Most often the problems I highlight involve an insurance company’s refusal to authorize (pay for) necessary treatment, and some of the tactics I use to force the issue. As you may know, delay in starting needed treatment increases the chances of complications and makes full recovery less likely. If the purpose of the workers’ compensation system is to get injured workers back to work, why do insurance companies intentionally delay treatment and thus lower the chances of a rapid return to work at full capacity.
There are times when an insurance adjuster takes such a ridiculous position – contrary to the law and to human decency – that I have to request a hearing so the case ends up with defense counsel. I’ll ask opposing counsel to explain the adjuster’s behavior and the other lawyer will have no answer. My guess is that the insurance companies figure they can run over unrepresented claimants or newbie lawyers so they act with total disregard of the law. Needless to say that nonsense does not work at Ginsberg Law Offices.
You would probably not be surprised to conclude that a workers’ compensation insurance company’s actions are driven primarily by money. They have obviously concluded that they will make more money fighting and delaying your legitimate claim with the hope of closing your case with a lowball settlement than they will paying for medical care and getting you back to work.
NPR recently published a story documenting how state legislatures throughout the country have helped the insurance industry agenda by weakening laws designed to help injured workers recover from on the job injuries. The NPR story notes:
The cutbacks have been so drastic in some places that they virtually guarantee injured workers will plummet into poverty. Workers often battle insurance companies for years to get the surgeries, prescriptions and basic help their doctors recommend.
Remember that insurance companies have deep pockets and they pay lobbyists millions of dollars to influence state legislators. Changes to state workers’ comp. laws are passed “under the banner of reform” based on “the false premise that costs are out of control.”
In fact, employers are paying the lowest rates for workers’ comp insurance since the 1970s. And in 2013, insurers had their most profitable year in over a decade, bringing in a hefty 18 percent return.
And who picks up the pieces? The Social Security disability system, another program under attack for alleged fraud and mismanagement.
We have seen some of these “reforms” here in Georgia:
- limits on the number of weeks you can collect lost wage benefits regardless of your medical status. With limited exception, your temporary total wage benefits stop after 400 weeks (7 ½ years) regardless of medical status:
- dollar figures are assigned to damaged body parts. If you lose:
- a thumb, the most you can collect is $31,500
- a big toe, the most you can collect is $15,750
- your arm, the most you can collect is $118,125
- Frequently injured workers collect far less than these maximums for lost body parts.
- More restrictions on “catastrophic loss” designations.
- The use of “offsets” which reduce your settlement to account for possible Medicare claims
Injured workers should assume that they will have a fight on their hands when they file a claim. The nasty tone of most workers’ compensation cases seems contrary to the stated purpose of Georgia law – which is to fairly balance the needs of injured workers with the financial interests of employers.
If you find yourself getting the runaround from the insurance company, please pick up the phone and call me – I can be reached at 770-351-0801.
Attorney Jodi Ginsberg represents employees who are injured on the job and who need medical care and missed wage benefits available under Georgia's workers' compensation laws.
Latest posts by Jodi Ginsberg (see all)
- Injured Workers Suffers Due to Insurance Company Tactics - April 21, 2016
- “Independent” Medical Exams Scheduled by the Insurance Company are Rarely Legitimate - February 26, 2016
- Is a Private Investigator Following You? - December 30, 2015