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.

• 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.