September 22, 2019

How, When and To Whom Do I Give Notice of my On-the-Job Injury?

Several times a year, I get a call from an injured worker who is facing a denial from the insurance company on the grounds that no timely notice of a claim was filed.  The Georgia workers’ compensation statute contains two separate notice provisions, both of which must be met:

Notice to Employer

The Georgia Code says that an injured worker must give notice to his employer within thirty (30) days after his on-the-job injury.   We advise our clients to give notice, preferably in writing, to a direct supervisor.  The the sooner you give this notice the better.   When giving notice to your supervisor you should be as clear as possible about the exact date and time you were injured and about exactly what happened.    The more specific the better as we find that employers tend to question vague and uncertain reports about a work injury.

Remember that workers’ compensation covers injuries “arising out of and in the course of ” your employment.  This means that an injury incurred while you are on break, or coming or going from work may be challenged.  Be suspicious if your employer’s workers’ comp rep tries to put words in your mouth about when or how your injury happened.  A quick word about the phrase “arising out of and in the course of employment.”  The Georgia State Board of Workers’ Compensation spends a lot of its time listening to lawyers argue about what this phrase means.  What you tell your employer about your injury, and what you tell your doctor can make a huge difference.  For this reason, we encourage injured workers to seek legal counsel sooner rather than later.

Once you report an on-the-job injury, your employer is supposed to write up a “first report of injury” and send it to both the State Board of Workers’ Compensation and to its insurance carrier.   Not surprisingly, this does not always occur as employers try to avoid filing claims with their workers’ comp. carriers.   Your employer may delay filing the required paperwork and may tell you to file with your group health insurer.  They may suggest you file under short or long term disability for lost time from work.   Do not let this happen as group health and/or STD/LTD carriers will not pay for either lost wages or medical costs related to a work related injuries, as workers’ compensation insurance is considered “primary” coverage.  We have seen some situations in which the group health carrier initially accepts the claim, but later rejects it once the file is audited.  This could leave you stuck with a medical bill that otherwise should be covered.

Notice to State Board of Workers Compensation

In theory, once you give your employer notice of your injury, the employer will file a notice of claim with the State Board of Workers’ Compensation.  A better course of action would be for you to file that notice directly.  You file notice using a form called a WC-14, and this form must be filed within one (1) year from the date of your accident.  Our office regularly completes and files WC-14 forms for our client.  If you are not sure how to fill out this form, you should speak to an experienced attorney as filling out this form improperly can negatively impact your case later on. [Read more…]

Georgia State Board of Workers’ Compensation Web Site – a Useful Resource

Our firm’s blog and web site makes frequent reference to the Georgia State Board of Workers’ Compensation.   The State Board functions as the court system for workers’ compensation claims in Georgia.  The Board is a creation of the state legislature and it uses different forms that what you might see in a Georgia State or Superior Court.

I hope that this blog, along with the Ginsberg Law workers’ compensation web site, will be helpful resources for you as you educate yourself about Georgia workers’ comp. law.  Another very useful site is the web site published by the State Board itself.   While some of the material on the State Board’s site is geared towards lawyers, insurance companies and employers, there is a great deal of useful information there for injured workers.  For example the State Board web site has a very helpful FAQ section written for the benefit of injured workers.   Another section is written for employers – as injured worker, however, you can learn from this as well.  Another area of the State Board web site that you may want to review is the section that includes the various official forms that employers, insurers and claimant’s lawyers must use.

One of the main themes of the State Board site relates to how workers’ compensation is different than personal injury law.   If you understand, for example, that pain and suffering are not part of a workers’ compensation claim, or that an insurance company does not have to settle, you can make better choices in your own case.  If you are an injured worker, you obviously have concerns that transcend the organizational structure of the State Board of Workers’ Compensation.  However, you may find that an understanding of how the Board works can help you maximize your recovery should you have an injury claim.

Medical Treatment in a Workers’ Compensation Case – What You Need to Know

If you are injured on the job and you are a covered worker under the workers’ compensation law, your employer is required to provide you with medical care.  However, as you may suspect, what you consider as reasonable and necessary care may not be the same thing as what your employer and its insurer want to provide.

The posted panel of physicians is the starting point for your claim for medical treatment. Under Georgia’s workers compensation law, employers are required to post a list or “panel” of doctors in a reasonably accessible place for employees to see.   A valid panel should have at least 6 indpendent medical providers on it and at least one of these doctors should be an orthopedist.

