December 10, 2018

Incredible: What Goes on Behind the Scenes of Your Georgia Workers’ Compensation Claim

Why is the Georgia workers compensation system so adversarial? As an injured employee you only have to prove that you were injured on the job – you do not have to prove negligence or any other fault on the part of your employer. Does it make sense that employers and their insurance companies fight so hard to deny claims?

It may not make sense, but employers and their insurance companies do contest claims, even those involving injuries that were witnessed and where all treating doctors diagnose a severe problem.

Some of what I see every day can only be described as incredible:

  • my client was injured and saw no posted panel of physicians in any breakroom or other employee area. Under the law, the employee can choose any doctor and the employer/insurer has to pay. The adjuster refused to authorize a doctor and suddenly a fresh, new posted panel appeared (after the fact)
  • a potential client called to say that she had received no TTD (temporary total disability) checks even though she was out of work and her claim accepted. When I was retained I called the adjuster who emailed me a printout of her screen showing that the TTD checks were sent out by their system, but, of course, never cashed. By the end of that week, the missing funds plus a penalty was fed-exed to my new client
  • I received a call from another potential client who had a serious neck injury. The insurance company would only authorize a hand specialist. After I was retained, we asked the ahnd doctor to authorize a neck specialist, which he did. The adjuster continued to refuse to authorize payment for the neck orthopedist. Only after requesting a hearing and getting a defense attorney to look at the case was the neck specialist approved.

[Read more…]

Why Would my Employer Deny my Legitimate Injury Claim?

I have written a lot on this blog about how strategies you and your lawyer can use to fight insurance company delays, refusal to authorize needed medical treatment and refusal to start weekly wage benefits.

You may be wondering why your employer – and by extension, their insurance company would fight you on a work injury claim that was witnessed and where even the posted panel doctor agrees that your injury arose from your job?

Isn’t there some sort of “good faith” requirement that insurance companies need to meet? And beyond that, what benefit accrues to the insurance company if their delays result in more needed medical treatment and more off-work status for you? [Read more…]

Delays in Medical Treatment: Bad for Your Work Injury Case

 

When you are hurt on your job, you should not delay seeking medical care.

Your employer and their insurance company will treat your delay in seeking treatment as an “admission” that your injury really is not that severe.  They will fight to avoid paying for medical tests and they will oppose your effort to see a specialist.  Your settlement will likely be negatively impacted.  When an insurance company lawyer deposes one of my clients, one of the first questions asked is “how soon after your injury did you first seek medical care.”

It does not matter if you think that you have a good reason for waiting to see a doctor.  Perhaps you believe that ice packs and a little rest will solve the problem, or perhaps you are concerned about reporting a work injury to a cynical or even hostile supervisor. [Read more…]

Seriously Injured Workers Likely to be Fired

Construction Worker Suffering Injury After Fall From Ladder

Many of the folks I speak with about work injury claims are, quite reasonably, concerned about their jobs.  Steady, well-paying jobs are hard to find and reporting an on-the-job injury could have negative consequences for your employment.

If you experience a relatively minor injury, you should not have much of a problem – minor muscle strains or bruises usually respond to ice and a day or two of rest, and then you can return to work without any issues.  In most of these cases, the posted panel doc’s treatment will be sufficient.  Our experience has been that employers recognize that bumps and bruises are part of almost any job and your employment will not be at risk if you access the posted panel doctor and the workers’ compensation system.

Problems often occur when your injury is more than a minor strain. Or perhaps you have had a series of minor and not so minor bumps and bruises that have resulted in several visits to the workers’ compensation clinic and more than a few days of missed work.  In cases where your employer decides that you are injury prone or that your minor injury really isn’t so minor, your job may be in jeopardy. [Read more…]

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…]

How Insurance Companies Try to Cut You Off

aggressive insurance companyYou might think that if your employer is paying weekly benefits and has paid for medical care, you are not likely to have any significant disputes in your work injury case. As the case I am about to discuss shows, however, challenges from the insurance company may be right around the corner.

The case I want to highlight is not one of my cases. The decision in this case is part of the public record in that it is published on the web site of the Georgia State Board of Workers’ Compensation. I bring this case to your attention for several reasons:

  • first, I want you to see how a State Board judge analyzes evidence
  • second, there are certain elements of this case that are not discussed in the decision, but we can assume they are there because the insurance company did not raise the issue and the judge did not mention the issue. We’ll read between the lines to reveal these issues.
  • third, this is a case that shows how insurance companies operate to cut off the benefits of a deserving claimant and to force a below market settlement.

The case I am discussing was decided in 2013 in south Georgia. Because State Board files are confidential, neither the name of the claimant nor the name of the employer is disclosed.  Here is a link to the written decision.

The employee is a female who worked as the manager of a restaurant. In December, 2006 the employee hurt herself and developed neck pain which radiated into both hands and lower back pain that radiated into both legs. The employer accepted the claim and began paying her TTD (weekly wage) benefits. The employer also paid for medical care that include surgery on her cervical spine and surgery on her lumbar spine. [Read more…]

Unrepresented Claimant with Rotator Cuff Injury Denied Necessary Rehab

post surgery rehabI want to talk with you today about rotator cuff injuries and the importance of both proper medical care and appropriate rehabilitation and followup.

In many respects the right kind of rehabilitation and follow-up medical care can make the difference between a return to full function and long term (and sometimes permanent) restriction of movement, stiffness and pain.

Recently I received a call from a prospective client who tore her right rotator cuff and underwent surgery, but was seeking legal advice because she sensed, correctly, that her workers’ comp doctor was not providing appropriate follow-up 1.

The prospective client told me that she hurt herself attempting to move a heavy box over her head and that shortly thereafter her right shoulder became painful, swollen and weak.  The industrial clinic doctor was unable to do much (other than waste a couple of weeks) and she was referred to a local orthopedist for consultation. [Read more…]

  1. I have changed the details of this case to preserve confidentiality, but the underlying principles are real.