I work at a job where I am using a computer keyboard all day long. Over the past few months, my right wrist started to hurt and get numb at times. I reported my injury on November 28, 2006 to the Human Resouces Manager requesting for a keyboard tray from desk.
The HR Manager told me that it was out of his hands and that I should order a tray through my manager for approval. I asked on several occasions for the tray and my injury started to become more aggravated, so I went to his boss asking him about the status of a computer tray. He told me that the tray was too expensive and I now needed a doctors note in order for me to receive a keyboard tray.
I went to my doctor and told him the same story and he suggested that I file a workmen's comp claim since it was a work related injury. It was filed the first week of February with the correct injury date of November 28th I am scheduled for surgery this Wednesday February 28th and they are now just informing me that I have to use my PTO to compensate my time off. Now, by law if I use the 21 days from the injury date (which it has been) shouldn't I receive full compensation?
–Alyce
Jodi Ginsberg responds: Alyce, thanks for your question. The law requires that you file your workers compensation claim within 30 days of the injury. Here it looks like your date of injury was November 28, but you did not file your claim until the first of February. Is your employer acknowledging that you "reported" your injury in November?
For the benefit of anyone reading this blog, employers and insurance companies use these "reporting deficiencies" all the time to deny claims. If you get hurt on the job, you should always try to report the claim in writing and, if possible, file a report of on-the-job injury yourself with the State Board of Workers' Compensation.
Assuming that your employer recognizes this as a workers comp injury, you ask about the 21 day rule. The 21 days runs not necessarily from date you reported it,but rather, from date of economic disability (when you stopped working). Did you continue working after the November, 2006 "injury date?"
By the way, if your injury did not "happen" on a specific day but was the result of months or years of overuse, then the injury date you choose is called a "fictitious injury date." In cases involving these types of "overuse" injury, it is even more important for the injured claimant to file his own Form 14 notice on injury with the State Board.
Technorati Tags: Georgia State Board of Workers Compensation, Form 14, fictitious injury date, notice of on the job injury, repetitive motion injury, carpal tunnel
Filed under Carpel Tunnel, Case studies, Georgia Workers' Compensation by 
Jodi, I am receiving TTD (temporary total disability) benefits and the authorized doctor told me that he is releasing me to return back to light duty work. Should I report to work immediately?
Jodi Ginsberg responds: No, you should not return to work right away. You should wait until you receive a form in the mail called the WC-240 form. The WC-240 form is completed by the insurance company and describes specifically a light duty job, the date and time that this light duty job will be available.
The WC-240 protects you, the injured worker. If you show up at your job site and your employer really does not have a light duty job that corresponds to the limitations on the WC-240, your refusal to try a job outside those limitations will not damage your case. Further, if you try the light duty job for up to 14 days and cannot perform it, your TTD benefits will resume immediately.
If you return to work without a WC-240, you risk the situation where the light duty job really is not light duty. If you cannot perform it and/or if your employer terminates you, your TTD will be cut off and, of course, your job is over as well. You then have to file for a hearing and wait two to three months to ask a judge to reinstate your benefits.
If you return to work with the WC-240, the burden falls on the employer/insurer to try to stop your benefits. If you return without this form, the burden may fall on you to try to get your benefits restarted. This is a big distinction and can determine whether you have money coming in every week while you recover. Further, if you have money coming in you will be less likely to be pressured into a cheap settlement.
Sometimes, an injured employee may be pressured to return to work immediately by his boss or even by a well meaning spouse or co-worker. Do not be manipulated in this manner. If you have been receiving benefits and your doctor tells you that he will be issuing a light duty release, wait for your WC-240.
As an aside, part of my job as a claimant's lawyer is to review the WC-240 to make sure that the light duty description is consistent with the medical records, and to object if it is not. Further, if it turns out that my client cannot perform the light duty work, I will assert my client's right to a resumption of TTD benefits.
Technorati Tags: WC-240, light duty return to work, georgia workers compensation claim, TTD benefits, temporary total disability
Filed under Georgia Workers' Compensation, Income benefits, Returning to work by
I have been classified Catostrophic by GBWC and am totally disabled. Everyone concerned has no objections. My insurance Co. has said that they may want to settle. Medicare setaside has already benn set. What should I be looking for in a settlement. Is there an amount that I should be looking for . I am 55 and will not be able to work again. My claim is covered by the SITF. , but my Ins. Co. is in rehab. Thanks I look forward to your answers.
–James
Jodi Ginsberg responds: James, thank you for your email. Here are my thoughts.
I look at a number of issues when settling a catastrophic workers' compensation claim. By the way, since some of those reading this blog entry may not be familiar with the term "catastrophic injury," I would like to briefly define the term. Under Georgia workers' compensation law, the State Board has the power to designate a claimant's injuries as catastrophic. This means that the Board recognizes that a claimant like James will not likely be able to return to work because of the severity of his injuries.
