Answers To Your Workers' Comp & Personal Injury Frequently Asked Questions

Doubt, uncertainty, and confusion can quickly cause painful situations to escalate into catastrophic traumas. Personal experience has taught us that when an accident victim allows his concerns to overwhelm his determination for justice, he neither gets relief nor justice. This is why we feel that getting answers to your injury questions are extremely important not only to relieve stress, but also to build a stronger injury claim. Allow us to address your concerns and come see for yourself how a simple answer can make a difference.

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  • What are my options if my employer doesn’t offer workers’ compensation insurance coverage?

    A worker is shocked to learn that her employer will not cover her work-related injuryGeorgia law requires all employers with three or more employees to provide workers’ compensation coverage for their employees. If your employer violates this law by not having the required insurance, this does not affect your right to benefits.

    What Penalties Are Associated With Violating the State's Workers' Compensation Law?

    An employer who fails to provide the appropriate workers' compensation coverage will still be held responsible for an employee's on-the-job injuries. Types of benefits the employer may be responsible for paying include:

    • Medical benefits: An employer must pay for all necessary medical care related to the employee’s on-the-job injury, including emergency visits, follow-up appointments, physical therapy, and care from qualified medical specialists. Medical benefits have a 400-week cap, unless the injury is catastrophic. Catastrophic injuries are entitled to lifetime medical benefits.
       
    • Temporary Total Disability (TTD): When an employee is unable to work while recovering from an on-the-job injury, TTD benefits replace lost income, up to the state maximum of $575 per week. TTD benefits pay up to two-thirds of your average weekly wage before your accident. They are subject to a 400-week maximum, except for catastrophic injuries, which are payable for the rest of the injured worker's life.
       
    • Temporary Partial Disability (TPD): If an injured worker is able to return to light duty or part time work and is earning less than before the injury, TPD benefits provide compensation for up to two-thirds of the difference in wages, up to a maximum of $383 per week. TPD benefits can't be collected for longer than 350 weeks from the date of the injury.
       
    • Permanent Partial Disability (PPD): When a worker suffers injuries that lead to permanent impairment, PPD benefits are paid at the same rate as TTD benefits. The number of weeks a worker can receive benefits is based on the specific body part that is injured.
       
    • Death benefits: When a worker suffers fatal injuries, death benefits are paid to the worker's spouse and children to cover burial expenses and provide funds to compensate for the deceased worker’s loss of income.

    In addition to these required benefits, the Georgia State Board of Workers' Compensation may assess penalties for refusing or willfully neglecting to secure insurance. This includes attorney’s fees, civil penalties, and a 10% increase in compensation to the employee.

    What If the Law Doesn't Apply to My Employer?

    If this workers’ compensation law does not apply to your employer (less than three employees) and you are injured in an on-the-job accident, you may have grounds to file a personal injury claim against the negligent party.

    A personal injury claim allows you to seek compensation for:

    • Medical expenses: The bulk of a personal injury settlement is typically compensation for medical expenses, including previously incurred medical expenses as well as any estimated future medical care necessary for injuries resulting in lasting disability.
       
    • Lost wages: Compensation for lost wages includes time off to recover and any estimated loss of future earning potential if your injuries result in lasting physical or mental disability.
       
    • Pain and suffering: Pain and suffering isn’t a recoverable element of damages in a workers’ compensation claim, but can be included in personal injury suits to cover both the physical pain and emotional trauma associated with your injuries.

    Unlike workers' compensation cases, a personal injury claim requires that the injured party prove negligence. Without evidence to prove that the employer failed to take reasonable care to prevent injuries, no compensation can be awarded.

    How Can I Best Protect My Legal Rights?

    If you've suffered an on-the-job injury, retaining the services of an experienced attorney will help protect your right to compensation. When your employer doesn't have the legally required workers' compensation coverage or is exempt from workers' compensation laws, your case will involve complex issues that are difficult to handle without an advocate on your side.

