October 23, 2019

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.

Case Study: Workers Compensation and Repetitive Motion Injuries

Welcome to the 3rd installment of my summer long series on Georgia Workers’ comp case studies. In the following case study, I discuss workers’ compensation and repetitive motion injuries.

An overview of DeQuervain’s Syndrome and Lateral CTS

DeQuervain Syndrome is also nicknamed Mother’s Wrist or Washerwoman’s Sprain. In more medical, technical terms it is known as de Quervain’s tenosynovitis, de Quervain’s stenosing tenosynovitis, or Radial styloid tenosynovitis. DeQuervain’s syndrome is an inflammation (or tendinosis) that occurs in the sheath or the tunnel which surround the two tendons which are responsible for the thumb’s movement.

Carpal Tunnel Syndrome or CTS is also referred to as median neuropathy at the wrist and is a condition that results from a compressing or pinching of median nerve in the wrist area. It typically leads to extreme pain, muscle weakness, and numbness of the hand. Night symptoms and waking up off and on are characteristics of CTS as well. The definitive or standard treatment of the condition is a surgical procedure known as carpal tunnel release.

It should be noted that although this surgical procedure effectively relieves the symptoms of CTS, established nerve dysfunction in the form of atrophy, constant or “static” numbness, and weakness are all permanent. Ironically, most CTS cases do not have a specific cause, and some individuals are predisposed at developing the condition based on genetics.

Workers’ Compensation case involving repetitive motion injury: The case of “Ms. C”

Our client, Ms. C, was diagnosed with bilateral CTS as a result of her repetitious work in cake decorating. According to Dr. D, she was diagnosed with “bilateral DeQuervains tenosynovitis and ulnar nerve injury.” As a result of Ms. C’s injuries, she underwent surgeries on both wrists. About 6 weeks later, she went through surgical procedures on the left wrist – carpal tunnel and DeQuervains release surgery.

Ms. C continues living in pain today, even after the different surgeries were performed. Pain is prevalent especially in the hand, at the incision, and in the wrist area. She is currently undergoing physical therapy and has limited range of movement (ROM) as well as the pain mentioned in the above areas. It is evident that she will continue to remain under medical care as well as receiving TTD for quite some time.

Given the residual problems that exist and her surgeries, the PPD (Permanent Partial Disability) rating of each wrist is 10%. Additionally, due to the repetitive nature of Ms. C’s work, it is very obvious that her capacity to perform her job has been severely limited and she will experience continued levels of pain. As a result of her case, we have demanded “X” amount in her Workers’ Compensation case and are awaiting settlement

What is a “Claimant’s IME” and How Can I Take Advantage of this Powerful Benefit?

I often explain to my clients that a major struggle in any workers’ compensation case relates to medical care.  Georgia law gives employers the first opportunity to decide where an injured worker must go for treatment but this control is not complete:

  • if your employer does not provide a valid “posted panel” of physicians you may be able to seek care with any physician and your employer and its insurer must pay for this care
  • you can switch between one posted panel physician to another without prior permission
  • you can request  a change in authorized treating physician
  • you can request a claimant’s IME

The claimant’s IME is a very interested feature of Georgia law.  First enacted in 1990, Section 34-9-201(e) provides that an injured worker can demand an independent medical exam with a physician of his choice, paid for by the workers’ comp. insurance carrier.  In my practice I use this “claimant’s IME” frequently to get a second opinion about questionable existing care or as evidence to support a request for permanent change in authorized treating physician.

Of course your right to a claimant’s IME under Georgia law is not absolute – I recently wrote an article about this topic on one of my web sites.   Take a look if you are not happy with the quality of medical care you are receiving – and let me know what you think.

Are medical and vocational rehabilitation costs covered under worker’s comp?

What is Worker’s Compensation?

Worker’s compensation, or more colloquially worker’s comp, refers to a type of insurance which provides certain benefits to employees that are injured on the job such as income due to lost wages and medical treatment. Additionally, the employee relinquishes their right to sue the employer for negligence once they file a worker’s compensation claim. Oftentimes, the trade-off between the assured, limited coverage versus the relinquishing of legal recourse is referred to as “the compensation bargain.”

What is covered and not covered?

While there are some differences between state worker’s compensation laws, the underlying intention and premise of worker’s comp benefits is the same. For instance, in the state of Georgia, any employer who employs three or more individuals, regardless of full-time or part-time status, must provide worker’s compensation insurance. They must also provide the injured employee, at their expense, proper medical care for the on-the-job injury.

Additionally, in cases involving the loss of a limb or the death of the employee is the case, worker’s compensation benefits are also provided. For instance, if you lose an arm or a leg and this causes you to take a lower paying job or position, you are entitled to benefits to cover the loss of wages. Similarly, if you die as a result of the industry, your spouse and children are entitled to benefits.

