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.

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.

I hope you also see the importance of timing in your workers’ compensation case.  It is no mistake that company doctors will try to return you to work before 21 days elapses.  In fact, efforts by insurance companies to put my clients back to work too early results in a lot of conflict in workers’ compensation cases.  If you are not careful, the insurance company can use its control over your medical treatment to manipulate your rights to lost wage payments.

You may sense that the workers’ compensation insurance company does not have your best interests at heart.   Please do not hesitate to call me if you want to discuss this – I can be reached at 770-351-0801.

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.

Checks Not Mailed on Time

If your check is not mailed on time, one of two late penalties apply.  If you are receiving weekly benefits because an administrative law judge at the State Board of Workers’ Compensation ordered the insurance company to pay you benefits, then you are entitled to a 20% late penalty on all benefits that are not timely mailed.  This means the insurance company must pay your full weekly benefit plus an additional 20%.

If you are receiving weekly benefits because the insurance company voluntarily started paying you, without an order from the Board, then you are entitled to a late penalty of 15% on all benefits that are not timely paid.  These penalties are automatic and an order from the Board is not necessary for them to be paid.

Late payment of weekly TTD (temporary total disability benefits) checks happens frequently and I am regularly on the phone with insurance adjustors trying to get my clients’ checks mailed.  If your checks are not getting to you on time, I’d be happy to help you – please call my office at 770-351-0801.

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.

Specifically, I am referring to situations in which you may have injuries to multiple body parts and you are receiving treatment from several different doctors.   Recently, for example I represented a young man who had fallen almost 4 stories from a building, causing injury to his spine, a broken leg and a closed head injury.   In this case, I felt that the orthopedic doctor treating the leg and back injury, and the neurologist treating the closed head injury were not providing the level of treatment appropriate for the degree of injury.

Unfortunately, Georgia law does not provide for more than one claimant’s IME, even when multiple body parts are affected.   Therefore, I had to choose between an orthopedist and a neurologist for the claimant’s IME.  In this particular case I chose to request an orthopedic IME because I felt that my client had a more immediate need for back care and because I felt that I would have opportunity later to challenge the opinion of treating neurologist.

The points to remember about the claimant’s IME:

• be very careful about choosing to use this right – you will have one and only one opportunity to demand an insurer paid independent medical exam.  Knowing when to assert this right and knowing who to choose to perform this exam are crucial factors
• if you have injury to more than one body part, you only get one IME
• the insurance adjuster is not an appropriate resource to advise you about how and when to assert your IME rights

If you have questions about your claimant’s Independent Medical Exam rights, please do not hesitate to call me at 770-351-0801 begin_of_the_skype_highlighting 770-351-0801 end_of_the_skype_highlighting or email me.   Please also feel free to post a comment on my blog.

• 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?

• First, do not expect your employer or its insurance company to offer to pay your spouse or significant other for attendant care.   Many insurance adjusters are not aware of the Hardee case and even some who are will tell you (incorrectly) that your spouse cannot collect.
• Second, it helps tremendously to have your authorized treating physician note the need for attendant care.  In my experience it sometimes is necessary to have the doctor write a letter specifically setting out the requirement for attendant care.
• Third, non-medical attendants like spouses or family members can get paid based on the State Board’s fee schedule, which sets a specific hourly rate and other limits
• Fourth, insurance companies will look for ways to avoid paying an injured workers’ spouse.  At a minimum, your spouse must have the physical and mental capacity to care for you.   You should seek legal counsel before submitting a request for spousal reimbursement.

If you would like to know more about spousal attendant care, please call me at 770-351-0801or send me an email.

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. Having worked as an insurance defense lawyer for several years at the beginning of my career, I can quickly identify an insurance company strategy to close out your case without addressing your medical needs or paying you a fair and necessary settlement.

Often the first indication you may have that something is not quite right may be a biased medical report.  Sometimes you sense the bias right away – when you visit an “industrial clinic” with an uncaring, assembly-line approach to medicine.  Sometimes the doctor you visit seems pleasant and caring, but you are stunned to read his report that minimizes your complaints, misstates your words, suggests that you are exaggerating your symptoms and releases you back to work far too soon.

Most of us are brought up to respect physicians and to defer to their opinions.  I am here to tell you that this type of blind deference is a major mistake in a workers’ compensation case.  You – or me as your representative – must advocate and advocate aggressively for your medical care.

Options if Your Workers’ Compensation Medical Care is Substandard

We have several options if we suspect that the posted panel doctor who is treating you is biased and unfair.

One Free Switch

First, under the Georgia workers’ comp. statute, we are allowed “one free switch” from one panel doctor to another.  Assuming that your employer’s posted panel is valid, you have the right to change doctors one time without explaining why.  In my experience, the quality of physicians on a posted panel can vary widely – sometimes switching from the industrial clinic doctor to a more independent physician can make a significant difference in your case.

Invalid Posted Panel

Second, we may discover that your employer’s posted panel is invalid.  I have written about the requirements for a valid posted panel of physicians elsewhere but if the panel if not valid, then you may have the right to seek company paid care with any doctor we choose, including quality health care providers that I know from other cases.

Along these same lines, Georgia law requires that posted panels contain the name of at least one orthopedist.  I regularly see panels of doctors that contain multiple names and thus appear to be valid, but do not contain the name of an orthopedist.  The absence of an orthopedist may very well invalidate the panel and give us control of your medical care.

Claimant’s IME

Third, under Georgia law, you as the injured employee can demand you “employee’s independent medical exam” (also known as the “claimant’s IME”).  This relatively recent change to the workers’ compensation law allows employees to choose a physician to conduct an evaluation that must be paid for by the employer/insurer.  While you will not get treatment at a claimant’s IME, the resulting report can be helpful evidence in your case and can support an effort to change the authorized treating physician.

Petition State Board for Change in Authorized Treating Physician

Finally, injured workers have the right to petition a judge at the Georgia State Board of Workers’ Compensation to order a change in the authorized treating physician.  In my practice I often find that I can negotiate a change in treating physician with the insurance adjuster.  If I see that your current doctor is not doing you any good or if I know that doctor to be biased in favor of the insurance company, then I will call the adjuster and arrange for a change.  If the adjuster will not work with me, then I request a hearing on the issue – although I rarely have to take such issues to court.

I hope you can see from this brief discussion that you do have many options if your current workers’ compensation authorized doctor is either not providing you with quality care or if that doctor is biased in favor of the insurance company.  I encourage you to tap into my knowledge and experience with workers’ compensation medical providers in Georgia.  Call me at 770-351-0801 or email me.  I look forward to hearing from you soon.

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.

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

• 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.

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.