October 23, 2018

Incredible: What Goes on Behind the Scenes of Your Georgia Workers’ Compensation Claim

Why is the Georgia workers compensation system so adversarial? As an injured employee you only have to prove that you were injured on the job – you do not have to prove negligence or any other fault on the part of your employer. Does it make sense that employers and their insurance companies fight so hard to deny claims?

It may not make sense, but employers and their insurance companies do contest claims, even those involving injuries that were witnessed and where all treating doctors diagnose a severe problem.

Some of what I see every day can only be described as incredible:

  • my client was injured and saw no posted panel of physicians in any breakroom or other employee area. Under the law, the employee can choose any doctor and the employer/insurer has to pay. The adjuster refused to authorize a doctor and suddenly a fresh, new posted panel appeared (after the fact)
  • a potential client called to say that she had received no TTD (temporary total disability) checks even though she was out of work and her claim accepted. When I was retained I called the adjuster who emailed me a printout of her screen showing that the TTD checks were sent out by their system, but, of course, never cashed. By the end of that week, the missing funds plus a penalty was fed-exed to my new client
  • I received a call from another potential client who had a serious neck injury. The insurance company would only authorize a hand specialist. After I was retained, we asked the ahnd doctor to authorize a neck specialist, which he did. The adjuster continued to refuse to authorize payment for the neck orthopedist. Only after requesting a hearing and getting a defense attorney to look at the case was the neck specialist approved.

I suspect that some of these outrageous actions by employers and insurance adjusters are intentional and mean-spirited, and sometimes their actions reflect overwork or just plain incompetence. Either way, you, as the injured worker, bear the burden of trying to survive without weekly wage benefits, and you have to suffer without medications or treatment while the insurance adjuster dithers.

Having represented injured workers for over 30 years, I know what is supposed to happen and when. If I sense that you are getting the runaround I will call, email and text the insurance adjuster or opposing counsel until I get a response. I’ll request a hearing or a conference call with the judge. If it makes sense to negotiate a resolution to speed up the process I’ll do that.

I could describe case after case of situations where the employer and their insurance company did not do what they were supposed to do, resulting in delay and most likely medical complications for the injured worker.

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