Georgia Workers Compensation blog

Jodi Ginsberg's Georgia Workers' Compensation Blog

Medical benefits

Medical Treatment in a Georgia Workers' Comp Case – Don't Assume the Insurance Company Has Your Best Interests at Heart

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As I have written in this blog and on my Georgia workers’ compensation web site, the quality and nature of your medical care following your injury will have a lot to do with whether you win your claim and with how much money you can expect at settlement.

I spend a good part of my day looking at my clients’ medical records and talking to my clients about the treatment they recieve.  It is not at all uncommon for the physician chosen by the employer or its insurance company to release my client back to work with limited or no restrictions, when in reality my client is unable to perform his regular job, a "light duty" job, or any job at all.

Unfortunately, the quality and effectiveness of the medical care that you receive in your workers’ compensation case depend in large part upon who has selected the doctor.  Many doctors work at medical clinics that get most of their patients from insurance companies for workers’ compensation treatment.   Insurance company adjustors frequently speak with these doctors and encourage them to release claimants back to work, and to release them with limited or no restrictions.

If I take on a new case and I see that the insurance company has directed my new client to certain doctors, you can be sure that my first course of action will be to call the adjustor and argue for a more neutral physician.  The law also gives us the right to demand an "independent" exam in certain circumstances and we also have the right to ask the State Board to designate a change in treating physician.

Sometimes insurance adjustors or defense lawyers will agree to a change in treating physician if I challenge their choice of a doctor who is known to be firmly in the insurance company’s camp.   In fact, I would say that knowing the reputation of many of the doctors that you are likely to see in a Georgia workers’ comp case has helped me become a more effective advocate for my clients.

In a workers’ compensation setting, you cannot assume that a doctor recommended to you by your employer or its insurer will have your best interests at heart.  Although most of us are conditioned to trust and respect physicians, you have to trust your gut if you find yourself in a workers’ compensation setting.  And if your gut tells you that your current doctor does not have your best interests at heart, you and your lawyer need to take immediate action to regain control of your medical treatment.

[tags] medical treatment under workers compensation, Georgia workers compensation, company doctor, medical benefits [/tags]

On the Job Injury Damages Left Arm – Now Right Arm Hurts Due to Overuse. Does Workers Comp Cover the Right Arm?

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I wanted to know if there was anything that could be done to help me. I had surgery on my left shoulder and have reached MMI with a disability rating and significant work/lifting restrictions (I’m a nurse). Now, my right arm is starting to grind and bother me. I know it’s from overuse of it because I had no problems with it until I kept having surgeries on my left (3) and had to use it all the time. Is this a part of my workers comp. claim or do I have to be on my own with this?
Sonji

Jodi Ginsberg replies:  Sonji, he injury to your right arm is potentially compensible as part of your workers’ compensation claim.  If your authorized treating physician will agree that the problems you are having with your right arm are consistent with overuse that is reasonably and logically the result of having only one functioning arm then you have a strong argument for benefits.

[tags] arising out of the course of employment, georgia workers compensation, overuse syndrome [/tags]

Company Doctor Will Not Help Me – Is There Anything I Can Do?

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My question is that, I’ve been out hurt for a year and 3 months with a crushed heel. I’ve seen 2 workers comp doctors and just saw a independent doctor. The independent doctor said that he could heal me,and do surgery but the workers comp doctor disputes his opinion. Now the insurance company says that their not going to let me see him nor pay for the surgery. If the workers comp doctor would have x-rayed my foot he would’ve saw that its still broke but he hasn’t x-rayed it in 6months or hasn’t seen me in 3 months and refuses to give me anything for pain. Isn’t that refusing me treatment? Please give me some advise???
-John

Jodi Ginsberg responds: John, thanks for your question. I am going to assume that you are not yet represented. If you are, you should speak with your lawyer to discuss the reasons for the denial and what you can do about it.

There are a number of approaches I would consider in your case. First, I would evaluate whether you have a good argument to ask for a change in your authorized treating physician. If you are not getting better and the independent medical exam doctor states that surgery is indicated, I think that the State Board would consider a request for change in treating physician. The law provides for such a change if the current doctor demonstrates a “failure to effect a cure or give relief.”