    Rechtman & Spevak's legal team is committed to helping employees of Home Depot, United Parcel Service, FedEx, Delta Airlines, Emory University/Emory Healthcare, Kroger, Publix, Northside Hospital, Piedmont Healthcare, Walmart, Lowes, Waffle House, Chick-fil-A, Randstad, and other Georgia businesses receive prompt and fair compensation for their injuries. Call today to schedule a free, no-obligation case review.
     

     

  • How do I notify my employer of a work-related injury?

    Filling out a work injury claim formWorkers’ compensation laws in Georgia require injured workers to provide their employers with prompt notice of work injuries. The statute says that if you sustain a workplace injury, you must report that injury to your employer within 30 days. This 30-day notice provision was included in Georgia’s workers’ compensation law so that employers can conduct an investigation of an injury claim while reliable evidence is still available.

    Regardless of the 30-day deadline, it’s best to report your injury immediately. You can make the report to your employer’s representative, your foreman, or your immediate supervisor.

    Information Included in a Work Accident Report

    Many employers have their own company-specific claim forms that they use to begin the workers’ compensation process. However, there is no requirement in the law that notice be in writing.

    When you report a workplace injury, you should provide as much detail as you can regarding the following:

    • Date and time of the incident.
    • Your location when the incident occurred.
    • What you were doing when the incident occurred.
    • Immediate symptoms you noticed that indicated you were hurt.
    • Specific body parts that are affected.
    • Any coworkers, supervisors, or others who witnessed the incident.

    If you do complete a written accident form for your employer, it is a good idea to make a copy of the form for your own records.

    Penalty for Failing to Report Your Accident

    Failing to abide by the 30-day deadline for providing a notice of injury may result in your workers’ compensation being denied by your employer and its insurer. If this occurs, you may lose your right to medical treatment and income benefits.

    Investigating the Incident

    After you’ve provided notice of your accident to your employer, your claim will be investigated. The investigation will look at how and why your injuries occurred, in addition to seeing if new policies or procedures should be implemented to make your workplace safer.

    Your own actions in regards to the incident generally aren’t relevant to your ability to receive compensation for your work injury.  However, your claim may properly be denied if the injury was due to your willful misconduct.  Willful misconduct encompasses horseplay, intentional self-inflicted injury, being injured while attempting to injure someone else, and the willful failure or refusal to use a safety appliance or perform a duty required under the law.  Your claim may also be denied if you were under the influence of drugs or alcohol while on the job, as revealed by a properly administered post-accident drug test. Injuries that were caused by inattentiveness or carelessness are fully covered under workers’ compensation law, but you may be subject to any applicable company disciplinary measures if you violated specific workplace safety rules.

    Seeking Medical Treatment

    Seeking medical treatment for a workplace injury is a little different than being treated for other health conditions. All non-emergency medical care related to a workers’ compensation claim should be provided through a doctor on the employer’s panel of physicians. Your employer will allow you to choose a doctor from the panel of physicians to serve as your care provider. If necessary, he will refer to you an approved specialist for further evaluation.

    If your employer fails to maintain a posted panel of physicians, the injured worker has the right to choose their own doctor. Despite this right, many employers will at least initially refuse to authorize your choice, and will insist that you treat with "the company doctor." If that happens, you should consult a workers' compensation attorney right away for guidance.  

    Failing to comply with the doctor’s treatment recommendations may jeopardize your right to benefits. If you disagree with your doctor regarding the severity of your injuries or the appropriate course of treatment, you are entitled to one free change to another doctor on the panel of physicians. An independent medical examination (IME) may also be an option to obtain a second opinion in some cases.

    Protecting Your Legal Right to Benefits

    Workers’ compensation law can be quite complex. Without experienced legal representation, it may be difficult for you to maximize your benefits on your claim. Retaining an attorney at an early stage in your case will allow you to fully focus on your recovery with confidence that you’ll receive the highest possible benefits.

