Winning Strategies

Doctor Deposition Testimony – Very Powerful Evidence to Help You Win

January 24, 2013 by Jodi Ginsberg

One of the areas where I can greatly enhance the value of your case has to do with depositions I take of the doctors who treat you for a work injury.

If you have read through my web sites and viewed my video on this topic, you know how much importance I place on pushing the insurance company to provide quality medical care. I am especially concerned about treatment provided by posted panel doctors because physicians who get most of their business from insurance companies may bring financial motivations into their treatment plans for you.

What often happens, therefore, is that many cases contain conflicting medical reports. The posted panel doctor may write that your back pain arises from a muscle strain and that your MRI report was inconclusive. A report from your claimant’s IME doc may identify a disc herniation and need for an (expensive) surgical consult.

Workers’ compensation judges, therefore are left with the task of trying to figure out from medical records and attorney produced forms what medical treatment is appropriate or just how severe an injury you have suffered.

Post Injury Recorded Statements: A Trap for the Unwary

September 19, 2012 by Jodi Ginsberg

When you are injured on the job, the workers compensation claim that arises will be filed against both your employer and an insurance company. This is why, by the way, that I frequently refer to the “employer/insurer” on this blog and on my web site.

As a worker, your dealings are obviously with your employer – your direct supervisor, a human resources manager or the owner of your company. Once you file a claim, however, responsibility for processing that claim goes to a claims adjuster working for an insurance company. It is possible, therefore, that your supervisor or HR manager may be pleasant, sympathetic and genuinely interested your well being but you may face a very different attitude by the claims adjuster.

Often, your first introduction to the claims adjuster may come when the adjuster contacts you to schedule a recorded statement by phone. Insurance companies use recorded statements to learn more about what happened when you got hurt, but they mainly use these statements to find reasons to deny your claim or limit your medical care.

You should assume that a recorded statement in your workers’ compensation case is like a police interrogation – anything you say can and will be used against you. [Read more…] about Post Injury Recorded Statements: A Trap for the Unwary

Double Standards Alive & Well at Insurance Companies

August 7, 2012 by Jodi Ginsberg

I am currently representing a client with a significant back injury who is currently treating with a posted panel doctor. The doctor in this case is well known to me and other claimant’s lawyers as a physician who very rarely keeps a patient on no work status very long and who is reluctant to order diagnostic tests or to refer a patient out to a specialist.

This particular doctor apparently gets all of his business from insurance companies and his medical decisions are a byproduct of his source of fees.

I know about this doctor’s bias and the insurance adjuster surely knows this as well, yet I find myself playing the same game once again. The panel doctor will release my client to full or light duty work. The insurance adjuster will issue a notice of termination of benefits. I will file for a hearing and/or a change in treating physician. Eventually, the adjustor or defense attorney and I will agree on a legitimate doctor who will most likely find that my client needs surgery. Benefits will be restored and my client will get the treatment he needs.

Even though the script has already been written, insurance adjusters keep trying to close out cases involving seriously injured claimants.

I suppose that sometimes they get away with this nonsense – either because the claimant is unrepresented or because the claimant has an inexperienced lawyer.

Having been on the other side, I know how this game is played and it is not going to happen on my watch. Insurance adjusters are quick to cut off benefits but when a physician calls for more expansive treatment, an MRI, or a referral to a specialist, the process usually grinds to a crawl.

I talk about this a lot with clients and colleagues but it bears repeating – you are going to get walked on if you let the insurance company dictate the pace and progress of events. Timing is everything in a workers’ compensation case and you have to demand action or nothing happens.

Last week I was recording some videos for my web site and I got to thinking about the insurance company double standard – here is what I think:

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When is the “Right Time” to Settle Your Case?

January 25, 2012 by Jodi Ginsberg

Perhaps no other element of a workers compensation case gives rise to as many questions as the subject of when and how to settle your case. In my opinion the timing of settlement negotiations can greatly influence the outcome of your case. Settle too soon and you may end up paying out of pocket for expensive medical services. Wait too late and your case can grow stale if the insurance company can calculate with certainty its exposure on your case.

Generally the best time to settle your case is when significant uncertainty remains regarding your future medical and lost wage eligibility. Remember – insurance companies are in the business of risk management. If we can show them that your future medical costs could soar into the tens of thousand and that your return to full duty work could be far into the future, they will be more likely to offer more money to eliminate that risk.

I tell my clients that identifying that “sweet spot” is more art than science. Sometimes a single line in a medical record, or a brief comment from my client will tell me that we are entering the zone where my client’s medical condition is stabilizing but enough unknowns remain for me to put forth a settlement demand that will result in a fair and generous settlement.

Insurance Adjuster Attempts to Use Nurse Case Manager Against Injured Worker’s Interests

January 16, 2011 by Jodi Ginsberg

This past July, I discussed on this blog issues related to the participation of a nurse case manager in a Georgia Workers’ Compensation claim. In that post I pointed out that insurance adjusters sometimes assign a nurse case manager to a particular claim. The nurse case manager is not an adjuster, and they do not deal with issues related to wage benefits. Instead, they deal with the medical component of your case only and a nurse case manager can be helpful in setting up medical appointments, coordinating transportation to and from doctor’s visits and working out issues with prescriptions.

Issues arise when the nurse case manager tries to influence your doctor about signing off on a return to work release or suggesting to the doctor that he include in his reports statements which say that your pain has subsided and that you are doing better. Some nurse case managers even try to influence the drug prescriptions written by the doctor. Others appear at each one of your appointments and try to stay in the room when your doctor examines you. You have the absolute right, by the way, to insist that your nurse case manager step outside during your examination and conversations with your doctor. [Read more…] about Insurance Adjuster Attempts to Use Nurse Case Manager Against Injured Worker’s Interests

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