September 20, 2018

Delay in Treatment of Your Back Pain May be Hazardous to Your Health

low back painIn my Georgia workers’ compensation law practice I interact with dozens of insurance companies each week and I frequently find that claims adjusters take a very short sighted approach towards medical treatment for back injuries.

At least half of the clients I represent are suffering from some form of back injury. Low back pain (often disc herniations at L5/S1) is the most common problem I see but I also represent clients with damage to the spine at all regions: cervical, lumbar, sacral and thoracic.

Regardless of where the injury is localized, a common argument I have with insurance adjusters has to do with the need for fast treatment.

Despite dozens of research studies which show that fast diagnosis and treatment of any type of back injury results in faster and more complete recovery, I almost always find that insurance companies work to limit access to care and slow down the course of treatment.

Even in cases where an MRI shows a herniated disc that will require surgery, I inevitably find myself fighting to get the insurance company to agree to a surgeon, authorize surgery, approve post-surgical physical therapy or agree to pay for even short term prescriptions for beds, home modifications or even medications. [Read more…]

How Insurance Companies Try to Cut You Off

aggressive insurance companyYou might think that if your employer is paying weekly benefits and has paid for medical care, you are not likely to have any significant disputes in your work injury case. As the case I am about to discuss shows, however, challenges from the insurance company may be right around the corner.

The case I want to highlight is not one of my cases. The decision in this case is part of the public record in that it is published on the web site of the Georgia State Board of Workers’ Compensation. I bring this case to your attention for several reasons:

  • first, I want you to see how a State Board judge analyzes evidence
  • second, there are certain elements of this case that are not discussed in the decision, but we can assume they are there because the insurance company did not raise the issue and the judge did not mention the issue. We’ll read between the lines to reveal these issues.
  • third, this is a case that shows how insurance companies operate to cut off the benefits of a deserving claimant and to force a below market settlement.

The case I am discussing was decided in 2013 in south Georgia. Because State Board files are confidential, neither the name of the claimant nor the name of the employer is disclosed.  Here is a link to the written decision.

The employee is a female who worked as the manager of a restaurant. In December, 2006 the employee hurt herself and developed neck pain which radiated into both hands and lower back pain that radiated into both legs. The employer accepted the claim and began paying her TTD (weekly wage) benefits. The employer also paid for medical care that include surgery on her cervical spine and surgery on her lumbar spine. [Read more…]

Body Parts and Insurance Companies

authorized treating physician refusal to treatI recently had a long and somewhat heated conversation with an insurance adjuster about body parts.  Specifically, I wanted the adjuster to authorize medical treatment for my client’s neck and back , but the adjuster only wanted to authorize the treating physician to provide care for my client’s back.

As ridiculous as this may sound, this type of negotiation happens all the time in a workers compensation.  Though common sense would tell you that an employee who injures his low back falling from an 8 foot ladder might reasonably be expected to suffer neck injuries as well (such as when his head hits a concrete floor), insurance companies are very careful not to assume anything.

The problem in my case arose from my client’s first conversation with the posted panel doctor.  My client’s low back was in spasm and he was absolutely miserable, and he did not specifically mention any pain in his neck to the treating doctor.

I am thinking that my client had probably incurred a concussion and was not thinking straight in the first place so who knows what he told the company doctor.  By the time I was retained, almost two months had passed and now my client is receiving epidurals for his lower back – although he may need surgery soon – but no treatment at all for his neck.

When my client goes to the workers’ comp. doctor and tries to talk about his neck pain, the doctor tells him that the insurance adjuster has not authorized treatment for the neck so the doctor will not treat the neck.

Imaging a doctor’s appointment where the physician tells you “I’m sorry you’re in pain but I am not allowed to treat that part of your body!” [Read more…]

Be on Alert for “Red Flag” Symptoms in Back Injury Cases

A significant number of work injuries in Georgia involve back injuries.   Unfortunately if you are being treated by a “posted panel” doctor, your treatment may be delayed or not taken seriously.  In this video, I discuss certain “red flag” issues that demand immediate treatment with a spine specialist whose focus is your well being.

 

Company Doctor Uses X-Rays Instead of MRI and Misses Herniated Disc


MRI ScanOften, when a worker injures his back on the job, the human resources manager will take down a claim and refer the worker to an industrial clinic for evaluation and treatment. All too often, the industrial clinic or other posted panel doctor will take X-rays, perform some basic neurological tests, then release the worker back to full duty work after a day or two of rest.

