Have you ever wondered how an insurance adjuster can influence your authorized workers’ compensation doctor? If you work in an industry where employees often get hurt, or where work injuries are likely to be serious, you can be certain that your employer’s insurance company has directed the human resource director at your company to include specific doctors on your company’s posted panel. Insurance adjusters know that physicians who derive most or all of their income from workers’ compensation referrals will be much less likely to keep you off work or order expensive tests.
The problem, of course, is that delays in needed tests, or delays in needed treatment can result in permanent injury to you. Further, if a panel doctor returns you to work and you are unable to perform your duties, you are likely to be fired putting you in a difficult financial situation and psychologically deterring you from pursuing your rightful benefits.
In this video I discuss a case where the authorized doctor flat out ignored his own physical therapist’s conclusions about my client’s very limited use of her arms, and issued a full duty return to work. I won’t let the insurer get away with this, of course, but I wanted you to see how broken the workers’ compensation medical system has become. I’d be willing to bet that this doctor knows that he was not living up to his oath to offer full and complete treatment to his patients, but his interest in making money and seeing those referrals seems to override his conscience.
Filed under Arms & Hands, Case studies, Medical Care, Understanding the Law by 
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 the problem that drives clients to call me relates to lost wage checks. Specifically, you may have been hurt a week or two ago, you are getting letters and State Board forms in the mail, but no lost wage check. What exactly are the rules regarding when you are supposed to get that first check?
the insurance company has 21 days after the date of your first missed day from work to issue your first lost wage check. You do not count your last day of work in this calculation
- you will not receive payment for the first 7 days of missed work unless you miss 21 consecutive days
- once you miss 21 consecutive days, the insurance company must pay you for the first 7 days of missed work
- if you do not miss 21 consecutive days, you should receive 2 weeks’ worth of benefits by day 21 after your first day of missed work
Confused? You are not alone. The law seeks to balance the needs of workers for money to pay their bills and the needs of the insurance company to conduct its investigation and set up a payment schedule. Personally, I think that an employee’s suffering when he is hurt and broke for 3 weeks outweighs an inconvenience to an insurance company, but this is the law as it exists currently. More on When Do I Get my First Lost Wage Check?
Filed under Income benefits, Returning to work by
I understand how important it is that you receive your weekly temporary total disability benefits on time. If you are like many of my clients, when you lose your regular paycheck and you are depending on workers’ compensation, you may be living week to week and you may face significant and dire consequences when your checks are late. Here is what you need to know about late payments, the penalties that the insurance company must pay and what you can do to force the insurance company to issue your check.
Assuming that your claim has been accepted and you are not currently working, your employer’s insurance company must pay your weekly benefit checks on time.
Your first weekly benefit check must be mailed on day 21 after the accident if that check is mailed within Georgia, and it must mailed on the 18th day after the accident if it is mailed from an address outside the state of Georgia. The day of the accident does not count when calculating dates.
Subsequent checks mailed from within Georgia must be postmarked as of the last day of the week (i.e. Saturday) in order for payment to be considered timely.
Subsequent checks mailed from outside of Georgia must be postmarked by the Thursday of the week it is due in order for the payment to be considered timely. More on What Happens if my Weekly Benefit Checks are Late?
Filed under Income benefits, Miscellaneous information, Understanding the Law by
Under Georgia’s workers’ compensation law, your employer gets to direct where you get medical care if your employer provides you with a valid “posted panel of physicians.” Not surprisingly, posted panel doctors sometimes bring a pro-employer bias to their treatment of you. I regularly see – and you have no doubt heard stories about – cases in which a seriously injured man or woman is given a regular duty return to work, only to end up in surgery a few weeks later.
In 1990, the Georgia legislature gave injured workers an important new right, the “claimant’s IME (independent medical exam). Under this law, an injured worker can request an independent medical examination with a doctor of his choosing, paid for by the employer’s insurance company.
When properly used as part of a effective claim strategy, your claimant’s IME can be used to:
- refute the unfair and biased claim of industrial clinic doctors
- contest a premature return to work demand by the insurance adjuster
- support a request for a change in authorized treating physician
- support a reasonable settlement demand
However, as important and valuable as your claimant’s IME rights may be, this right is not open ended and it can be wasted if not used properly. More on Am I Entitled to More than One Independent Medical Exam if I have Multiple Work Injuries?
Filed under Medical benefits, Medical Care by
Many of my clients are surprised to learn that their husband, wife or significant other can ask for payment for “attendant care” of an injured worker at home. Why? Often my seriously injured clients cannot take care of basic necessities such as:
- bathing
- dressing
- meal preparation
- driving
- cleaning
Given that hospitals often release patients home as soon as possible, I see more and more instances where my clients recover mostly at home, with outpatient visits to rehab.
Under Georgia law (Georgia Code Section 34-9-200(a)), the employer/insurer must provide care that “shall be reasonably required and appear likely to effect a cure, give relief, or restore the employee to suitable employment.” In the case of Medical Office Management v. Hardee, the Georgia Court of Appeals held that:
There is no express prohibition in the Workers’ Compensation Act against the recovery by an employee of attendant care services provided by a family member, including a spouse. Nor does the employer show that a family member cannot provide attendant home care under the Board’s rules and regulations…
The employer had argued against this “spousal reimbursement” on the grounds that the spouse was performing tasks he/she would do otherwise. The Georgia Court of Appeals, as you can see, ruled otherwise, and permitted Ms. Hardee’s husband to collect a fee under the State Board fee schedule for attendant services.
What does this mean to you? More on Can my Spouse Get Paid by the Insurance Company for Helping Me Recover at Home from my Injury?
Filed under Medical benefits, Medical Care, Recent developments by
If you have never been involved in the Georgia workers’ compensation system before, you may be shocked and disappointed to learn that some of the physicians you meet seem to have an agenda other than your health and best interest. The Georgia workers’ compensation statute has created an environment where insurance companies have a financial interest to find and use doctors who downplay the seriousness of your injuries and who intentionally avoid referring you for necessary, but expensive care. The net result of this system can mean delay and unnecessary suffering for you.
I sometimes receive calls from injured workers who are receiving weekly wage benefits as well as medical care, who wonder why they should hire counsel if everything “seems to be working out okay.” Sometimes they sense that something is not quite right but are wary of rocking the boat.
Know Your Doctor’s Reputation
I respond that one of the most valuable services I offer my clients has to do with my knowledge of and opinions about the medical providers that accept workers’ compensation referrals in Georgia. After 20+ years of practice in this area of law, I have seen or know about the biases and quality of work offered by most of these doctors. More on What to do About Substandard Medical Care in Your Workers’ Compensation Case