    Rechtman & Spevak’s attorneys have extensive experience helping injured Georgia workers process their workers’ compensation claims in a timely fashion. Our firm has assisted employees of Home Depot, United Parcel Service, FedEx, Delta Airlines, Emory University/Emory Healthcare, Kroger, Publix, Northside Hospital, Piedmont Healthcare, Walmart, Lowes, Waffle House, Chick-fil-A, Randstad, and many other local businesses in accessing their benefits. Please call today to schedule a free, no-obligation initial case review.
     

     

  • Can I choose my own doctor to treat my work-related injury?

    When you are injured in a workplace accident, your employer is required to provide you with the necessary medical care. Unfortunately, workers’ compensation claims have certain limitations—including restrictions on which doctor you can see for your treatment.

    Receiving Emergency Medical Treatment

    An employee with serious or life threatening injuries requiring immediate medical care may seek out treatment at the nearest emergency room. Workers’ compensation insurance is required to pay for the cost of any emergency care related to an on-the-job injury, including diagnostic testing and emergency surgical procedures.

    Seeking Treatment From the Panel of Physicians

    Once your condition has been stabilized or if your injuries did not require emergency medical care, your employer is supposed to provide you with a list of physicians. The list is called a panel of physicians and should include six or more doctors, with at least one orthopedic surgeon and at least one minority doctor and no more than two industrial clinics. In most cases, all providers should be within 50 miles of the job site.  

    The doctor that you choose from this panel is called an “authorized treating physician” (ATP). This doctor may provide you with medical treatment for up to 400 weeks following your accident (unless your claim is deemed catastrophic, in which case you will be entitled to medical benefits for the rest of your life). If your condition isn’t one that can be treated by your ATP, he or she may refer to you a specialist for further evaluation and treatment.

    You will not need to pay any of the cost of your medical care, including any medications prescribed by your treating physicians, since all treatment from an ATP or referred specialist is fully covered under your workers’ compensation benefits. In addition, you are also entitled to be reimbursed for your mileage and other travel expenses.  

    Making a Change to Your Medical Care

    If you are dissatisfied with the treatment you are receiving from your ATP, you are allowed to make a one-time change to another doctor on the panel of physicians without receiving prior approval. In certain situations, you are allowed to seek an opinion from a physician of your choosing as an independent medical examination (IME). 

    Using Your Own Health Insurance Benefits

    You may think it would be better to use your own health insurance or pay out-of-pocket, and just have your regular family doctor handle your medical care. Unfortunately, choosing to do this could jeopardize your case. If you do not treat with a panel physician, your employer and its workers' compensation insurer do not have to follow the recommendations of the unauthorized physician, and most likely will refuse to pay you income benefits based on any disability documentation that you obtain from your family doctor.  

    If your claim is denied in whole or in part, or if your employer does not have a properly posted panel of physicians, you are technically able to choose your own doctor. However, this issue should be discussed in greater detail with your attorney.

    Protecting Your Legal Rights

    Georgia laws regarding workers’ compensation benefits can be quite complex. To protect yourself, you should strongly consider hiring an experienced attorney who can advocate for your right to benefits.

    Rechtman & Spevak is dedicated to helping workers who’ve been hurt on the job receive the benefits they need to move forward with their lives. We’ve assisted employees of Home Depot, United Parcel Service, FedEx, Delta Airlines, Emory University/Emory Healthcare, Kroger, Publix, Northside Hospital, Piedmont Healthcare, Walmart, Lowes, Waffle House, Chick-fil-A, Randstad, and many other local businesses in resolving their workers’ compensation claims. Call today to schedule a free, no-obligation consultation.
     

  • How long can I wait to file my workers’ compensation claim?

    Paying close attention to state deadlines is crucial in ensuring that you're able to maximize your workers' compensation benefits. Under Georgia workers' compensation law, an injured worker has one year from the date of the accident to file a notice with the State Board of Workers' Compensation. However, if your employer has provided medical treatment for your workplace injury, this deadline may be extended.