I often get these cases four to six weeks later when the injured worker finds himself unable to work because of severe back pain and limited mobility.   In some instances the injured worker faces pressure and even harassment from his employer due to his decreased productivity, and when I get the case, the employer/insurer may try to argue that any serious injury to the employee may have happened at home instead of at work.

Recently I represented a very nice young man in a back injury case that clearly demonstrates why X-rays are insufficient to evaluate back pain.

My client is a 31 year old man whose job involved installing and reinstalling fence posts.  Starting at 8 AM, my client, using a sledge hammer, loosened fence posts by breaking up their cement foundations, cleaned the post base, then reinstalle the post with fresh cement.  Beside using the sledge hammer, my client had to carry heavy buckets of cement and pour them in to holes in the ground.

By 2 PM that day, my client felt a “pop” in his back when he tried to lift the sledge hammer and he felt radiating pain in both legs.  He reported the injury to his supervisor, who referred him to an industrial clinic.  The clinic doctor took X-rays which described “mild disc space narrowing at L4-5” but no other impairment. [Read more…]

Case Study: Auto Accident While On the Job

Case Study: Private investigator sustains 2 separate injuries while on the job

“Mr. L,” a private investigator, received significant injuries when he was working a case in bad weather. He was involved in a serious automobile accident when he lost control of his vehicle and crashed into a large pine tree. His airbags deployed and his vehicle was damaged on both sides. As a result, he incurred injuries to his cervical spine, chest, left arm, right elbow, and right shoulder.

He would be treated for his injuries in the local ER and then released into the care of two doctors (Doctors M and N) where he would receive necessary follow-up care. The condition of his cervical spine could not be treated by Doctors M and N, so he was referred to Dr. S for specialized care and further testing. Dr. S performed a CT scan and an EMG. During this time, Mr. L continued to work his PI job when he was confronted by a police officer, arrested, and then handcuffed in the process.

As the arresting officer handcuffed him, he forced the man’s neck and shoulder into a position which resulted in further injury to Mr. L, therefore creating further problems for him! At this time, Mr. L went into the care and treatment of Dr. P, an orthopedist. Dr. P immediately discovered the injuries that Mr. L received during the arrest and diagnosed them as “a right C 6-7 radiculopathy; herniated disc and stenosis at C5-6; as well as a partial rotator cuff tear of the right shoulder.”

In September of 2005, he was referred to a surgeon who would perform “anterior cervical discectomy and fusion with plating.”  The surgeon also placed him on what is called a “no work” status. In other words, he was forbidden from working since he was always in pain and movements that were typically performed on the job could no longer be made. He began receiving regular TTD payments of $394.52. Additionally, he was treated with a bone stimulator to assist with the fusion part of his treatment.

In addition to the bone stimulator, Mr. L was also being treated by having to wear a hard neck brace for the ensuing several months. Additionally, he was prescribed numerous medications including Celebrex, Reglan, and Ultracet because of his intense pain and his limited ROM or Range of Motion. To this day, Mr. L continues to live with neck pain and according to Dr. D, the extent of the damage to the man’s cervical spine is now a source for the chronic pain he has been diagnosed with.

Mr. L continued living in pain and a restricted ROM because of the torn rotator cuff in his right shoulder. He continues to be under the care of Doctors A and P. At that time, arthroscopic surgery was performed on the injured shoulder which didn’t relieve his pain or his symptoms. Despite the fact that Mr. L attempted to go back to work as a PI, it was immediately apparent that the injuries to his right arm and shoulder would cause significant pain so he could not properly perform his job any longer.

At this time, Dr. P also performed another surgical procedure wherein Mr. L was anesthetized and the doctor tried to manipulate his shoulder in order to relieve his pain. To this date, he still encounters pain and discomfort when driving. Everything to this point had failed to ease Mr. L’s symptoms despite his continued medication and therapy. He was then referred (again) to Dr. A for a consult and then a decided-upon treatment. At that point in time, a post-surgical MRI revealed the full extent of Mr. L’s injuries.

Dr. A performed three different procedures including surgery to repair his torn rotator cuff. After this time, Mr. L went to Dr. M for an IME (independent medical examination) where several things were documented such as:

  • constantly aching shoulder
  • pain encountered with movement overhead
  • rotator cuff issues

Mr. L continues to need medication and ongoing pain management. Neither post-surgery medications nor therapies have helped Mr. L live without pain or limited ROM. He is restricted with the amount of hours that he can perform functions including:

  • standing
  • walking
  • sitting
  • reaching overhead
  • lifting
  • pushing
  • pulling

    He can occasionally bend, crouch, kneel, or stoop; drive no more than 30 minutes at one time; and cannot operate dangerous machinery because of his pain medications.

