• 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.

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.

You have been injured on the job and are now receiving Georgia workers' compensation benefits.  Who decides which doctor you can see?  What if you are not happy with the company doctor?  Are there any circumstances when you can choose a doctor of your choice?

In this video, attorney Jodi Ginsberg speaks about the rights of injured workers to receive quality medical care as well as options to change treating physicians in the event that company provided medical care is sub-standard.

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.

Jodi Ginsberg responds:   Alice, thank you for your email. Many times medical offices/hospitals will send bills to patients when it is a workers compensation injury. The law in Georgia prohibits them from collecting money from you when the medical provider is authorized under workers comp.  In your case, you indicated that your employer or the workers comp insurer directed you to go to the local hospital.  If this is the case then the hospital visit is "authorized" for workers' compensation purposes and the workers' comp. insurer is required to pay the bill.

You should first make sure you put in writing and keep a copy for yourself the fact this is a workers comp case; name and address of employer and workers comp insurance company with your name and date of service etc. Send that info to the hospital with a letter telling them to file it under workers comp. As well, send a copy of the bill to the employer and workers comp ins co and tell them to pay the bill. Keep a copy to the letter you send them as well. This should take care of it. If not, you may need to get an attorney to ask for a hearing.

Physicians regularly employ a variety of tests to help identify a malingerer.  Although these tests are not always accurate and can be rebutted, you are much better off doing everything in your power to avoid the malingering label in the first place.

Tests that physicians, psychologists and psychiatrists use to spot malingering usually fall into one or more of the following four categories:

• Effort tests – are your scores too low based on what prior tests have shown to be your capability?
• Pain scales – are you identifying pain in parts of your body inconsistent with diagnostic or clinical evidence?
• Symptom Endorsement – are you identifying too many symptoms, or symptoms inconsistent with your diagnosis?
• Waddell's signs – physical actions that should not cause pain but elicit complaints.  A classic Waddell test is the "distracted leg raise" where a patient has no complaints of knee pain when seated, but painful on straight leg raise.

As you might imagine, your physician will not necessarily tell you that you are being tested for malingering.  Obviously, you should be completely honest and forthright with your physician – you want to create a physician-client relationship based on trust, not on trickery.

If you get the sense that your doctor has a bad attitude about you or is suggesting that you are being less than honest when you are telling the truth, report this situation to your lawyer at once.

Technorati Tags: malingering, workers compensation, workers comp, Waddell's signs, symptom endorsement

I spend a good part of my day looking at my clients' medical records and talking to my clients about the treatment they recieve.  It is not at all uncommon for the physician chosen by the employer or its insurance company to release my client back to work with limited or no restrictions, when in reality my client is unable to perform his regular job, a "light duty" job, or any job at all.

Unfortunately, the quality and effectiveness of the medical care that you receive in your workers' compensation case depend in large part upon who has selected the doctor.  Many doctors work at medical clinics that get most of their patients from insurance companies for workers' compensation treatment.   Insurance company adjustors frequently speak with these doctors and encourage them to release claimants back to work, and to release them with limited or no restrictions.

If I take on a new case and I see that the insurance company has directed my new client to certain doctors, you can be sure that my first course of action will be to call the adjustor and argue for a more neutral physician.  The law also gives us the right to demand an "independent" exam in certain circumstances and we also have the right to ask the State Board to designate a change in treating physician.

Sometimes insurance adjustors or defense lawyers will agree to a change in treating physician if I challenge their choice of a doctor who is known to be firmly in the insurance company's camp.   In fact, I would say that knowing the reputation of many of the doctors that you are likely to see in a Georgia workers' comp case has helped me become a more effective advocate for my clients.

In a workers' compensation setting, you cannot assume that a doctor recommended to you by your employer or its insurer will have your best interests at heart.  Although most of us are conditioned to trust and respect physicians, you have to trust your gut if you find yourself in a workers' compensation setting.  And if your gut tells you that your current doctor does not have your best interests at heart, you and your lawyer need to take immediate action to regain control of your medical treatment.

Technorati Tags: medical treatment under workers compensation, Georgia workers compensation, company doctor, medical benefits

Jodi Ginsberg replies:  Sonji, he injury to your right arm is potentially compensible as part of your workers' compensation claim.  If your authorized treating physician will agree that the problems you are having with your right arm are consistent with overuse that is reasonably and logically the result of having only one functioning arm then you have a strong argument for benefits.

Technorati Tags: arising out of the course of employment, georgia workers compensation, overuse syndrome

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.

Technorati Tags: independent medical examination, workers compensation doctor, company doctor, georgia workers compensation

Mrs. Clark, a 64 year old lady, worked as a greeter at WalMart. She injured herself while attempting to move a decorative sled while standing on a 10 foot ladder. Ms. Clark had previously been diagnosed with osteoporosis. After initially accepting the claim, WalMart cut Ms. Clark off, arguing that Ms. Clark was not entitled to presume that her on-going back pain was solely the result of her job injury given the pre-existing osteoporosis.

The North Carolina Supreme Court agreed with WalMart that Ms. Clark, as the injured employee, had the burden of proving that her on-going disability arose from her job injury and remanded the case back to the North Carolina Industrial Commission (which is roughly equivalent to the Georgia State Board of Workers' Compensation). The Industrial Commission ruled that Ms. Clark was permanently disabled and that WalMart had to pay for her medical care, including spine care associated with osteoporosis.

This case highlights an issue that we often see here in Georgia. Often our client's work injury is not the only medical problem afflicting him or her. Sometimes, our client has a pre-existing medical problem (one known to the employer) that makes recovery from the new on-the-job injury more time-consuming or complicated. Sometimes an unknown medical problem will arise due to the stress and shock of a sudden work injury.

Employers and their insurers will attempt to limit the medical treatment to the specific work injury and will refuse to pay for medical treatment that is not directly related. As you might imagine this stance creates issues as often the "other" medical problem limits healing or affects treatment. Certainly, in Mrs. Clark's case, her job injury at WalMart did not cause her osteoporosis, but the osteoporosis most definitely affected her healing and the extent of her recovery.

As is the case in North Carolina, disputes between employers and their insurers about what constitutes compensable care ends up before workers' compensation judges.

Technorati Tags: Clark v. Walmart, pre-existing conditions, payment of medical care in workers' compensation cases