    Reporting a Workplace Injury to Your Employer

    Ideally, an injury should be reported immediately after it happens. This helps guarantee that evidence is preserved to support your claim and that you receive the medical care you need. You can notify your employer orally or in writing, although written documentation is preferable as a way to build a paper trail for your case.

    Of course, not all injuries can be reported immediately. Although cuts and broken bones from a fall leave no doubt as to the fact that a worker has been hurt, injuries such as sprains and strains are less apparent. For this reason, Georgia law allows you 30 days to provide initial notice to your employer. If you fail to report the injury within this timeframe, you risk losing your right to benefits.

    When you notify your employer of your injury, you'll be asked when the accident happened, what caused you to hurt yourself, and what symptoms you are experiencing. You may also be asked if anyone witnessed the incident who can be called upon to support your statement. Be as accurate as possible in completing your report, but avoid unfounded speculation.

    After your injury has been reported, your employer should provide you with a list of doctors that you can choose from for any necessary medical treatment. Instead of seeing your regular doctor, you'll need to obtain treatment for your work-related injury from one of the providers listed on your employer's panel of physicians

    At this time, your employer should also contact its workers' compensation insurance company to open a claim regarding your work accident. If your claim is approved, you may be entitled to Temporary Total Disability (TTD) or Temporary Partial Disability (TPD) benefits. 

    Filing a Workers' Compensation Claim

    It's a common misconception that reporting a workplace injury is the same as filing a workers' compensation claim. Your employer's workers' compensation insurer may begin providing you with medical treatment immediately, but that is not the same as filing notice with the state.

    A formal claim isn't filed until you submit a Notice of Claim (Form WC-14) to the State Board of Workers' Compensation. A copy of this form must also be submitted to your employer and your employer’s workers’ compensation insurance company. Submitting this form in a timely fashion is a crucial step in protecting your legal right to benefits.

    You have one year from the date of the accident or the date you last received medical treatment provided by your employer or its insurer within which you may file a Notice of Claim if you did not receive any weekly income payments. 

    Paying close attention to the statute of limitations for your workers' compensation claim is vital. If you miss the deadline that applies to your case, the Georgia State Board of Workers' Compensation will have no legal jurisdiction to review your claim.

    Obtaining Legal Representation

    The deadlines and documentation requirements for Georgia workers' compensation benefits may seem overwhelming when you're struggling to recover from an on-the-job injury. Retaining skilled legal representation is the best way to make sure that your claim is handled in a timely manner.

    Please contact the legal team at Rechtman & Spevak for a free, no-obligation case review. We are committed to helping employees of FedEx, Delta Airlines, Emory University/Emory Healthcare, Kroger, Publix, Northside Hospital, Piedmont Healthcare, Walmart, Lowes, Waffle House, Chick-fil-A, Randstad, and other local businesses receive the compensation they need to move forward with their lives after a workplace injury.

     

  • Does workers’ compensation reimburse me for mileage and other travel expenses?

    The workers’ compensation program in Georgia may reimburse you for mileage and other reasonable travel expensesWhile most people know that injured workers are entitled to compensation for the cost of their medical care, many people don’t realize that mileage and other travel expenses can also be reimbursed under the state’s workers’ compensation law. Including these expenses as part of your workers’ compensation claim can help alleviate some of the financial strain associated with your injury and inability to work.

    Reimbursable Travel Expenses According to State Board of Workers’ Compensation

    Reimbursable travel expenses fall into a few distinct categories:

    • Mileage: Workers who are injured on the job can receive mileage reimbursement for the cost of traveling between their home and any necessary doctor’s appointments or physical therapy appointments. Travel to a pharmacy to pick up prescriptions related to the injury is also reimbursable. Mileage is currently reimbursed at 40 cents per mile.
    • Professional transportation services: If you have no other way to attend your necessary medical appointments, you may be entitled to reimbursement for the services of a medical transportation company. The insurer may arrange for such transportation at its own expense. In some cases, taxi service may also be reimbursable as a form of transportation to your necessary appointments.  
    • Parking: Parking is considered a reimbursable expense if it’s related to your need to seek medical treatment.
    • Meals and lodging: If you are required to travel beyond your home city and will spend four hours or more on the road, you are allowed to recover the cost of your meals and lodging. However, reimbursement for meals is limited to a maximum of $30 per day.

