December 13, 2019

Employee’s Failure to Honor Light Duty Restrictions Results in Denial of Benefits

How are your rights under Georgia’s workers compensation law affected if you return to work light duty but end up performing full duty work?

In a recent case heard by the Georgia Court of Appeals, an injured worker was denied weekly wage benefits because he worked beyond the light duty restrictions set out by his supervisor.

The employee in this case was a cook, cashier and clean up worker at a fast food restaurant. In January, 2013, the employee injured his back when lifting a pot of chili. Shortly thereafter he aggravated his back throwing trash into a dumpster. He was instructed by his supervisor to avoid heavy exertion.

On November 19, 2013, the employee injured his back again when a stack of boxes collapsed on his head and chest while he was unloading supplies. Following this accident, the employee’s supervisor instructed him “not to lift anything unless given permission to do so by a member of management.” Four days later, however, the employee was observed by his supervisor lifting heavy items while restocking the store. [Read more…]

Back Pain Claims Under Georgia Workers’ Compensation Law – Avoid the Runaround

Back injuries that occur on the job are the most common type of injury claimed by employees under the Georgia workers’ compensation system.  This is not surprising since a back injury can occur when you are lifting, carrying, pushing or stooping.  You can also injury your back when you slip on a wet floor, or if you fall off a ladder or scaffold.

Whatever the reason for your injury, if you hurt your back while working you are automatically covered by your employer’s workers’ compensation insurance.  Your employer does not have the option to “opt out” of workers’ compensation coverage.

Once you report your on-the-job injury to your employer, a workers’ compensation insurance company will get involved and  this is where you may begin seeing problems.

You are Only a Number to the Insurance Company

Even if you are a long time employee, cherished by your boss and treated like a member of the family, your employer’s insurance company will see you only as a number and a cost that they need to keep down.   Many of our clients have expressed frustration and anger at the disrespect showed to them by their employer’s insurance company. [Read more…]

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…]