Most importantly, once a claim has been deemed catastrophic, the 400 week cap on benefits does not apply. In theory a catastrophic claimant could collect temporary total benefits for the rest of his life, as opposed to a maximum of 400 weeks for a non-catastrophic claim. Note, however, that just because a claim has been deemed catastrophic, there is no automatic right to 400 weeks. In theory a treating doctor could return a catastrophic claimant back to work.
That being said, catastrophic claims have a higher value for settlement purposes since the employer/insurer's exposure is unlimited. Also, when a case is deemed catastrophic, a "rehabilitation supplier" is assigned to your case – these case workers are neutral in theory, but usually their interests lie more with the insurer.
Now, back to James' question. I go through a checklist to evaluate the value of a catastrophic claim. My checklist includes factors like:
-
what is the insurance company's exposure for future temporary total disability – what do the actuarial tables say about your projected lifespan?
-
how much future medical care will you require?
-
what is the likelihood of needing future surgeries?
-
will home modifications be required because of your injuries
-
will vehicle modifications or a vehicle purchase be required
-
will home health care services be needed?
-
what are the provisions of the Medicare Set Aside
-
since the Subsequent Injury Trust Fund (SITF) is involved, and your because the insurer is not fully solvent (the Insolvency pool is involved), timing would be an issue. My experience has been that the SITF complicates matters because there are layers of bureaucracy involved in getting an SITF case settled
-
what future benefits will Social Security provide for post-settlement living costs
-
would a structure settlement be in your best interest?
-
should you settle in the first place? – sometimes your best bet is to maintain the status quo and continue to receive benefits for a period of months or years
These factors are among the ones that I consider when looking at a catastrophic case. I can't really comment more without knowing about your specific case, but I think you get the idea. If I can be of service to you, please do not hesitate to call me.
Technorati Tags: catastrophic injury and georgia workers compensation, subsequent injury trust fund, medicare set aside, settling a catastrophic georgia workers' compensation case
As I was loading a 400lb. piece of freight on an aircraft, my (L) knee twisted. I was sent to a clinic and evaluated that I might need a knee replacement. I have a history of several knee surgeries, my job function is loading and unloading airplanes for 30 years. My question is can I obtain my own Dr. in the state of Ga., under the workmans compensation laws………Thanks
–Andrew
Jodi Ginsberg responds: Andrew, thanks for your interesting question. Here is how I would analyze your situation. First, I would want to know if your potential need for a knee replacement is the result of your most recent injury or is it a combination of this injury and your past injuries/surgeries?
Your employer and its insurer may try to argue that your current problem is the result of past injuries as opposed to this incident, and they may try to deny coverage.
Even if your employer tries to deny coverage based on your old knee problems, your case may be winnable if a treating doctor will go on record that your most recent injury aggrevated your pre-existing condition, and if you did not misrepresent your knee problems at the time you were hired.
If your employer has accepted responsibility for covering your knee problem, then the next step would be to get you to a specialist. Under Georgia's workers' compensation law, an authorized treating doctor can refer you to a specialist and, generally, the insurer would be responsible for paying the specialist to treat you. If your employer has a valid "posted panel of physicians" there may be a specialist there that you could choose.
If the employer is denying coverage, you would need to request a hearing on the issue of whether your injury is compensable.
As you can see, the answer to your question depends on a number of factors. I do not think you can or should assume that your employer or its workers' compensation carrier will act in your best interest.
Feel free to call me at 770-351-0801 if you wish to discuss further.
Technorati Tags: knee injury and georgia workers compensation, arising out of and in the course of employment, pre-existing condition and workers compensation
I was injured in a car accident in Dec. 2004 while on the job. Workers comp accepted responsibility and paid my medical and PT expenses. Extensive injuries included broken femur, broken (upper) arm, fractured liver (which required surgery for continued bleeding), broken ribs, punctured lung, etc. Spent 24 days in ICU. After several months recovery at home, Dr. declared me at 7% disability, and worker's comp paid several months worth of benefits based on that rating. Now it is 2 years later and while I am able to work, I still have little strength in my arm, and I walk with a limp (and occasionally my leg gives way and I nearly fall). Some days are pretty painful, although I manage to hold down a full-time job. One year ago, they asked if I wanted to settle (not naming a figure) and I declined. Nothing else has been mentioned. Can you give me a vague figure for settlement for these type injuries and also will my time run out for settlement?
Jodi Ginsberg replies: I look at a number of factors when creating a demand for settlement. There are two "big picture" concepts that apply:
1) the best time to settle is when there is maximum uncertainty in your case. Perhaps you are facing surgery, which would mean unknown medical costs and unknown lost wage benefits payable. Perhaps your doctor is proposing conservative treatment in the form of several months of physical therapy after which possible surgery. As your lawyer, I can make the argument that the insurance company's potential financial exposure might be XYZ dollars. If your doctor has released you back to work or if your doctor has already performed surgery and you are participaing in an uneventful rehabilitation, there is less uncertainty and less reason for the insurance company to value the case at a high number.
