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.