What Do You Mean When You Say “Employer/Insurer Friendly” Vs. “Worker Friendly” Doctors In A Workers Compensation Case?
There are some doctors in the workers’ compensation arena who are known as Employer/Insurer Friendly and have a reputation of minimizing injuries and sending people back to work when they shouldn’t. They’re not necessarily practicing medicine in the best interest of the patient; they’re practicing medicine in order to get more insurance referrals. Industrial clinics are famous for undertreating work injuries.
In any situation, you have to follow the money and determine where the incentives lie. Many doctors will make the right choices for their patients despite the fact that all the business is coming from the insurance company, but there are some doctors who are notorious for under-diagnosing work injuries to maximize workers’ compensation insurance referrals.
It takes longer to resolve those cases and much more effort from a medical treatment perspective and from the perspective of the attorney. The danger is that what could be a temporary injury might become more serious and even permanent without adequate medical attention as quickly as possible.
What Evidence Is Critical In Proving My Workers’ Compensation Claim?
The most common issue in a workers’ compensation claim is whether the employer was notified within 30 days. The second most common issue is whether you, the employee, received treatment immediately after the injury or whether there was a delay. If there was a delay, that might indicate that the injury was not work-related.
Another issue that comes up frequently is the work status of the injured employee. You have to make sure that the doctors put on a work status as the case progresses. Other issues include whether the claim was filed within a year, whether the injury resolves, and whether you can return to work on light duty or not at all, whether you have reached maximum medical improvement and whether you have been issued a disability rating either as to a part of the body or the whole body.
How Long Does Someone Have To File A Workers’ Compensation Claim In The State Of Georgia?
You have one year from work injury to file what’s called a WC-14, which is a request for a hearing. You have 30 days to notify your employer of the injury.
What Are Some Of The Common Reasons That A Workers’ Compensation Claim Would Be Denied, Disputed, Or Undervalued?
The most common reason a workers’ compensation claim is disputed, denied, or undervalued is prior work injuries and medical injuries that could be considered pre-existing and not a result of the injury that occurred in the workplace. It’s very important that we have a good medical history and that we can differentiate prior injuries from the current injury in order to prove that the work injury aggravated a pre-existing injury.
As people age, they’ll get what’s called disc and their spine will not be as healthy as it was when they were younger. Often, disc is asymptomatic; someone who has it might get injured and have back pain when they didn’t before, but the insurance companies will argue that the disc was actually partially or completely responsible for the injury, not the event which occurred in the workplace.
As a lawyer, you have to be very familiar with different types of medical conditions and medical records so that you can establish that whatever occurred in the workplace is the cause of the injury, and that the injury was not pre-existing from either old age or a previous injury.
What Options Do I Have If My Workers’ Compensation Claim Is Denied?
If your workers’ compensation claim is denied, you can file for a hearing with the workers’ compensation board. You can file a WC-14 to indicate how you were injured and what relief you are seeking (e.g., medical expenses, disability benefits, income benefits). This must be filed within one year of the injury date. Many times, you’ll have to treat for several months after a work injury, so you have to make sure that if your claim is not resolved, you file a hearing request within one year.
Once you file the hearing request, it’s kind of like filing a lawsuit for a personal injury case in that you have a right for discovery. This means that you can request documents from and ask questions of the employer, and vice versa. You can also take depositions of witnesses, employers who received the reports, and the treating physicians. You can review the medical records from the treating physicians and request independent medical examinations that may increase the value of your claim or undermine the defenses being pursued during the course of the litigation.
After discovery is completed, you’ll have a hearing at a workers’ compensation board, which is a hearing with the judge (no jury will be present). At this hearing, your witnesses will be questioned and you will provide the judge with medical records that you think are relevant. Once the record is closed, the judge will issue a written order after the attorneys submit trial briefs.
How Are Workers’ Compensation Benefits Calculated In Georgia?
There are three types of income benefits in a workers’ compensation claim in Georgia. The first is temporary total disability (TTD) benefits, which apply when you’re completely out of work because of the work injury. These benefits are in the amount of $800 a week for up to 400 weeks.
The second is temporary partial disability (TPD) benefits, which apply when you have an economic injury, or due to your work injury you’re earning less than you would be had you not been injured. These benefits are two-thirds of the difference between your pre-injury income and post-injury income for 350 weeks.
The final type of benefit is what’s called permanent partial disability (PPD), which is determined after treating with the doctor and reaching maximum medical improvement. The doctor will give you a disability rating from the American Medical Association’s Guides to Permanent Impairment, 5th Edition.
If you receive a whole-body disability rating, then you would multiply that by the number of weeks. For example, a 10 percent disability rating would result in 40 weeks of income of up to $800. The disability rating also applies for certain parts of the body, and there is a different schedule for different parts of the body.