Yesterday, I settled a very intense closed head injury case for almost $200,000. In looking back over this case, it strikes me that there are several important lessons here for anyone pursuing Georgia workers’ comp benefits.
This case involved a 47 year old construction worker who was struck in the head by a 100 lb. beam that fell on top of him from a height of over 14 feet. Although my client was wearing a hard hat, the impact from the steel beam knocked him unconscious and resulted in a fractured vertebrae in his neck.
Over the next 12 months, my client, acting without a lawyer, looked to his employer’s workers’ compensation insurance carrier to provide medical care. During that time he visited six different doctors on referral from the worker’s comp adjustor. Each time, he had to fill out an extensive new client questionnaire and he had to explain, as best he could, what had happened to him. This repeated new client intake process was very difficult for my client because he was in pain, suffering from memory loss and depression as well as severe emotional turmoil resulting from his accident. Despite all of these doctor visits, my client had not been referred for surgery and his condition was not signficantly improved.
Approximately 12 months after the accident, this gentleman called me to ask for help with his workers’ compensation case. Because the medical treatment so far had not helped much, I was able to convince the adjustor to approve as treating physician a top orthopedic surgeon here in the Atlanta area. My client subsequently underwent a two level fusion in his cervical spine (neck). We were then able to get a pain management physician approved as well as a psychiatrist to help with my client’s depression. And, after deciding that the timing was right to settle, we engaged in arbitration with the insurance company and agreed to settle the case for $195,000.
This was not a case where the insurance company denied the claim – there was no dispute that my client’s injuries arose out of and in the course of employment. When I was retained, my client was receiving his weekly wage benefits. The problem I had to deal with here was the insurance company’s unwillingness or inability to offer my client needed medical care.
Because my client was in pain, emotionally distraught and, most of all, unfamiliar with the Georgia workers’ comp system, he was not able to formulate a “big picture” strategy for his case.
The lessons you can learn from this case:
- you need to have a case strategy to follow and you need to demand that the insurance company fulfil its responsibilities to you
- do not assume that because the insurance adjustors are polite and cooperative that they are also working in your best interest. The adjustor’s primary goal is to minimize the insurance company’s financial exposure
- physicians on the “posted panel of physicians” or who are referred by the adjustor may have divided loyalties. You and your attorney are entitled to participate in the choice of physicians who treat you
- delay in getting appropriate medical treatment can result in longer recovery times and less satisfactory results
[tags] georgia workers’ compensation, posted panel of physicians, workers comp settlement [/tags]
Jodi Ginsberg
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I am working for a lawyer in the field of workers’ comp. Is there a text book I could order to help me along in the learning process?
Jonathan Ginsberg replies: For Georgia workers’ compensation law, the Hiers & Potter book is a great resource.
am i suppose to be under a treating physcian at all times when injured on the job
I was struck in the head by a 100 lb. b0xes that fell on top of me from a height of over 14 feet. the impact from the boxes knocked me unconscious and resulted in injury in his head and neck.
Over the next 12 months, I, acting without a lawyer, looked to his employer’s workers’ compensation insurance carrier to provide medical care. During that time he visited six different doctors on referral from the worker’s comp adjustor. Each time, I had to fill out an extensive new client questionnaire and I had to explain, as best I could, what had happened to me. This repeated new client intake process was very difficult for me client because I was in pain, suffering from memory loss and depression as well as severe emotional turmoil resulting from my accident. Despite all of these doctor visits, I had not been referred for surgery and my condition was not signficantly improved.
Approximately 12 months after the accident, I called a lawyer to ask for help with my workers’ compensation case. Because the medical treatment so far had not helped much, I was able to approve as treating physician a top orthopedic surgeon here in the DC area. underwent a two level fusion in his cervical spine (neck). W
This was not a case where the insurance company denied the claim – there was no dispute that my injuries arose out of and in the course of employment.The problem I had to deal with here was the insurance company’s unwillingness or inability to offer mE needed medical care.
my lawyer do not have a case strategy to follow and want me to accept $45000 when my doctor put me in disability my lawyer need to demand that the insurance pay more are you agree with me?