Other benefits that may be necessary

In addition to the above, not all of the benefits provided by Worker’s Compensation Insurance involve lost wages and medical care. Sometimes it is necessary to provide the injured employee with either rehabilitation benefits or vocational benefits. If this is the case, you will receive these benefits should there be an injury rehabilitation period involved, or if you need vocational training in order to perform a different job or have to take on a new position in the company where you were injured.

Worker’s comp rehab benefits apply to a variety of circumstances when they become necessary due to the on-the-job injury you have incurred. These include:

  • Prosthesis and learning how to perform your job with the artificial limb
  • Physical therapy required in order so that you can function and perform your job normally
  • Speech therapy
  • Vocational therapy (learning how to perform a different job)

If you need further information regarding any of the above or have any questions, please call contact us by visiting our website or sending us a comment using the form below.

Independent Contractors and Workers’ Compensation

What is an independent contractor?

Any business, corporation, or individual that provides products or services to a business entity and is specified contractually or by verbal agreement is referred to as an “independent contractor.” According to the IRS tax codes, they are not defined or recognized as an employee of that business or corporation. They typically work as they are required to and are usually subject to what is called the Law of Agency.

Additionally, independent contractors (hereinafter referred to as IC’s) are responsible for paying their own federal and state taxes; this is not the responsibility of the business, corporation, or individual who has contractually procured the IC’s products or services. Compensation is normally made on a freelance basis and the IC may be working through a limited company which they own themselves or via what is called an “umbrella company,” a company that acts as the agent for the IC.

Does worker’s comp cover the independent contractor?

Under the worker’s compensation laws of the state of Georgia, independent contractors are not covered for any injury sustained while performing their work. However, the definition of an independent contractor under state statutes has very specific guidelines in order to determine if the individual is an employee or an IC. Employers do not always use this definition correctly or properly. Additionally, the IRS’ guidelines regarding IC’s are not followed by worker’s compensation law.

For these reasons, this is a very problematic area. However, it is extremely ironic that an individual who has opted for being an independent contractor and who engage in dangerous or high risk occupations are not covered by Worker’s Compensation Insurance based on their independence or freedom from an employer. But the fact that employers would love to classify employees as independent contractor is what leads some to cheat and do exactly that so they are not responsible for worker’s comp benefits.

The bottom line is that if a business owner or corporate entity has 3 or more individuals working for them and they require a method, manner, time, and the type of work that the individuals are expected perform, they cannot classify the individual as an IC. Any business owner who employs 3 or more individuals is required to carry Worker’s Compensation Insurance. It is not surprising then that some employers try to “cheat the system” in order to avoid purchasing this type of coverage.

If you would like more information regarding the independent contractor/worker’s compensation issue, please feel free to contact us at our website. We will be happy to answer any questions you may have and provide you with additional information.

Judge Orders Injured Worker to Allow Insurance Company to Examine His Computer

Last July, I wrote a post on this blog about how your Facebook profile could be used against you in your case.  The Georgia State Board of Workers’ Compensation will allow defense counsel to introduce status updates and pictures to challenge your assertions that you are injured and cannot work.  This is in addition to the surveillance and other investigation that defense counsel use to impugn your credibility.

More recently I have learned of a case where the insurance company’s defense lawyer used a “request for the production of documents” to demand that an injured claimant turn over his personal computer to be examined by the lawyer.  As you may know, when you file a workers’ compensation claim in Georgia, both sides are allowed to demand information from the other per Georgia’ “discovery rules.”

Apparently, in this case, the insurance company believes that the claimant’s hard drive will reveal damaging information – perhaps photos, evidence of work or physical activity, or it may be just a fishing expedition.

Now, this was not my case, and at this point, at least, this demand for the claimant’s computer has not become a regular part of defense counsel’s arsenal, but I think that this type of request sets a very bad precedent.  I learned about this case in a monthly meeting I attend with a few other claimant’s lawyers who get together to discuss current developments in the law and winning strategies.  All of us in last month’s meeting were somewhat taken aback by this discovery request as well as the presiding judge’s approval of the request.  We all agreed that if any of use are involved in a case and the insurance company asks to look at our clients’ computers, we will fight this request vigorously. [Read more…]

Employee Gets Bad Information About Legitimate Job Injury

Although Georgia’s workers’ compensation system is supposed to foster an environment where legitimately injured workers can get needed treatment and then return to work, the reality is much different.   It has been my experience that workers’ compensation practice is just about as adversarial as divorce practice.  Often justice and fair play take a back seat to “winning” and efforts by employers insurance companies to avoid paying benefits.

Case in point.  This week I received the following email from a young woman who works at a factory in north Georgia:

Where I work I have been told that carpel tunnel is not recognized as a workman’s comp injury if I wasn’t having problems with numbness before.  Is this correct?

The short answer is “no, this is not correct.”  Repetitive motion injury (often resulting in a diagnosis of carpel tunnel syndrome) is a very common work injury, especially for factory workers performing manual labor with their hands.

Any employer who tells an employee that “carpel tunnel is not recognized as a workers’ comp. injury” is either very misinformed or downright dishonest. [Read more…]