If your employer has a posted panel, you may select a doctor and schedule an appointment, with the cost borne by the ermployer/insurer.  Often, your employer will try to direct you to a particular doctor or clinic with whom the employer has an on-going relationship.  Under Georgia law, you as the injured worker have the right to select from any of the doctors on the panel.  You can do yourself a real favor by avoiding doctors who may not have your best interest at heart – Ginsberg Law’s extensive experience with physicians throughout the State can be a huge benefit to you if you become our client.

If you choose to select a doctor on the panel that is different from the doctor that your supervisor is “suggesting,” you would be wise to ask the doctor’s office to verify that the workers’ compensation insurer has agreed to pay for the appointment.  Some employers honestly do not understand that employees have the right to choose a physician, and sometimes employers and insurers will intentionally playing games with the payment of medical providers for unrepresented claimants even if those providers are authorized.

If there is no posted panel of doctors, or if there is a panel that is not accessible, or if you have never been given any explanation of how the panel works, Georgia law can provide you the right to select your own doctor.  As you might imagine, employers and their insurers will do everything in their power to retain control of the course of your medical treatment. You may hear things like “that doctor is not authorized,” or “that doctor is not on our panel,” or “that doctor is not in our network.”  Be aware that there have been dozens of litigated cases in Georgia relating to the posted panel, and factors that either validate or invalidate the panel.  Part of our job as your attorney is to identify whether the posted panel issue is something to pursue or not.

To illustrate the importance of asserting your rights under workers compensation law, I would like to relate to you the story of a recent client of mine who suffered permanent nerve damage in his spine because of delays caused by the insurance company.  As any reputable doctor will tell you, time is of the essence if you have a serious injury. If you have a serious injury to your back, neck, arm, knee, foot, head or hand a delay in diagnosis can result in permanent injury and inability to return to work.

Our case involved a situation where a client hired us after enduring almost a year of frustrating delays in medical care. The client had a significant back injury after falling off the back of a truck. He hit the ground and had sharp, shooting pains in his back and radiating down his leg, with numbness in his toes. He was ordered by his employer to see the clinic down the road from his job. For several months, he stayed under the care of this clinic – taking medication and undergoing therapy that did not help, and actually made him worse.
When this injured worker (not yet represented by our firm) asked for a referral to a specialist he was ignored and offered more therapy. The clinic doctors released him to “light duty,” which he tried to do with very limited success. Finally, after many months the clinic doctor ordered an MRI scan, which revealed herniated discs at 2 levels impinging on a nerve in the spine.

Again, the injured worker asked for a referral to a spine specialist and after another full month of delay, he finally got the referral. The specialist confirmed the diagnosis of disc and nerve injury and ultimately the injured worker (now our client) underwent a fusion of his spine. Unfortunately, the surgery did not relieve his pain, because our client had incurred permanent nerve damage due to the delay in care.

The Importance of Reporting Your Injury Completely and Thoroughly and Why an Incomplete Report Can Damage Your Case

One of the issues that I sometimes face arises from my client’s initial report of his injury.  When you are hurt on the job, you can help your case greatly by thoroughly and accurately reporting your injury.

Don’t just talk about the one injury that is hurting you right now.  Instead, take an “inventory” of every part of your body that was involved.  Don’t exaggerate, but don’t minimize problems either.  For example, if you fell off a ladder, you might have immediate back pain.  But, you might also have:

  • concussion
  • headaches from the hard landing or from hitting your head
  • neck pain from sudden impact
  • foot problems from landing on your foot ackwardly
  • knee problems from landing on or twisting your knee
  • hand problems from falling hard on your hands

Your employer may send you to a doctor.  When you meet with the doctor, you want to begin creating an accurate paper trail.  Report each and every body part that is affected, even if the doctor does not seem interested.  Most doctors ask you to fill out an intake form – that form will become part of your case record.  Use it to identify all problems.

If you fail to list all problems at the outset, the insurance company may use this gap to deny coverage and to limit treatment.  If the insurance company identifies your case as a low back/hip case, they may not authorize your doctor to treat your knees or feet.  You could literally find yourself being treated for one part of your leg, but not another part because the doctor is specifically not authorized to treat that other part.

It may sound crazy to you that your doctor will only treat part of your problems, but this is a common situation in workers compensation.  The insurance companies put very specific limits on what they will pay the doctors to treat.

Now, what happens if you did not give your supervisor or your initial treating doctor an accurate description of your injury?  It may not be too late.  You may still be able to update your report of your injury and preserve your rights.  I would advise you to speak to an attorney before trying to do this on your own. 

Here is an example from one of my recent cases that demonstrates the importance of accurately reporting your injury.

