December 10, 2018

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…]

Can You Collect Workers’ Compensation Benefits if You Were at Fault in your Work Accident

Would you be surprised to learn that you are eligible to pursue workers’ compensation benefits in Georgia cases even if you were at fault in the accident?

Workers’ compensation law in Georgia is considered a “no fault” system, meaning that you are covered even if your injuries arose from your own negligence.  Under Georgia law, you are automatically covered by workers’ compensation is your injury arose out of and in the course of your employment.  This idea that in order to be covered you need to be acting for the benefit of your employer is common in workers compensation statutes in many states – for example in North Carolina the work injury law asks if your employer exercise control and direction over your work?

Examples:

  • a forklift driver turns too late and knocks over a scaffolding, causing boxes to fall on him, resulting in a broken arm and a closed head injury.  The forklift driver is eligible for benefits.
  • an industrial sewing machine operator gets distracted and loses a finger to a cutting knife.  The machine operator can pursue workers’ comp. benefits
  • a backhoe operator fails to properly park his machine and he gets run over when trying to exit the cab.  The backhoe operator is covered.

While you are eligible for workers’ compensation benefits even if you were at fault, you can be denied if your injury was the result of “horseplay.” [Read more…]

How to Combat Insurance Company Delay Tactics and Refusal to Authorize Medical Treatment

What can you do if your treating doctor wants to refer you to a specialist, or tries to order an MRI or CT scan, but the workers’ compensation insurance company refuses to authorize this needed treatment?
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Under Georgia workers’ compensation law, if you are receiving care from a “authorized treating physician” and that authorized physician refers you to a specialist, the referred doctor is supposed to be authorized automatically.

Similarly, if an authorized treating physician writes an order for an MRI, CT or other diagnostic test, that test should also be authorized.

What we are finding, however, is that when the referred doctor or the medical testing center calls the insurance company to verify that they will be paid, the insurance adjustor may say “no.” And of course, if a medical provider or testing center does not have a source of payment, they will not provide treatment to 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…]

Injured Workers Suffers Due to Insurance Company Tactics

This is a video from a TV news report in Michigan but the issues raised are the same as what we face here in Georgia.  Workers’ compensation insurance companies frequently send claimants to “independent” medical examinations that result in bogus diagnoses and unconscionable claim denials.

I wrote about this issue on this blog back in February – this video clip shows the human tragedy that can occur when a claimant gets railroaded.

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…]

Delay in Treatment of Your Back Pain May be Hazardous to Your Health

low back painIn my Georgia workers’ compensation law practice I interact with dozens of insurance companies each week and I frequently find that claims adjusters take a very short sighted approach towards medical treatment for back injuries.

At least half of the clients I represent are suffering from some form of back injury. Low back pain (often disc herniations at L5/S1) is the most common problem I see but I also represent clients with damage to the spine at all regions: cervical, lumbar, sacral and thoracic.

Regardless of where the injury is localized, a common argument I have with insurance adjusters has to do with the need for fast treatment.

Despite dozens of research studies which show that fast diagnosis and treatment of any type of back injury results in faster and more complete recovery, I almost always find that insurance companies work to limit access to care and slow down the course of treatment.

Even in cases where an MRI shows a herniated disc that will require surgery, I inevitably find myself fighting to get the insurance company to agree to a surgeon, authorize surgery, approve post-surgical physical therapy or agree to pay for even short term prescriptions for beds, home modifications or even medications. [Read more…]