September 22, 2019

Returning to Work on Light Duty – Proceed with Caution

return to work under wc-240aI have previously written about the importance of never returning to light duty work without a WC-240a form completed by your doctor after being out and receiving temporary total disability benefits.  The WC-240 and WC-240a will set out specific limitations for the type of activities you can perform in your light duty.

Board Form WC-240 contains a “Notice to Employee of Offer of Suitable Employment” containing the a job title, rate of pay, hours of work and date light duty work is to start.  Form WC-240 is filled out by your employer/insurer. A WC-240a should be attached to the WC-240.

Board Form WC-240a must be completed by your authorized treating physician.  It contains a detailed checklist setting out specific activity limitations for your light duty return to work.

If you return to work with a WC-240 and WC-240a and within 15 days, you find that the offered job does not fit within your limitations and you cannot perform the job duties, you can leave the workplace and your TTD benefits will resume automatically (although your employer can subsequently ask for a hearing to terminate your benefits).

If you return to work without a WC-240 description of activity limitations, and cannot perform the job, you also have 15 days to determine whether you can perform your job and thus get an automatic reinstatement of your TTD benefits.  However, my experience has been that insurance adjusters are much more likely to challenge your decision to leave a light duty job by filing paperwork to cut off benefits if there is no WC-240 description of a light duty job for you.

If you wait more than 15 days to decide that you cannot perform the light duty job, your benefits will not automatically restart and you will have to wait weeks or months with no income coming in to get a hearing date to bring the matter before a judge. [Read more…]

Double Standards Alive & Well at Insurance Companies

I am currently representing a client with a significant back injury who is currently treating with a posted panel doctor.   The doctor in this case is well known to me and other claimant’s lawyers as a physician who very rarely keeps a patient on no work status very long and who is reluctant to order diagnostic tests or to refer a patient out to a specialist.

This particular doctor apparently gets all of his business from insurance companies and his medical decisions are a byproduct of his source of fees.

I know about this doctor’s bias and the insurance adjuster surely knows this as well, yet I find myself playing the same game once again.  The panel doctor will release my client to full or light duty work.  The insurance adjuster will issue a notice of termination of benefits.   I will file for a hearing and/or a change in treating physician.   Eventually, the adjustor or defense attorney and I will agree on a legitimate doctor who will most likely find that  my client needs surgery.  Benefits will be restored and my client will get the treatment he needs.

Even though the script has already been written, insurance adjusters keep trying to close out cases involving seriously injured claimants.

I suppose that sometimes they get away with this nonsense – either because the claimant is unrepresented or because the claimant has an inexperienced lawyer.

Having been on the other side, I know how this game is played and it is not going to happen on my watch.   Insurance adjusters are quick to cut off benefits but when a physician calls for more expansive treatment, an MRI, or a referral to a specialist, the process usually grinds to a crawl.

I talk about this a lot with clients and colleagues but it bears repeating – you are going to get walked on if you let the insurance company dictate the pace and progress of events.  Timing is everything in a workers’ compensation case and you have to demand action or nothing  happens.

Last week I was recording some videos for my web site and I got to thinking about the insurance company double standard – here is what I think:

 

Social Media and Workers’ Compensation Claims – a Bad Combination!

Would you be surprised if I told you that those photos you uploaded to Facebook, or that video of your child’s basketball game now playing on YouTube, or even your restaurant “check-in” on Yelp could cost you thousands of dollars and seriously undermine your workers’ compensation case?  Unfortunately all of these things have happened to men and women pursuing work injury claims in Georgia.

If you did not realize this already, understand that privacy in the United States is pretty much dead.  If you participate in social media like:

  • Facebook
  • My Space
  • Yelp
  • Tumblr
  • Wordress (blogging)
  • Blogger
  • Pinterest
  • YouTube
  • Twitter
  • and many more

information about your life can be available to anyone who is looking.  And you can bet that insurance adjusters and insurance defense lawyers are looking.   While private eye surveillance is still used, insurance defense adjusters also run searches for you on various social media platforms.  If they see you running, jumping, lifting or doing anything inconsistent with your claimed injury, they will use that video, photograph or post as grounds to cut off your benefits.

A colleague of mine tells the story of a client of his who decided to video her son’s high school wrestling match and thereafter uploaded to YouTube.  At one point the video shows the claimant climbing bleachers, then jumping  up and down to cheer her son.  Unfortunately this woman was asserting a job injury to her hips and lower back that she claimed was disabling.  When confronted with the video, she insisted that the wrestling match was a one-time event and that she ended up in bed for a week thereafter.  The workers’ compensation judge did not accept this argument and upheld the insurance company’s termination of benefits.  A case that could have settled for $50,000 to $75,000 ended up settling for nuisance value of less than $5,000.

Don’t let this happen to you.  If you are pursuing Georgia workers’ compensation benefits, close or suspend your social media activities until your case is over.

 

 

What to do About Substandard Medical Care in Your Workers’ Compensation Case

industrial clinic doctorIf you have never been involved in the Georgia workers’ compensation system before, you may be shocked and disappointed to learn that some of the physicians you meet seem to have an agenda other than your health and best interest. The Georgia workers’ compensation statute has created an environment where insurance companies have a financial interest to find and use doctors who downplay the seriousness of your injuries and who intentionally avoid referring you for necessary, but expensive care.  The net result of this system can mean delay and unnecessary suffering for you.

I sometimes receive calls from injured workers who are receiving weekly wage benefits as well as medical care, who wonder why they should hire counsel if everything “seems to be working out okay.”  Sometimes they sense that something is not quite right but are wary of rocking the boat.

Know Your Doctor’s Reputation

I respond that one of the most valuable services I offer my clients has to do with my knowledge of and opinions about the medical providers that accept workers’ compensation referrals in Georgia.  After 20+ years of practice in this area of law, I have seen or know about the biases and quality of work offered by most of these doctors. [Read more…]

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.

    The Nurse Case Manager – Who is She and Does She Belong on Your Case

    [mc id=”175″ type=”audio”]Jodi discusses the role of the nurse case manager and when it makes sense to terminate her involvement[/mc]One of the lesser known players used by Georgia workers’ comp insurers is the nurse case manager. In the past, insurers could assign nurse case managers to every claim. Now, claimants and their lawyers can terminate the involvement of nurse case managers, except in the instance of catastrophic injury cases. Who is the nurse case manager and what does she do? In this short audio report, I explain how insurance companies sometimes use nurse case managers to try and influence treating doctors and I discuss a recent case in which I pulled the plug on a nurse case manager’s involvement.