May 20, 2019

Why Your First Doctor’s Appointment Following Your Accident is so Important

doctor visit after work accidentMost of us have seen police dramas on TV where the arresting officer tells the suspect that “anything you say can and will be used against you.” In your Georgia workers’ compensation claim not only do you have to worry about what you say, but you also have to worry about what you do not say.

In my practice, I often have to deal with the situation where my client does not discuss with his doctor all of the physical problems that arise from the accident.

  • Example: you fall from a ladder and land on your tailbone but you do not mention to the doctor that your neck is sore as well.
  • Example: you strain your lower back lifting a heavy box but fail to mention to the doctor that your wrist is swollen and sore and that your thumb is numb where the box fell on it

If you do not provide a complete list of your medical problems to the first doctor who sees you, later on you may find that the insurance company will refuse to authorize treatment for that omitted body part.

This results in a situation where later on in the case, for example, the insurance company notifies the doctor that they will pay for treatment of your lower back but not your neck, wrists or hands. You can find yourself meeting with a doctor who will literally refuse to treat you for the unapproved body part even if you are in extreme pain and likely to suffer permanent nerve injury if you do not get treatment. [Read more…]

When is the “Right Time” to Settle Your Case?

Perhaps no other element of a workers compensation case gives rise to as many questions as the subject of when and how to settle your case.  In my opinion the timing of settlement negotiations can greatly influence the outcome of your case.  Settle too soon and you may end up paying out of pocket for expensive medical services.  Wait too late and your case can grow stale if the insurance company can calculate with certainty its exposure on your case.

Generally the best time to settle your case is when significant uncertainty remains regarding your future medical and lost wage eligibility.  Remember – insurance companies are in the business of risk management.  If we can show them that your future medical costs could soar into the tens of thousand and that  your return to full duty work could be far into the future, they will be more likely to offer more money to eliminate that risk.

I tell my clients that identifying that “sweet spot” is more art than science.  Sometimes a single line in a medical record, or a brief comment from my client will tell me that we are entering the zone where my client’s medical condition is stabilizing but enough unknowns remain for me to put forth a settlement demand that will result in a fair and generous settlement.

Insurance Adjuster Attempts to Use Nurse Case Manager Against Injured Worker’s Interests

illegal actions by workers compensation adjusterThis past July, I discussed on this blog issues related to the participation of a nurse case manager in a Georgia Workers’ Compensation claim.   In that post I pointed out that insurance adjusters sometimes assign a nurse case manager to a particular claim.  The nurse case manager is not an adjuster, and they do not deal with issues related to wage benefits.  Instead, they deal with the medical component of your case only and a nurse case manager can be helpful in setting up medical appointments, coordinating transportation to and from doctor’s visits and working out issues with prescriptions.

Issues arise when the nurse case manager tries to influence your doctor about signing off on a return to work release or suggesting to the doctor that he include in his reports statements which say that your pain has subsided and that you are doing better.  Some nurse case managers even try to influence the drug prescriptions written by the doctor.  Others appear at each one of your appointments and try to stay in the room when your doctor examines you.  You have the absolute right, by the way, to insist that your nurse case manager step outside during your examination and conversations with your doctor. [Read more…]

Workers’ Comp Tip: If your work involves tips, keep good/accurate records of wages earned

Recently I had a workers’ comp case where my client suffered from a very severe and complex ankle injury and had to undergo 2 surgeries over a period of several months. Even after the surgeries, she still required ongoing medical care and had limited range of movement, resulting in her inability to work certain jobs.

When her initial workers’ comp benefit was calculated, she was awarded a weekly TTD benefit that was a gross underpayment when you looked at all the care she needed and the specifics of her case. After a careful review of the case, it became obvious that her benefit was mis-calculated due to her position as a waitress – where a lot of the money she brought in was due to TIPS.

You see, many times servers and bartenders and other workers who bring in significant income from tips end up experiencing improper wage calculations and mis-calculations of benefits owed when in pursuit of workers’ comp cases. The same is true for workers who work off commissions or receive large bonuses.

In my client’s case, we were able to get her the benefits she deserved (we ended up securing higher TTD benefits, plus TPD and PPD as well), and we were also able to re-calculate her wages to reflect a more accurate picture of what she had been making at the time of the accident. This is why it pays to have a workers’ comp attorney helping you with your case – we see these situations often and can often help you maximize your benefits.

In any case, the tip of the day is this: To anyone bringing in significant income from tips, commissions, or bonuses, KEEP GOOD RECORDS in the event that you are one day injured and have to pursue a workers’ comp case!

How Facebook Can Undermine Your Workers’ Compensation Case

If you have a computer and enjoy sufing the web, there is a good chance that you have a profile on Facebook, mySpace, Twitter or any of more than a hundred social media sites.   These sites exist to help you connect with others – often for social purposes, and sometimes for business purposes.

How can an account at Facebook or many of these other sites hurt your workers’ compensation case?  When you create a profile on Facebook, your account has a default privacy setting that offers no privacy.  Anyone who has a Facebook account anywhere in the world can find your profile and read what you have posted, what others have posted on your “wall” and view photos that have been “tagged” with your name.

Insurance defense lawyers are well aware of Facebook, and they are aware that many Facebook users may not be very savvy about changing privacy settings.   Perhaps there is a photo of you attending a ball game or a family gathering.  Maybe you listed yourself as the CEO of ABC Enterprises. Thanks to New York workers’ compensation lawyer Jim Reed who posted about this issue on his New York InjuryLaw blog.

Photos and updates can easily be taken out of context.   Even your frequency of posting can be used as evidence that you have the capacity to perform clerical type of work.   Posts on Facebook and other social media sites can be used against you to put you on the defensive and as leverage to reduce the value of your case.