    Documenting Travel Expenses

    Reimbursement for travel expenses is available to anyone who is eligible to receive workers’ compensation benefits. This includes both full-time and part-time employees, as well as most temporary or seasonal workers regardless of the length of time they’ve been working for their current employer.

    There is no official form that is used to document travel expenses for workers’ compensation reimbursement, but you might find the following Medical Mileage Reimbursement Form helpful. When you are seeking reimbursement for mileage, you should prepare the same type of record you’d use to deduct mileage on your income taxes. Keep a log documenting:

    • Date and time of the trip.
    • Purpose of the trip.
    • The places you visited for medical purposes.
    • Your start and end mileage according to your vehicle’s odometer.

    If you purchased gas for your vehicle while traveling, save your receipts to support your mileage log claim. If you’re seeking reimbursement for meals and lodging, keep these receipts as well. 

    Receiving Reimbursement

    You must submit your request for reimbursement within one year of the date the treatment took place. The workers’ compensation insurer has 15 days to provide reimbursement after you’ve submitted documentation of mileage, meals, and lodging. If the insurer doesn’t pay within this timeframe, it can be subject to a late penalty.

    Download FREE Medical Mileage Reimbursment Form

    Maximizing Your Available Compensation

    When you’re injured and facing the stress of being unable to work, taking the time to document your travel expenses might seem like an unnecessary hassle. However, if you’re going to several doctors’ appointments each week or live usually far from your healthcare provider, these expenses can quickly add up. To protect your financial future, you need to do everything in your power to maximize your workers’ compensation benefits.

    If you’re struggling to receive payment for a work-related injury, hiring an attorney with experience in workers’ compensation claims will allow you to focus on your recovery without the hassle of dealing with the insurance company directly. The legal team at Rechtman & Spevak is committed to helping injured Georgia workers receive the compensation they need to move forward with their lives. Please call today to schedule a free, no-obligation case review.

  • Can I receive workers’ compensation benefits as a part-time employee?

    Georgia law requires all employers with three or more employees, including both full-time and part-time workers, to provide workers’ compensation coverage for on-the-job injuries. If you are injured on the job as a part-time employee, you will generally be eligible for workers’ compensation benefits.

    Requirements for Workers’ Compensation Coverage

    Part time warehouse working fell and severely injured

    To be eligible for workers’ compensation benefits, you simply need to have been injured while performing job duties within the course and scope of your employment with an employer that has at least three employees. The number of hours you work per week or your length of time with your employer are irrelevant. Age is also not a factor, which means a teen who was injured on his part-time job would be able to receive workers’ compensation if he meets the other necessary eligibility criteria.

    Types of Benefits

    Your workers’ compensation claim may include several different types of benefits:

    • Medical benefits pay for the cost of care related to your workplace injury, including emergency room care, surgery, hospital stays, physical therapy, and prescription medication.
       
    • Temporary Total Disability (TTD) benefits are intended to replace lost income if you’re unable to work at all because of your injury. These benefits pay two-thirds of your average weekly wage prior to your accident and are subject to a 400-week maximum.
    • Temporary Partial Disability (TPD) benefits are designed to replace lost income if you are under light duty restrictions and are working fewer hours or returned to work in a lower-paying position due to your injury. These benefits will pay you two-thirds of the difference between your previous wage and the amount you are earning working light duty. TPD benefits are payable up to 350 weeks following your accident.
    • Permanent Partial Disability (PPD) benefits are payable after you are no longer receiving TTD or TPD benefits, and have been assigned a permanent partial impairment rating by your treating physician. You will receive a number of weeks at the same rate as TTD benefits, which is determined by the percentage loss of use of the specific body part that was injured. To figure out exactly how much money you will receive in permanent partial disability benefits, you can use our PPD calculator.
       
