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.
Filed under Medical benefits, Understanding the Law by 
If you are injured on the job and you are a covered worker under the workers’ compensation law, your employer is required to provide you with medical care. However, as you may suspect, what you consider as reasonable and necessary care may not be the same thing as what your employer and its insurer want to provide.
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.
One of the issues that I sometimes face arises from my client’s initial report of his injury. When you are hurt on the job, you can help your case greatly by thoroughly and accurately reporting your injury.
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.
Filed under Back & neck injuries, Georgia Workers' Compensation, Medical benefits, Winning Strategies by
This morning I received a bill in my name for payment due. I called the establishment to inform them that this is a Worknman"s Comp claim and the employee there told me that it has not been filed with Workman’s Comp Insurance Company . I relayed this information to our office with a fax number for the paperwork to be sent to the company expecting their money. What else can I do to have this matter resolved? The company I work for is in the process of being closed and I want to make sure this bill is paid.
–Alice
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.
Also be aware that workers comp pays on a reduced fee schedule in Georgia. This means that the hospital will get paid a set amount for services rendered and this set amount will likely be less than they might bill a non-workers’ comp. patient. Any balance remaining over the reduced fee schedule is NOT your responsibility and you should not be sent any bills for the differential owed. If you get billed for the differential, tell the hospital this is workers comp and you are not paying it and do not have to by law.
It is important that you are proactive and assert your rights. If your account is not coded as a workers’ comp account, you may find that your credit is damaged even if the charges are eventually paid by the workers’ compensation carrier. Don’t let this happen – be firm and insist on fair treatment.
Finally, you note your company is going out of business. Do not worry. Despite the fact they are closing, as long as there is workers comp insurance you have a claim with the carrier regardless of whether the employer is or is not open for business.
[tags] medical reimbursement under workers comp, Georgia workers’ compensation, SBWC fee schedule [/tags]
Filed under Georgia Workers' Compensation, Medical benefits by
The term "malingering" can cause you a great deal of problems if it appears in your medical records. If a judge believes that you are a malingerer, he will likely disregard much of your testimony and he will have an unfavorable attitude about you and your case. Malingering suggests lying and judges rarely award benefits to claimants who appear to be dishonest.
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.
[tags] malingering, workers compensation, workers comp, Waddell’s signs, symptom endorsement [/tags]
Filed under Medical benefits by
As I have written in this blog and on my Georgia workers’ compensation web site, the quality and nature of your medical care following your injury will have a lot to do with whether you win your claim and with how much money you can expect at settlement.
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.
[tags] medical treatment under workers compensation, Georgia workers compensation, company doctor, medical benefits [/tags]
Filed under Medical benefits by
I wanted to know if there was anything that could be done to help me. I had surgery on my left shoulder and have reached MMI with a disability rating and significant work/lifting restrictions (I’m a nurse). Now, my right arm is starting to grind and bother me. I know it’s from overuse of it because I had no problems with it until I kept having surgeries on my left (3) and had to use it all the time. Is this a part of my workers comp. claim or do I have to be on my own with this?
Sonji
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.
[tags] arising out of the course of employment, georgia workers compensation, overuse syndrome [/tags]
