September 22, 2019

2013 Changes to Georgia’s Workers’ Comp. Laws

Georgia state legislatureEvery year the Georgia legislature considers a variety of proposed laws which may impact workers’ compensation.  This year, several bills passed the Georgia House and Senate and were signed by Governor Deal:

TTD maximum increases to $525 per week.  If you were injured on July 1, 2013 or after, your maximum temporary total disability payment amount increases from $500 per week to $525 per week.  The formula for calculating TTD benefits remains the same – you are entitled to 2/3 of your average weekly wage with a maximum benefit payment which is now $525 per week.

Mileage payments must be made faster.  When we submit documentation to recover mileage reimbursement (for travel to and from the doctor, a deposition or other approved reason), the insurance company must reimburse you within 15 days of submission date.  Previously they could wait up to 30 days to send the reimbursement.  If the mileage check is late, then you will be owed a penalty.

WC-240 return to work procedure changed.  If you attempt to return to work under a WC-240 or not, you must attempt to work for at least 8 hours or one shift for that attempt to be considered reasonable 1.  I continue to encourage my clients to make good faith work attempts.  Under the law if you cannot work for more than 15 days under the work attempt your TTD benefits must be reinstated.

Medical care now limited to 400 weeks.  As of July 1, 2013 injuries, the insurance company is obligated to pay for medical care up to 400 weeks (which is more than 7 years). Only if your case is deemed catastrophic will the 400 week medical benefit cap not apply 2.

  1. I strongly suggest that you not return to work without a WC-240 form.  The WC-240 is completed by your doctor and sets out your work activity limitations.  Read more about the WC-240 procedure here
  2. I have long argued that timing is one of the most important factors in maximizing your settlement.  This change – limiting the insurance company’s obligation to pay for medical treatment makes it even more crucial that we understand and calculate the insurance company’s possible exposure properly.  I discuss this timing issue more in this video

Bogus Independent Medical Exam Requested by Insurance Company Puts Benefits at Risk

bad faith workers compensationI received this question from one of my blog readers.  The situation this person describes is, unfortunately, quite common:

I was injured at work over 7 months ago. I went to iworks and then went to my doc, Both docs have me on restrictions and 2 months ago the company had me go see another doc of there choice , with no records or anything he seen me for maybe 15 mins and sent a report saying i can go back to work.. So now my work informs me that even though Iworks and my back specialist says restrictions that I have to return to work back on the floor and ignore the restrictions. Iworks even says no patient transfers but my work says they don't care about Iworks i have to go back to my CNA job. So now what do i do?

Here are my thoughts:  I am assuming by what you have written that you do not have a lawyer.  It may be that the insurance company accepted your claim and paid temporary total disabiltiy benefits initially, which might have made you think that you did not need legal help.  Setting aside the question of whether anyone with a serious injury should proceed without counsel, I think that the insurance company's decision to send you to one of their doctors should have been a red flag.

Insurance companies send you to so-called "independent medical examinations" so they can get evidence which they can use to cut  you off.   Obviously, the IME doctor's 15 minute exam without review of other records was not intended to do anything but cut you off, and while not every IME is this bogus, many are.

An experienced lawyer would most likely have recognized the IME doctor as a bought and paid for shill for the insurance company and would have argued for a more fair medical provider.  At the same time, your lawyer would seek documentation from your treating physicians that their restrictions are valid.  As soon as the return to work notice was issued your lawyer would have requested a hearing and, if you are in Georgia, could have used the claimant's IME to gather additional evidence to support your claim of disability.

[Read more…]

Numbness or Tingling in Your Arms or Legs? You May have a Neurological Injury

sciaticaIf there is a neurological component to your neck or back injury, time becomes your worst enemy, says neurosurgeon Thomas Morrison of Peachtree Neurosurgery, P.C. in an article published on the georgia1st.com web site.

Neurosurgeons like Dr. Morrison recognize nerve involvement in an injury when a patient experiences numbness, tingling, burning or muscle weakness.  When the nerve becomes inflamed, pain may radiate down from the nerve root into your extremities.   

  • Neurological injury to the cervical (neck area) spine, may cause radiating pain into the shoulders and arms
  • Neurological injury to the lumbar spine may cause radiating pain into the buttocks, thighs, legs or even the feet       
  • Numbness in the genital region can be an indicator of a very serious neurological condition that can result in bladder or urinary incontinence or sexual dysfunction

Nerve involvement in a spinal injury must be treated quickly because nerves do not regenerate like muscles, and the pain can be intense.  If you have ever experienced sciatica (nerve pain running down you legs), you know how debilitating nerve pain can be.  In the workers’ compensation world, insurance companies are notorious for turning a treatable neurological injury into a permanent, lifelong impairment by delaying treatment.