    • Death benefits for workers who’ve been killed in on-the-job accidents include funds for burial expenses as well as payments to the worker’s spouse and dependent children.

    Benefits for Seasonal Employees

    Seasonal employees, whether working part-time or full-time hours, are generally eligible to receive workers’ compensation benefits if they meet all of the other necessary criteria. However, certain situations can limit your eligibility for benefits:

    • Georgia law specifically exempts farm employers from being required to provide workers’ compensation coverage. If you’re hurt as a seasonal farm worker, you can only receive workers’ compensation benefits if your employer has voluntarily opted to purchase this insurance coverage.
       
    • If you are a seasonal employee working on a job site through a temporary employment service, the agency that placed you in the position must provide your workers’ compensation benefits. Businesses utilizing the services of a temp agency are not considered the employer of the injured worker for the purpose of processing a workers’ compensation claim.

    Benefits for Undocumented Workers

    Georgia law doesn’t specifically bar undocumented workers from receiving workers’ compensation benefits if they have a legitimate on-the-job injury. Your immigration status is not relevant to your workers’ compensation claim, even if your employer was unaware that you were in the country illegally.

    Benefits for Independent Contractors

    Sometimes, unscrupulous employers will try to get out of paying workers’ compensation claims by classifying a part-time employee as an independent contractor. This distinction is extremely important, since independent contractors are not eligible for workers' compensation benefits.

    There are several factors used to distinguish between an independent contractor and an employee. Factors pointing towards a finding that a person is an independent contractor include, but are not limited to: the individual has the right to exercise control over the time, manner, and method of the work he is to perform; the person is paid by the job or per unit of work rather than by the hour or other unit of time; the individual furnishes his own tools and equipment; the person sets his own hours rather than the alleged employer setting the same; the alleged employer does not withhold taxes from money paid to the individual; and the alleged employer does not have the right to add work without adding additional pay. It is important to understand that no single one of these factors is absolutely determinative of whether an individual will be deemed to be an independent contractor or an employee. Instead, it is up to an administrative law judge to determine the relative weight to be given each of the factors in your case.  

    If you feel that your employer is falsely claiming that you are an independent contractor in order to avoid paying you benefits, you should contact an attorney immediately for help regarding your claim.  

    Seeking Legal Assistance

    If you’re a part-time employee who believes you have been unfairly denied workers’ compensation benefits, it is in your best interests to consult an attorney as soon as possible. Please call Rechtman & Spevak to schedule a free, no-obligation consultation.
     

  • How are my workers’ compensation weekly benefits calculated?

    If you’ve been injured on the job, knowing how much you can expect in workers’ compensation benefits can help alleviate some of your financial stress.

    Temporary Total Disability Benefits

    If you are disabled from working following your accident, Georgia law provides that you are to be paid two-thirds of your average weekly wage up to a statutory maximum in TTD benefits.  If your accident occurred on or after July 1, 2019, that maximum is $675 per week.  For accidents prior to that date, please see this chart for the maximum TTD benefit rate that you can receive.

    For example:

    • Mark earns $15 per hour. Working 40 hours per week, his earnings before the accident were $600 per week. His workers’ compensation benefit would be $400.
    • Jane earns $20 per hour or $800 per week. Her workers’ compensation benefits would be $533.33 per week.
    • Bill earns $30 per hour or $1,200 per 40-hour work week. Two-thirds of his average weekly wage would be $800, but he would be limited to the maximum payout of $675 per week.

    Injured workers can collect temporary total disability benefits for up to 400 weeks. However, a worker with a claim that qualifies as a catastrophic injury may be eligible to receive lifetime benefits. Examples of catastrophic injuries include paralysis, severe brain injury, amputation, and blindness.

