September 22, 2019

Injured Atlanta Cops Fight Workers Comp System

A front page story in the Sunday, May 24, 2009 edition of the Atlanta Journal-Constitution details the struggle of five catastrophically injured Atlanta police officers to obtain needed medical help from the City of Atlanta’s workers’ compensation office.  Each of these police officers was injured in the line of duty – with injuries ranging from brain damage to paralysis arising from gunshot wounds to the spinal cord.

Like many city and county governments, the City of Atlanta “self-insures” against workers’ compensation claims, meaning that weekly wage benefits and funds for medical treatment come directly out of the City’s budget.  The City does use a private claim’s administration service called NovaPro Risk Solutions out of San Diego.

The City is not denying responsibility for paying wage or medical claims, but it has been refusing to pay for various medical procedures and medical devices.

In one instance a police officer who had been rendered a parapalegic from a gunshot wound needed surgery on his Achilles tendon  because his feet kept slipping off his wheelchair footrests. [Read more…]

Closed Head Injury Case Results in $195,000 Settlement

Yesterday, I settled a very intense closed head injury case for almost $200,000. In looking back over this case, it strikes me that there are several important lessons here for anyone pursuing Georgia workers’ comp benefits.

This case involved a 47 year old construction worker who was struck in the head by a 100 lb. beam that fell on top of him from a height of over 14 feet. Although my client was wearing a hard hat, the impact from the steel beam knocked him unconscious and resulted in a fractured vertebrae in his neck.

Over the next 12 months, my client, acting without a lawyer, looked to his employer’s workers’ compensation insurance carrier to provide medical care. During that time he visited six different doctors on referral from the worker’s comp adjustor. Each time, he had to fill out an extensive new client questionnaire and he had to explain, as best he could, what had happened to him. This repeated new client intake process was very difficult for my client because he was in pain, suffering from memory loss and depression as well as severe emotional turmoil resulting from his accident. Despite all of these doctor visits, my client had not been referred for surgery and his condition was not signficantly improved.

Approximately 12 months after the accident, this gentleman called me to ask for help with his workers’ compensation case. Because the medical treatment so far had not helped much, I was able to convince the adjustor to approve as treating physician a top orthopedic surgeon here in the Atlanta area. My client subsequently underwent a two level fusion in his cervical spine (neck). We were then able to get a pain management physician approved as well as a psychiatrist to help with my client’s depression. And, after deciding that the timing was right to settle, we engaged in arbitration with the insurance company and agreed to settle the case for $195,000.

This was not a case where the insurance company denied the claim – there was no dispute that my client’s injuries arose out of and in the course of employment. When I was retained, my client was receiving his weekly wage benefits. The problem I had to deal with here was the insurance company’s unwillingness or inability to offer my client needed medical care.

Because my client was in pain, emotionally distraught and, most of all, unfamiliar with the Georgia workers’ comp system, he was not able to formulate a “big picture” strategy for his case.

The lessons you can learn from this case:

  1. you need to have a case strategy to follow and you need to demand that the insurance company fulfil its responsibilities to you
  2. do not assume that because the insurance adjustors are polite and cooperative that they are also working in your best interest.  The adjustor’s primary goal is to minimize the insurance company’s financial exposure
  3. physicians on the “posted panel of physicians” or who are referred by the adjustor may have divided loyalties.  You and your attorney are entitled to participate in the choice of physicians who treat you
  4. delay in getting appropriate medical treatment can result in longer recovery times and less satisfactory results

[tags] georgia workers’ compensation, posted panel of physicians, workers comp settlement [/tags]