In my view, delaying treatment for a neurological injury is counterproductive because it will result in a longer recovery and decreases the odds that a injured claimant will return to work.  However, many insurance adjusters open their claims files with the assumption that the injured worker is faking or malingering, so delayed treatment is quite common.

[Read more…]

Body Parts and Insurance Companies

authorized treating physician refusal to treatI recently had a long and somewhat heated conversation with an insurance adjuster about body parts.  Specifically, I wanted the adjuster to authorize medical treatment for my client’s neck and back , but the adjuster only wanted to authorize the treating physician to provide care for my client’s back.

As ridiculous as this may sound, this type of negotiation happens all the time in a workers compensation.  Though common sense would tell you that an employee who injures his low back falling from an 8 foot ladder might reasonably be expected to suffer neck injuries as well (such as when his head hits a concrete floor), insurance companies are very careful not to assume anything.

The problem in my case arose from my client’s first conversation with the posted panel doctor.  My client’s low back was in spasm and he was absolutely miserable, and he did not specifically mention any pain in his neck to the treating doctor.

I am thinking that my client had probably incurred a concussion and was not thinking straight in the first place so who knows what he told the company doctor.  By the time I was retained, almost two months had passed and now my client is receiving epidurals for his lower back – although he may need surgery soon – but no treatment at all for his neck.

When my client goes to the workers’ comp. doctor and tries to talk about his neck pain, the doctor tells him that the insurance adjuster has not authorized treatment for the neck so the doctor will not treat the neck.

Imaging a doctor’s appointment where the physician tells you “I’m sorry you’re in pain but I am not allowed to treat that part of your body!” [Read more…]

How do Workers’ Compensation Adjusters Pressure Authorized Doctors?

Have you ever wondered how an insurance adjuster can influence your authorized workers’ compensation doctor?   If you work in an industry where employees often get hurt, or where work injuries are likely to be serious, you can be certain that your employer’s insurance company has directed the human resource director at your company to include specific doctors on your company’s posted panel.  Insurance adjusters know that physicians who derive most or all of their income from workers’ compensation referrals will be much less likely to keep you off work or order expensive tests.

The problem, of course, is that delays in needed tests, or delays in needed treatment can result in permanent injury to you.  Further, if a panel doctor returns you to work and you are unable to perform your duties, you are likely to be fired putting you in a difficult financial situation and psychologically deterring you from pursuing your rightful benefits.

In this video I discuss a case where the authorized doctor flat out ignored his own physical therapist’s conclusions about my client’s very limited use of her arms, and issued a full duty return to work.  I won’t let the insurer get away with this, of course, but I wanted you to see how broken the workers’ compensation medical system has become.  I’d be willing to bet that this doctor knows that he was not living up to his oath to offer full and complete treatment to his patients, but his interest in making money and seeing those referrals seems to override his conscience.

Be on Alert for “Red Flag” Symptoms in Back Injury Cases

A significant number of work injuries in Georgia involve back injuries.   Unfortunately if you are being treated by a “posted panel” doctor, your treatment may be delayed or not taken seriously.  In this video, I discuss certain “red flag” issues that demand immediate treatment with a spine specialist whose focus is your well being.

 

Am I Entitled to More than One Independent Medical Exam if I have Multiple Work Injuries?

posted panel of physiciansUnder Georgia’s workers’ compensation law, your employer gets to direct where you get medical care if your employer provides you with a valid “posted panel of physicians.”   Not surprisingly, posted panel doctors sometimes bring a pro-employer bias to their treatment of you.  I regularly see – and you have no doubt heard stories about – cases in which a seriously injured man or woman is given a regular duty return to work, only to end up in surgery a few weeks later.

In 1990, the Georgia legislature gave injured workers an important new right, the “claimant’s IME (independent medical exam).  Under this law, an injured worker can request an independent medical examination with a doctor of his choosing, paid for by the employer’s insurance company.

When properly used as part of a effective claim strategy, your claimant’s IME can be used to:

  • refute the unfair and biased claim of industrial clinic doctors
  • contest a premature return to work demand by the insurance adjuster
  • support a request for a change in authorized treating physician
  • support a reasonable settlement demand

However, as important and valuable as your claimant’s IME rights may be, this right is not open ended and it can be wasted if not used properly. [Read more…]