  • What Does Catastrophic Mean in a Workers’ Compensation Claim?

    The goal of workers' compensation payments is to alleviate the financial strain of being unable to work due to an employment-related injury. Ideally, the injured worker should be able to recover, then return to suitable employment in a timely fashion. But allowances are made for people with injuries designated as catastrophic.

    Defining Catastrophic Injuries

    A catastrophic injury is the most serious type of workers' compensation claim. As such, there are strict criteria that must be met to qualify for benefits with this designation. The Georgia Workers’ Compensation Act defines this type of claim as one or more of the following:

    • An employee sustained a severe brain or closed head injury.
    • An employee has a spinal cord injury resulting in severe paralysis of the arm, leg, or trunk.
    • The injury resulted in the amputation of an arm, a hand, a foot, or a leg.
    • The injury resulted in second or third degree burns covering more than 25 percent of the body or third degree burns covering 5 percent or more of the worker's face or hands.
    • The worker has a diagnosis of industrial or total blindness.
    • The employee's injuries render him unable to perform his prior work, as well as any additional work available for which he is otherwise qualified.

    The last classification—"unable to perform his prior work, as well as any additional work available"—results in the most litigation due to the subjective nature of the statement. It is easy to determine if someone has had a limb amputated or lost their eyesight, but evaluating if someone is unable to work is more difficult.

    Some of the factors to be considered include:

    • Past work experience
    • Education level
    • Feasibility of additional job training
    • Vocational analysis
    • Types of opportunities available in the current job market
    • Whether the worker qualifies for Social Security disability benefits

    Removing the Time Limits for Benefits

    In the majority of cases, workers' compensation benefits have a strict time limit of availability:

    Workers who are most seriously injured are considered to have catastrophic injuries. Georgia law allows these individuals lifetime medical treatment and indemnity (weekly income) benefits in addition to appropriate rehabilitation benefits.

    Eligibility for Rehabilitation Services

    In addition to eliminating the cap on medical assistance and weekly income benefits on catastrophic injury claims, this designation also allows injured employees to receive rehabilitation services. What this involves will vary depending upon the type of injury and the worker's past employment history, but could include:

    • Career counseling
    • Analysis of transferable skills
    • Vocational evaluations
    • Resume writing
    • Interview coaching
    • Working with potential employers regarding job accommodations and modifications
    • Receiving tuition assistance for retraining
    • Miscellaneous job placement services

    An employee with a catastrophic injury receives these services at no additional cost, and is required by law to utilize any rehabilitation benefits that are deemed appropriate to his case.

    Meeting the Burden of Proof

    When determining whether a worker's injury should be classified as catastrophic, the burden of proof rests with the employee and his attorney. Therefore, having access to skilled legal representation is essential to the success of your case. Due to the high cost associated with catastrophic claims, workers' compensation insurers will do everything possible to avoid this designation. Please contact the legal team at Rechtman & Spevak for a free, no-obligation case review.

     

  • Can the Workers’ Compensation Insurer Deny Surgery My Doctor Ordered?

    If you've been told by your workers’ compensation doctor that surgery is required for your injury, it may be a shock to have the surgery denied. Unfortunately, there are several reasons why this can happen.

    Reasons for a Claim Denial

    Workers' comp doctor denying needed surgery

    Slip and fall accidents, heavy lifting accidents, work truck accidents, and injuries caused by defective machinery or equipment can result in serious injuries that require surgery to repair. However, for specific treatment to be approved for workers’ compensation benefits, your claim must meet the following three criteria:

    • Causation: Your need for medical treatment must be the direct result of a workplace accident. If you can't establish that the injury was caused by something that occurred while on the job, the claim can be denied.
    • Likelihood of effectiveness: Treatment will only be approved if it's reasonably likely to cure your condition and/or allow you to return to suitable employment.
    • Authorized provider: Workers’ compensation laws require treatment to be administered by an authorized provider on your employer's panel of physicians. A surgery performed by someone who doesn't have the necessary approval could legally be denied.

