurt at work.

If you are injured on the job and you think that you may have a claim, call me or another experienced workers' compensation lawyer for an opinion.

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.

Notice to Employer

The Georgia Code says that an injured worker must give notice to his employer within thirty (30) days after his on-the-job injury.   We advise our clients to give notice, preferably in writing, to a direct supervisor.  The the sooner you give this notice the better.   When giving notice to your supervisor you should be as clear as possible about the exact date and time you were injured and about exactly what happened.    The more specific the better as we find that employers tend to question vague and uncertain reports about a work injury.

Remember that workers' compensation covers injuries "arising out of and in the course of " your employment.  This means that an injury incurred while you are on break, or coming or going from work may be challenged.  Be suspicious if your employer's workers' comp rep tries to put words in your mouth about when or how your injury happened.  A quick word about the phrase "arising out of and in the course of employment."  The Georgia State Board of Workers' Compensation spends a lot of its time listening to lawyers argue about what this phrase means.  What you tell your employer about your injury, and what you tell your doctor can make a huge difference.  For this reason, we encourage injured workers to seek legal counsel sooner rather than later.

Once you report an on-the-job injury, your employer is supposed to write up a "first report of injury" and send it to both the State Board of Workers' Compensation and to its insurance carrier.   Not surprisingly, this does not always occur as employers try to avoid filing claims with their workers' comp. carriers.   Your employer may delay filing the required paperwork and may tell you to file with your group health insurer.  They may suggest you file under short or long term disability for lost time from work.   Do not let this happen as group health and/or STD/LTD carriers will not pay for either lost wages or medical costs related to a work related injuries, as workers' compensation insurance is considered "primary" coverage.  We have seen some situations in which the group health carrier initially accepts the claim, but later rejects it once the file is audited.  This could leave you stuck with a medical bill that otherwise should be covered.

Notice to State Board of Workers Compensation

In theory, once you give your employer notice of your injury, the employer will file a notice of claim with the State Board of Workers' Compensation.  A better course of action would be for you to file that notice directly.  You file notice using a form called a WC-14, and this form must be filed within one (1) year from the date of your accident.  Our office regularly completes and files WC-14 forms for our client.  If you are not sure how to fill out this form, you should speak to an experienced attorney as filling out this form improperly can negatively impact your case later on.

Case Study – Injured Employee Files WC-14 Two Weeks too Late

Our office, like many workers compensation firms, subscribes to a service that reports about recent Georgia court decisions involving workers' compensation.   A recent case decided by the Court of Appeals illustrates why it is so important to carefully complete your notice forms and to be extremely clear as to when and where your accident happened.

In this particular case, an individual was injured on the job but he claimed that he could not remember the exact date of his injury.  He did not file his WC-14 until a year and two weeks after his accident.   The employer denied receiving notice so the court was left with the WC-14 date only.  Because the WC-14 was dated more than a year after the accident, the court found that this claimant was barred from filing a claim because he filed his notice too late.

Unfortunately it is not at all unusual for witnesses supporting the employer to "not remember" a conversation when a claimant gives notice.  In tough economic times your co-workers and supervisors do not want to do anything to jeopardize their jobs.  You must be an advocate for yourself and if this means hiring a lawyer to pursue your rights you should take that step.

I hope that this blog, along with the Ginsberg Law workers' compensation web site, will be helpful resources for you as you educate yourself about Georgia workers' comp. law.  Another very useful site is the web site published by the State Board itself.   While some of the material on the State Board's site is geared towards lawyers, insurance companies and employers, there is a great deal of useful information there for injured workers.  For example the State Board web site has a very helpful FAQ section written for the benefit of injured workers.   Another section is written for employers – as injured worker, however, you can learn from this as well.  Another area of the State Board web site that you may want to review is the section that includes the various official forms that employers, insurers and claimant's lawyers must use.

One of the main themes of the State Board site relates to how workers' compensation is different than personal injury law.   If you understand, for example, that pain and suffering are not part of a workers' compensation claim, or that an insurance company does not have to settle, you can make better choices in your own case.  If you are an injured worker, you obviously have concerns that transcend the organizational structure of the State Board of Workers' Compensation.  However, you may find that an understanding of how the Board works can help you maximize your recovery should you have an injury claim.

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.