My client was a carpenter who was carrying a 2×4 board on his left shoulder.  His right hand was in his apron  He fell down and landed on his left shoulder, leaving him in severe pain.  The employer sent him to a local emergency room where he complained about his left shoulder.  An MRI was done, showing a torn left rotator cuff that required surgery.

Following surgery and physical therapy, my client remained in severe pain.  At this point, the injured carpenter called me.  My first question – are you having headaches?  I asked this because I know that headaches are a common symptom of cervical (neck) disc problems.  I used the “employee’s second opinion” to have my client seen by an orthopedist who specializes in neck injuries.  Sure enough, my client had a herniated disc in his cervical spine. 

This cervical spine issue necessitated additional surgery and rehabilitation.  Because the injury was more severe than originally thought, this case had significantly more settlement value as well.  My client did have any medical background and there is no reason for him to know about the anatomy of the neck and shoulder.  I do have an understanding of this anatomy because I have represented dozens of claimants with similar issues.  This is a case where I was able to use my experience and knowledge for the benefit of my client.

Revealing the “Return to Work Trap” in Georgia Workers’ Compensation Law

What is the biggest trap that you can face in your Georgia workers’ compensation case?  Without question, issues relating to your return to work after being injured must be handled very carefully.

Let me give you an example.  Earlier this month, I received a call from a potential client.  This young man – I’ll call him "Tom" – had been working with earth moving equipment for a large construction company that was building a dam on a river in north Georgia.  Tom and a co-worker were working late – all of the supervisors and most of the co-workers were gone.  The co-worker pushed a large boulder towards Tom and when Tom tried to control the boulder, it rolled onto his hand, crushing a finger and badly injuring his hand.

Tom’s co-workers took him to the emergency room at a local hospital where his condition was stabalized and a hand surgeon was brought in.  Tom underwent surgery that very night to repair his hand.  Tom was released to go home late that night with a prescription for strong pain medicine and instructions not to use his hand until further notice.

The next morning, a supervisor from Tom’s employer called.   Although the accident had literally happened the night before, the supervisor began pressuring Tom to return to work.  During that first day after the accident, various supervisors from the employer called and emailed Tom repeatedly to demand that he return to work.

Within a few days, Tom received a letter from the employer’s workers’ compensation insurer stating that his claim would be accepted and that his TTD (temporary total disability benefits) would be forthcoming.   At the same time, during this first week, Tom continued to receive calls from his employer requesting that he report back to work.

Tom does not know much about workers’ compensation law, but he sensed that the employer’s actions were not in his best interest.   He found Ginsberg Law Offices on the Internet and he called our office.  When I first spoke with Tom, he advised me that his employer had never posted a panel of physicians, they had not offered him a prescription drug card, nor had anyone from the employer ever explained to him anything at all about how to file a workers’ compensation claim or about any of his rights thereunder.

Where is the "return to work trap?"

The trap arises when an employee returns to work.  Under the Georgia workers’  compensation law, if an injured worker who is receiving his weekly TTD benefits returns to work without a form WC-240, and he cannot perform the assigned job, the TTD benefits stop.  If the employer does not volutarily restart them the employee will have to request a hearing (and wait the two to three months for a hearing date) to try and get them restarted.

However, if that same employee returns to work with a WC-240, and cannot perform the assigned job, his TTD benefits will start again immediately.

What is this special form, the WC-240?

A WC-240 is a State Board from that sets out a specific light duty job description.  The WC-240 includes the start date for the light duty return to work, specific activity limitations as described by an authorized treating physician, the name and contact information for a supervisor and the light duty rate of pay.

If you return to work with a WC-240 and cannot perform the job duties, you notify the contact supervisor, then you return home knowing that your TTD benefits will start again automatically.

In Tom’s case, had he returned to the dam building site without a WC-240 and been unable to resume work in his heavy construction job, there is a good chance that the employer would have cut him off.   At that point, Tom would have no job, no income and no workers’ compensation benefits. 

As you can imagine, Tom’s settlement leverage would be very minimal.

I think it is fairly obvious that Tom’s employer has taken an aggressive, "in-your-face" approach to Tom’s case.  Even the insurance company adjustor confided to me that the employer was not acting properly in what amounts to harassment of Tom.

Sometimes employers understand Georgia law fully and they use this "return to work trap" to squeeze injured employees.  They know that an injured employee who has no money will be more likely to settle for a miminal lump sum out of desparation.

Other employers are not based in Georgia and they don’t know anything about a WC-240, but will take adavantage of the leverage associated with an undocumented return to work.

I think that Tim’s case also illustrates why an injured employee needs legal representation. 