I would also discuss with you whether you might consider a settlement of your claim. Sometimes, when there is uncertainty in a claim (differing opinions by the doctors), you have an opportunity to maximize your settlement dollars since the insurance company faces an unknown risk in future surgeries and wage benefits. Settlement would only be appropriate if you feel comfortable that you could pursue medical treatment on your own and are prepared to assume that risk.

New Job Injury Triggers Related Medical Problems – What is Compensable?

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North Carolina workers’ compensation lawyer Dan Deuterman recently wrote about one of his cases, Clark vs. WalMart, that ended up in the North Carolina Supreme Court. Although the Clark case arose under North Carolina law, there are implications for Georgia workers’ compensation claimants.

Mrs. Clark, a 64 year old lady, worked as a greeter at WalMart. She injured herself while attempting to move a decorative sled while standing on a 10 foot ladder. Ms. Clark had previously been diagnosed with osteoporosis. After initially accepting the claim, WalMart cut Ms. Clark off, arguing that Ms. Clark was not entitled to presume that her on-going back pain was solely the result of her job injury given the pre-existing osteoporosis.

The North Carolina Supreme Court agreed with WalMart that Ms. Clark, as the injured employee, had the burden of proving that her on-going disability arose from her job injury and remanded the case back to the North Carolina Industrial Commission (which is roughly equivalent to the Georgia State Board of Workers’ Compensation). The Industrial Commission ruled that Ms. Clark was permanently disabled and that WalMart had to pay for her medical care, including spine care associated with osteoporosis.

This case highlights an issue that we often see here in Georgia. Often our client’s work injury is not the only medical problem afflicting him or her. Sometimes, our client has a pre-existing medical problem (one known to the employer) that makes recovery from the new on-the-job injury more time-consuming or complicated. Sometimes an unknown medical problem will arise due to the stress and shock of a sudden work injury.

Employers and their insurers will attempt to limit the medical treatment to the specific work injury and will refuse to pay for medical treatment that is not directly related. As you might imagine this stance creates issues as often the “other” medical problem limits healing or affects treatment. Certainly, in Mrs. Clark’s case, her job injury at WalMart did not cause her osteoporosis, but the osteoporosis most definitely affected her healing and the extent of her recovery.

As is the case in North Carolina, disputes between employers and their insurers about what constitutes compensable care ends up before workers’ compensation judges.

Nasty Surprises for First Time Workers' Comp Claimants

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If you have never filed an on-the-job injury claim before, prepare yourself for a rude shock once you file your workers’ compensation claim. In theory, Georgia’s workers’ comp. law is designed to reduce disputes between employers and employees – in fact, I believe that workers’ compensation is just as adversarial as divorce or any other hotly contested litigation.

In theory, the Georgia’s workers’ comp statute reduces conflict by eliminating fault from the claim equation. If a worker is injured, he need only prove that he was on the clock performing a duty of his employment. Negligence is not an issue. Bad judgment, if honest and unintentional, is compensible.

By comparison, you cannot recover damages in a car accident if you were at fault. For example, if you are driving a company vehicle on a delivery and you run off the road and hit a tree, workers’ comp will cover you. If you had this same accident on the weekend, you would have no source of recovery in negligence.

There is a tradeoff for not having to prove fault. In workers compensation, you cannot recover money damages for pain and suffering. Instead, the Georgia comp statute provides that you can recover for your economic loss (temporary total disbability) and for your permanent medical impairment (total or partial permanent disability). Typically, recoveries for injuries in worker’s comp are less than the same injuries in a negligence case.

Because negligence is not an issue, the “battleground” in a workers’ comp case often arises from a dispute about the severity of your injury. Often, I spend a lot of my time fighting with the insurance company over who the treating doctor ought to be.

It should come as no surprise that the insurance companies who process workers’ compensation claims in Georgia have identified dozens of doctors who take a very conservative approach to on-the-job injury claims. These doctors are likely to minimize the significance of your injury and will release you back to work quickly.

Having been in practice for over 15 years, I have met, deposed and reviewed the work of most of the doctors who you will likely see in your workers’ comp claim.

By contrast, my job is to secure for you medical care that is focused on your well being. I will also expect that your treating doctor’s loyalty is directed towards you, not to an insurance company that sends him work.

[tags] georgia workers’ comp law, workers’ comp vs. car accident, company doctor [/tags]