    Since his last surgery, Mr. L’s medical condition has not changed very much and after reading through the medical records I discussed with Mr. L the advisability of settlement.   Mr. L had indicated to me that while he would not be resuming his career as a private investigator, he was exploring other avenues to earn money.  Because he had been a private investigator, he readily understood that the insurance company would likely put  him under surveillance and that if he was seen engaging in any significant activity, the insurer would move to cut off his benefits.  We decided that this was a good time to settle and after several weeks of negotiation the insurance company agree to pay well over six figures.

    Case Study: Back Injuries and Workers Compensation

    The prevalence of on-the-job back injuries

    According to government statistics,  nearly 20% of all the work-related injuries involve back injuries and back pain, especially lower the back area.   The cost of these work injuries continues to soar – currently estimates put the cost of treatment and lost productivity at nearly $20 billion annually.   Not surprisingly many of the cases I see involve some form of back injury – ranging from cervical (neck) damage to lumbar and thoracic (mid to lower back) injuries.   In my experience, quick diagnosis and treatment can greatly improve the chances of a more complete recovery.

    General causes of back injuries

    Back injuries can result from numerous causes including:

    • Heavy lifting
    • Remaining in the same position for too long and too often
    • Repetitious activities and movements
    • Stressful lifestyles

    Back braces and modified lifting techniques can help but not prevent back injuries.

    The back injury case of Mr. S

    Mr. S worked for a company that owned several large trucks.   The company was selling several of its trucks and Mr. S’s supervisor directed him to show the truck to a potential customer. Mr. S was attempting to push open the hood of the truck when the hood (weighing 300 lbs.) detached and fell on him, pinning him to the floor.  Mr. S  began experiencing pain in his lower back as well as radiating pain in his leg.

    This accident was witnessed by both the potential truck buyer and Mr. S’s supervisor, who instructed Mr. S to go to one of the posted panel doctors.   Upon arriving at the doctor’s office, Mr. S noted that the line of patients was out the door and since he did not want to sit around and wait, he decided to return to work and took pain medication before returning to the job. Mr. S continued working for the next 4 months, relying on over the counter pain pills to reduce his pain.  At no point did he ever actually meet with a doctor.

    Around 4 months later, Mr. S again injured his back while working on a truck.  This time, he felt a definite “pop” and his legs went numb.  The supervisor again sent Mr. S to a  posted panel doctor who took Mr. S off work and began conservative treatment (prescription pain pills and physical therapy)  When Ms. S was unable to perform the exercises during physical therapy, the panel doctor ordered an MRI.  The MRI revealed several bulging discs as well as 2 herniations with impingement on the spinal cord.

    The panel doctor then referred Mr. S to an orthopedist for surgery.   Mr. S was not impressed with the surgeon and he emailed me with his story to ask if he had any options.   I suggested to him that if I was dealing with the same injury I would want to be evaluated by a specific neurosurgeon, and I also explained what Mr. S could expect in terms of rehab and case settlement.  At that point, Mr. S retained me to serve as his lawyer.

    Once I was retained I contacted the insurance adjuster and suggested that we agree that Mr. S should be seen by a neurosurgeon who I know to be very capable.  The adjuster agreed (to my surprise) and my client underwent a multi-level fusion, which my client underwent.

    There was one other interesting twist to this case – at the time my client was seen by the original panel doctor for the second time, the adjuster assigned a nurse case manager to assist with my client’s care.  For those of you who are not familiar with the role of the nurse case manager, she is a nurse who works on behalf of the insurance company to facilitate care.  Sometimes, nurse case managers can be helpful in cutting through red tape – such as getting diagnostic reports like MRI films to a doctor. In other instances, the nurse case manager can interfere with treatment by advocating on behalf of the insurance company – for example I have seen cases where a nurse case manager attempted to influence a treating doctor to return a claimant to work too early.

    Years ago, the insurance company had a right to assign a nurse case manager.  Under current law that right exists only in catastrophic cases.  Otherwise the claimant (usually through counsel) can terminate the involvement of the nurse case manager.

    In this case, we had to do just that.  The nurse case manager was attending my client’s medical exams and she was pressuring the surgeon to speed up the rehabilitation process.  I felt that her motivation and value were in question and I advised the adjuster that we no longer needed her services.