Finally, you should be aware that the WC-240 was appropriate in this case because Tom had already been receiving TTD benefits.  If your employer has controverted the claim and no TTD benefits have commenced, a different strategy might be necessary.

Many of the calls I get from injured workers are triggered by questions about returning to work.  If your doctor has suggested that you are ready to return to work – full duty or light duty, or if your employer is pressuring you to return to work, please do not make any decisions without talking to me or to competent legal counsel.

Can a Hospital Bill Me Directly for Workers’ Comp Related Treatment?

This morning I received a bill in my name for payment due.  I called the establishment to inform them that this is a Worknman"s Comp claim and the employee there told me that it has not been filed with Workman’s Comp Insurance Company . I relayed this information to our office with a fax number for the paperwork to be sent to the company expecting their money.  What else can I do to have this matter resolved? The company I work for is in the process of being closed and I want to make sure this bill is paid.
–Alice

Jodi Ginsberg responds:   Alice, thank you for your email. Many times medical offices/hospitals will send bills to patients when it is a workers compensation injury. The law in Georgia prohibits them from collecting money from you when the medical provider is authorized under workers comp.  In your case, you indicated that your employer or the workers comp insurer directed you to go to the local hospital.  If this is the case then the hospital visit is "authorized" for workers’ compensation purposes and the workers’ comp. insurer is required to pay the bill.

You should first make sure you put in writing and keep a copy for yourself the fact this is a workers comp case; name and address of employer and workers comp insurance company with your name and date of service etc. Send that info to the hospital with a letter telling them to file it under workers comp. As well, send a copy of the bill to the employer and workers comp ins co and tell them to pay the bill. Keep a copy to the letter you send them as well. This should take care of it. If not, you may need to get an attorney to ask for a hearing.

Also be aware that workers comp pays on  a reduced fee schedule in Georgia.  This means that the hospital will get paid a set amount for services rendered and this set amount will likely be less than they might bill a non-workers’ comp. patient.  Any balance remaining over the reduced fee schedule is NOT your responsibility and you should not be sent any bills for the differential owed. If you get billed for the differential, tell the hospital this is workers comp and you are not paying it and do not have to by law.

It is important that you are proactive and assert your rights.  If your account is not coded as a workers’ comp account, you may find that your credit is damaged even if the charges are eventually paid by the workers’ compensation carrier.  Don’t let this happen – be firm and insist on fair treatment.

Finally, you note your company is going out of business. Do not worry. Despite the fact they are closing, as long as there is workers comp insurance you have a claim with the carrier regardless of whether the employer is or is not open for business.

[tags] medical reimbursement under workers comp, Georgia workers’ compensation, SBWC fee schedule [/tags]

 

Workers Comp Claims For Wrist Repetitive Motion Injury

I work at a job where I am using a computer keyboard all day long.  Over the past few months, my right wrist started to hurt and get numb at times.  I reported my injury on November 28, 2006 to the Human Resources Manager requesting for a keyboard tray from desk.

The HR Manager told me that it was out of his hands and that I should order a tray through my manager for approval.  I asked on several occasions for the tray and my injury started to become more aggravated, so I went to his boss asking him about the status of a computer tray.  He told me that the tray was too expensive and I now needed a doctors note in order for me to receive a keyboard tray.

I went to my doctor and told him the same story and he suggested that I file a workmen’s comp claim since it was a work related injury. It was filed the first week of February with the correct injury date of November 28th  I am scheduled for surgery this Wednesday February 28th and they are now just informing me that I have to use my PTO to compensate my time off.  Now, by law if I use the 21 days from the injury date (which it has been) shouldn’t I receive full compensation?

–Alyce

Jodi Ginsberg responds:  Alyce, thanks for your question.  The law requires that you file your workers compensation claim within 30 days of the injury.  Here it looks like your date of injury was November 28, but you did not file your claim until the first of February.   Is your employer acknowledging that you “reported” your injury in November?

For the benefit of anyone reading this blog, employers and insurance companies use these “reporting deficiencies” all the time to deny claims.  If you get  hurt on the job, you should always try to report the claim in writing and, if possible, file a report of on-the-job injury yourself with the State Board of Workers’ Compensation.

Assuming that your employer recognizes this as a workers comp injury, you ask about the 21 day rule.  The 21 days runs not necessarily from date you reported it,but rather, from date of economic disability (when you stopped working). Did you continue working after the November, 2006 “injury date?”

By the way, if your injury did not “happen” on a specific day but was the result of months or years of overuse, then the injury date you choose is called a “fictitious injury date.”  In cases involving these types of “overuse” injury, it is even more important for the injured claimant to file his own Form 14 notice on injury with the State Board.