So, if you enjoy using Facebook or similar sites, take a few minutes to learn about the privacy settings.  Block your profile to all but known friends and avoid “friending” someone that you don’t really know.

If you were not already aware that there is no real privacy in the world, now you know.  Take steps to protect yourself.

What Are the Factors Used in Evaluating a Catastrophic Injury Case for Settlement?

I have been classified Catostrophic by GBWC and am totally disabled. Everyone concerned has no objections. My insurance Co. has said that they may want to settle. Medicare setaside has already benn set. What should I be looking for in a settlement. Is there an amount that I should be looking for . I am 55 and will not be able to work again. My claim is covered by the SITF. , but my Ins. Co. is in rehab. Thanks I look forward to your answers.
–James

Jodi Ginsberg responds:  James, thank you for your email.   Here are my thoughts.

I look at a number of issues when settling a catastrophic workers’ compensation claim.  By the way, since some of those reading this blog entry may not be familiar with the term "catastrophic injury," I would like to briefly define the term.  Under Georgia workers’ compensation law, the State Board has the power to designate a claimant’s injuries as catastrophic.   This means that the Board recognizes that a claimant like James will not likely be able to return to work because of the severity of his injuries. 

Most importantly, once a claim has been deemed catastrophic, the 400 week cap on benefits does not apply.  In theory a catastrophic claimant could collect temporary total benefits for the rest of his life, as opposed to a maximum of 400 weeks for a non-catastrophic claim.  Note, however, that just because a claim has been deemed catastrophic, there is no automatic right to 400 weeks.  In theory a treating doctor could return a catastrophic claimant back to work.

That being said, catastrophic claims have a higher value for settlement purposes since the employer/insurer’s exposure is unlimited.  Also, when a case is deemed catastrophic, a "rehabilitation supplier" is assigned to your case – these case workers are neutral in theory, but usually their interests lie more with the insurer.

Now, back to James’ question.   I go through a checklist to evaluate the value of a catastrophic claim.  My checklist includes factors like:

  • what is the insurance company’s exposure for future temporary total disability – what do the actuarial tables say about your projected lifespan?

  • how much future medical care will you require?

  • what is the likelihood of needing future surgeries?

  • will home modifications be required because of your injuries

  • will vehicle modifications or a vehicle purchase be required

  • will home health care services be needed?

  • what are the provisions of the Medicare Set Aside

  • since the Subsequent Injury Trust Fund (SITF) is involved, and your because the insurer is not fully solvent (the Insolvency pool is involved), timing would be an issue.  My experience has been that the SITF complicates matters because there are layers of bureaucracy involved in getting an SITF case settled

  • what future benefits will Social Security provide for post-settlement living costs

  • would a structure settlement be in your best interest?

  • should you settle in the first place? – sometimes your best bet is to maintain the status quo and continue to receive benefits for a period of months or years

These factors are among the ones that I consider when looking at a catastrophic case.  I can’t really comment more without  knowing about your specific case, but I think you get the idea.  If I can be of service to you, please do not hesitate to call me.

[tags] catastrophic injury and georgia workers compensation, subsequent injury trust fund, medicare set aside, settling a catastrophic georgia workers’ compensation case [/tags]

 

What is Two Year Old Case Worth in Settlement if I Have Returned to Work?

I was injured in a car accident in Dec. 2004 while on the job. Workers comp accepted responsibility and paid my medical and PT expenses. Extensive injuries included broken femur, broken (upper) arm, fractured liver (which required surgery for continued bleeding), broken ribs, punctured lung, etc. Spent 24 days in ICU. After several months recovery at home, Dr. declared me at 7% disability, and worker’s comp paid several months worth of benefits based on that rating. Now it is 2 years later and while I am able to work, I still have little strength in my arm, and I walk with a limp (and occasionally my leg gives way and I nearly fall). Some days are pretty painful, although I manage to hold down a full-time job. One year ago, they asked if I wanted to settle (not naming a figure) and I declined. Nothing else has been mentioned. Can you give me a vague figure for settlement for these type injuries and also will my time run out for settlement?

Jodi Ginsberg replies:  I look at a number of factors when creating a demand for settlement.  There are two "big picture" concepts that apply:

1) the best time to settle is when there is maximum uncertainty in your case.   Perhaps you are facing surgery, which would mean unknown medical costs and unknown lost wage benefits payable.  Perhaps your doctor is proposing conservative treatment in the form of several months of physical therapy after which possible surgery.  As your lawyer, I can make the argument that the insurance company’s potential financial exposure might be XYZ dollars.  If your doctor has released you back to work or if your doctor has already performed surgery and you are participaing in an uneventful rehabilitation, there is less uncertainty and less reason for the insurance company to value the case at a high number.

2) insurance companies look at their potential financial exposure when deciding how much to offer you in settlement.  They don’t care who you are or what you did.   They are only concerned about money.   If we can convince them that they may be on the hook for hundreds of thousands of dollars, they will offer substantially more than they would if they calculate their exposure at a few thousand dollars.

Here, my biggest concern has to do with the age of your case.  First, you may have a statute of limitations problem.  Second, you would have to link your current problems back to an accident that happened two years ago, despite your return to work.  The insurance company will argue that any current problems may have to do with your post-December, 2004 work (or perhaps non-work) activity.

Returning to work, as you may have guessed, can create issues with settling a case.

They have already paid you PPD (permanent partial disability) so you would need another doctor to give you a higher PPD rating that what you already have.

I think that your case has some settlement value, but perhaps not as much as it would have had in 2005.  If you want to call me to discuss, please feel free to do so.

[tags] workers compensation settlement, ppd rating, ttd benefits, georgia worker compensation [/tags]