My question is that, I’ve been out hurt for a year and 3 monthswith a crushed heel. I’ve seen 2 workers comp doctors and just saw a independent doctor. The independent doctor said that he could heal me,and do surgery but the workers comp doctor disputes his opinion. Now the insurance company says that their not going to let me see him nor pay for the surgery. If the workers comp doctor would have x-rayed my foot he would’ve saw that its still broke but he hasn’t x-rayed it in 6months or hasn’t seen me in 3 months and refuses to give me anything for pain. Isn’t that refusing me treatment? Please give me some advise???
-John
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.
[tags] independent medical examination, workers compensation doctor, company doctor, georgia workers compensation [/tags]
Filed under Case studies, Foot/crush injuries, Georgia Workers' Compensation, Medical benefits by 
North Carolina workers’ compensation lawyer Dan Deuterman recently wrote about one of his cases, Clark vs. WalMart, that ended up in the North Carolina Supreme Court. Although the Clark case arose under North Carolina law, there are implications for Georgia workers’ compensation claimants.
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.
[tags] Clark v. Walmart, pre-existing conditions, payment of medical care in workers’ compensation cases [/tags]
If you have never filed an on-the-job injury claim before, prepare yourself for a rude shock once you file your workers’ compensation claim. In theory, Georgia’s workers’ comp. law is designed to reduce disputes between employers and employees – in fact, I believe that workers’ compensation is just as adversarial as divorce or any other hotly contested litigation.
In theory, the Georgia’s workers’ comp statute reduces conflict by eliminating fault from the claim equation. If a worker is injured, he need only prove that he was on the clock performing a duty of his employment. Negligence is not an issue. Bad judgment, if honest and unintentional, is compensible.
By comparison, you cannot recover damages in a car accident if you were at fault. For example, if you are driving a company vehicle on a delivery and you run off the road and hit a tree, workers’ comp will cover you. If you had this same accident on the weekend, you would have no source of recovery in negligence.
There is a tradeoff for not having to prove fault. In workers compensation, you cannot recover money damages for pain and suffering. Instead, the Georgia comp statute provides that you can recover for your economic loss (temporary total disbability) and for your permanent medical impairment (total or partial permanent disability). Typically, recoveries for injuries in worker’s comp are less than the same injuries in a negligence case.
Because negligence is not an issue, the “battleground” in a workers’ comp case often arises from a dispute about the severity of your injury. Often, I spend a lot of my time fighting with the insurance company over who the treating doctor ought to be.
It should come as no surprise that the insurance companies who process workers’ compensation claims in Georgia have identified dozens of doctors who take a very conservative approach to on-the-job injury claims. These doctors are likely to minimize the significance of your injury and will release you back to work quickly.
Having been in practice for over 15 years, I have met, deposed and reviewed the work of most of the doctors who you will likely see in your workers’ comp claim.
By contrast, my job is to secure for you medical care that is focused on your well being. I will also expect that your treating doctor’s loyalty is directed towards you, not to an insurance company that sends him work.
[tags] georgia workers’ comp law, workers’ comp vs. car accident, company doctor [/tags]
Filed under Georgia Workers' Compensation, Medical benefits by
