December 10, 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.

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Why Would my Employer Deny my Legitimate Injury Claim?

I have written a lot on this blog about how strategies you and your lawyer can use to fight insurance company delays, refusal to authorize needed medical treatment and refusal to start weekly wage benefits.

You may be wondering why your employer – and by extension, their insurance company would fight you on a work injury claim that was witnessed and where even the posted panel doctor agrees that your injury arose from your job?

Isn’t there some sort of “good faith” requirement that insurance companies need to meet? And beyond that, what benefit accrues to the insurance company if their delays result in more needed medical treatment and more off-work status for you? [Read more…]

Can You Collect Workers’ Compensation Benefits if You Were at Fault in your Work Accident

Would you be surprised to learn that you are eligible to pursue workers’ compensation benefits in Georgia cases even if you were at fault in the accident?

Workers’ compensation law in Georgia is considered a “no fault” system, meaning that you are covered even if your injuries arose from your own negligence.  Under Georgia law, you are automatically covered by workers’ compensation is your injury arose out of and in the course of your employment.  This idea that in order to be covered you need to be acting for the benefit of your employer is common in workers compensation statutes in many states – for example in North Carolina the work injury law asks if your employer exercise control and direction over your work?

Examples:

  • a forklift driver turns too late and knocks over a scaffolding, causing boxes to fall on him, resulting in a broken arm and a closed head injury.  The forklift driver is eligible for benefits.
  • an industrial sewing machine operator gets distracted and loses a finger to a cutting knife.  The machine operator can pursue workers’ comp. benefits
  • a backhoe operator fails to properly park his machine and he gets run over when trying to exit the cab.  The backhoe operator is covered.

While you are eligible for workers’ compensation benefits even if you were at fault, you can be denied if your injury was the result of “horseplay.” [Read more…]

How to Combat Insurance Company Delay Tactics and Refusal to Authorize Medical Treatment

What can you do if your treating doctor wants to refer you to a specialist, or tries to order an MRI or CT scan, but the workers’ compensation insurance company refuses to authorize this needed treatment?
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Under Georgia workers’ compensation law, if you are receiving care from a “authorized treating physician” and that authorized physician refers you to a specialist, the referred doctor is supposed to be authorized automatically.

Similarly, if an authorized treating physician writes an order for an MRI, CT or other diagnostic test, that test should also be authorized.

What we are finding, however, is that when the referred doctor or the medical testing center calls the insurance company to verify that they will be paid, the insurance adjustor may say “no.” And of course, if a medical provider or testing center does not have a source of payment, they will not provide treatment to you. [Read more…]

Delays in Medical Treatment: Bad for Your Work Injury Case

 

When you are hurt on your job, you should not delay seeking medical care.

Your employer and their insurance company will treat your delay in seeking treatment as an “admission” that your injury really is not that severe.  They will fight to avoid paying for medical tests and they will oppose your effort to see a specialist.  Your settlement will likely be negatively impacted.  When an insurance company lawyer deposes one of my clients, one of the first questions asked is “how soon after your injury did you first seek medical care.”

It does not matter if you think that you have a good reason for waiting to see a doctor.  Perhaps you believe that ice packs and a little rest will solve the problem, or perhaps you are concerned about reporting a work injury to a cynical or even hostile supervisor. [Read more…]

Injured Workers Suffers Due to Insurance Company Tactics

This is a video from a TV news report in Michigan but the issues raised are the same as what we face here in Georgia.  Workers’ compensation insurance companies frequently send claimants to “independent” medical examinations that result in bogus diagnoses and unconscionable claim denials.

I wrote about this issue on this blog back in February – this video clip shows the human tragedy that can occur when a claimant gets railroaded.

“Independent” Medical Exams Scheduled by the Insurance Company are Rarely Legitimate

Funny Doctor breaks the bad newsA very common tactic used by workers’compensation insurance companies to cut off your benefits involves the use of something called an “independent medical exam” or IME.  As you might guess, in my experience these medical evaluations are rarely independent and they often serve no purpose other than medical support for termination of benefits.

Fortunately, most of the State Board judges that consider workers’ comp issues understand how the IME game works, and they look at these results with a very critical eye, but insurance adjusters continue to use this practice as a matter of course.

When I get an IME notice, the first thing I will look for is the name of the examining doctor.  There are a number of physicians out there who work extensively for the insurance industry and in almost every file sent to one of these doctors, the resulting report will minimize the extent and nature of the work injury, question the relation of injury to the accident at work , and suggest that a full duty return to work is appropriate.

Because the insurance company has the right to send you out for one of these biased IMEs, you have no choice but to go.  I can usually predict what the forthcoming report will say and that the insurance company is planning to try to cut you off, so I gear up to request a hearing challenging the proposed cut off.

The file will end up on the desk of a defense lawyer who I most likely know.  He or she and I will talk and acknowledge that the insurance IME was a waste of time and we will either start to discuss settlement, or try to agree on a more unbiased doctor to see you. [Read more…]