2) insurance companies look at their potential financial exposure when deciding how much to offer you in settlement. They don't care who you are or what you did. They are only concerned about money. If we can convince them that they may be on the hook for hundreds of thousands of dollars, they will offer substantially more than they would if they calculate their exposure at a few thousand dollars.
Here, my biggest concern has to do with the age of your case. First, you may have a statute of limitations problem. Second, you would have to link your current problems back to an accident that happened two years ago, despite your return to work. The insurance company will argue that any current problems may have to do with your post-December, 2004 work (or perhaps non-work) activity.
Returning to work, as you may have guessed, can create issues with settling a case.
They have already paid you PPD (permanent partial disability) so you would need another doctor to give you a higher PPD rating that what you already have.
I think that your case has some settlement value, but perhaps not as much as it would have had in 2005. If you want to call me to discuss, please feel free to do so.
Technorati Tags: workers compensation settlement, ppd rating, ttd benefits, georgia worker compensation
Filed under Georgia Workers' Compensation, Maximizing your settlement, Settlements by
Here is a question I received from a gentleman named Leon: Injured shoulder 11/16. Have seen Comp Dr. twice. Mentioned pain and 'popping' in shoulder. Diagnosis is a mussle or ligament tear. There was no mention of a possible rotator cup injury. Comp. insurance company has approved 2-3 weeks PT. Company has said they will pay me thru this period @full pay while on 'light duty'. I have agreed to this. It was skilfully implied that this arrangement was in lieu of filing a claim. Can I wait to see if this PT is effective and file a claim at a later date?
Jodi Ginsberg responds: Leon, the thing you need to realize is that if you wait to file a claim you may be compromising your claim should you need to pursue it. There are many complications that can occur when you hold off on filing. For example, your employer may try to use your delay against you by contending that you hurt yourself at home or that you had a pre-existing claim. Some employers try to pursuade you not to file the claim so their premiums do not go up. If you agree and then find yourself with no claim, no coverage and no job and a denial of the claim.
There is a 30 day notice requirement to report the injury to a supervisor and a one year filing requirement with the State Board of Workers' Compensation to perfect the claim.
Although workers' compensation is supposed to be a "no fault" system that covers you if you are injured while on the clock, over the years it has become a very adversarial system. In some instances, employers will turn on loyal employees with a long work history and solid performance history. Often the employer will demand a resignation as part of settlement negotiations.
On the other hand, I do not necessarily think you would be acting wisely to trust your employer to do the right thing. Although I would want to speak with you further about your claim, I generally advise anyone who is injured on the job to report that injury as a workers compensation injury sooner rather than later. I also think you need to get a better idea of exactly what is wrong with your shoulder and what your likely course of treatment would be. You did not specify what you do at work so it is difficult to give you any specifics. Feel free to call me at 770-351-0801 and I would be happy to discuss your case with you further.
Technorati Tags: shoulder injury on the job, georgia workers compensation, State Board of Workers' Compensation, rotator cuff injury
Filed under Case studies, Georgia Workers' Compensation by
I injured my ankle back in August. I have missed work, been place on restricted hours. I finally got sent to a specialist this past thursday. I start rehab on Monday. I had a phone interview with my workers comp. represenative and she told me that i would be reimbursed for time i missed worked and the days that i worked limited hours.
She told me that it would take 13 weeks from today before i would receive any compensation. She also told me that I have to have 13 weeks of time worked prior to the date of the injury and that time worked is a factor of how much i am to receive.
I am hoping that physical therapy will help my ankle so that i can go back to working full time. Is the workers Comp. rep. trying to get over on me or is the 13 weeks waiting period normal. please let me know as soon as possible. Thank You
–Jason
Jodi Ginsberg replies: Jason, thank you for your inquiry. The answer is "NO." You do not have to wait 13 weeks (91 days) to get payment when an authorized treating doctor gives you a "no work" form or puts you on light duty and the job has no light duty.
The ins company rep is not telling you the correct information. The law states that when there is an accepted claim, there is a 21 day waiting period from the date of accident and then you can recover TTD (temporary total disability) benefits. The 13 weeks comes into play when they look at your average weekly gross wage so they can figure how much to pay you in TTD weekly. There is obviously a big difference between waiting 3 weeks as opposed to 13 weeks. Again, you only have to wait 21 days (3 weeks) for your first check if the insurance company accepts responsibility for the claim.
Your TTD benefit is an average of the past 13 weeks of gross wages of your salary OR if you were not there for 13 weeks then of a similar employee. The TTD benefits are 66 2/3 % of average wage and depending upon the year there is a cap paid. Right now the cap is $450 per week for injuries in 2006.
You are welcome to call me at 770-351-0801 to discuss your case further and rights you have under the law when it comes to benefits, proper medical care, payment, reimbursement and settlement. Please be careful when dealing with the ins company as they may tell you things that are not always correct or that you misinterpreted.
Technorati Tags: TTD benefit in Georgia, 21 day waiting period workers comp, 13 weeks and georgia workers compensation, georgia workers comp benefits
Filed under Georgia Workers' Compensation, Income benefits by