    If there's a problem in any one of these areas, your claim may be denied, regardless of what your doctor previously said about the recommended treatment.

    Independent Medical Examinations (IME)

    When an insurance company requests that you see another doctor after your doctor already recommended surgery, it is typically an indication that the company may be looking to deny authorization for the surgery. The insurer is likely sending you for an independent medical examination seeking to obtain an opinion that the surgery recommended by your doctor is not necessary.  That opinion may then be used as a basis for denying your claim pending a hearing before an administrative law judge.

    The phrase "independent medical exam" (IME) is a bit misleading, since the doctors who conduct these examinations regularly receive referrals from workers’ compensation insurance companies. This may give them financial incentive to write a report favoring the insurer's financial interest, regardless of what the exam reveals. 

    Don't agree to submit to an independent medical exam before discussing the issue with your attorney. After evaluating your case, your attorney can develop a strategy to help counter any negative reports from the independent medical examiner.

    Using Your Own Health Insurance to Pay for Surgery

    In some circumstances, using your health insurance to pay for surgery may be a better option than waiting for a hearing to have a judge determine whether you are entitled to have surgery under your workers' compensation claim. Doing it this way will allow you to have the surgery sooner, and may provide additional leverage on your claim. Your attorney may then be able to settle your case prior to a hearing, and get the cost of the surgery taken into account in the settlement amount.

    However, using your health insurance benefits can complicate your case. Before taking action, it is important to discuss this issue at length with your attorney before making a final decision.

    Protecting Your Right to Compensation

    The legal team at Rechtman & Spevak has extensive experience helping injured Georgia workers maximize the settlement value on their claims. If your employer or insurer is attempting to: deny your workers’ compensation benefits; suggest your injuries aren’t severe enough to require a recommended surgery; or terminate your employment altogether, we can help. Please contact us for a free, no-obligation case review. 

  • Should I accept a nurse case manager’s assistance?

    Growing numbers of Georgia employers are using nurse case managers to oversee injured workers’ medical care. However, Georgia law does not require case managers be used, and someone hurt at work is free to accept or refuse a case manager’s help, as he may prefer. If you’ve been hurt on the job, there are several important factors you’ll want to consider before deciding to accept a nurse case manager’s assistance.

    About the Nurse Case Manager’s Role

    A nurse case manager is typically hired by a workers’ compensation insurer to work with the injured worker, and to act as a liaison between the doctors and the insurance company. In the majority of cases, a nurse case manager is a trained registered nurse with previous experience in the health care field.

    Tasks a nurse case manager may perform include:

    • To perform “triage” immediately after an injury to schedule the necessary care and position the worker for a quick recovery.
       
    • To provide telephonic or field case management services.
       
    • To coordinate ongoing appointments with various care providers.
       
    • To obtain information needed to process the claim.
       
    • To answer questions from the injured worker.
       
    • To develop a plan to return the worker to his regular employment duties.
       
    • To make home visits to make sure an injured worker is following the doctor’s recommendations regarding his recovery.
       
    • To meet with the injured worker’s supervisor to perform on-site evaluations and recommend modifications necessary for a return to work.

    Some employers and workers’ compensation insurers will automatically attempt to assign a nurse case manager to every injured worker. Others make decisions based on the severity of the injury or only assign a nurse case manager if the injured worker doesn’t appear to be making progress towards returning to work.

    Potential Conflicts of Interest

    As the nurse case manager is working for the insurance company, this can often result in a conflict of interest with respect to coordinating your medical care. Potential problems that may arise include:

    • She may advise you to stop treatment in order to save your employer money—even though you’re not yet fully recovered from your injuries.
       
    • She may direct you to a doctor who is known to release patients back to work before they’re ready to perform their normal job duties.
       
    • She may try to convince you to avoid seeking a second opinion, even though you may feel that the treating physician is not properly addressing your injury complaints.
       
    • She may try to convince your doctor to sign reports that say you’re exaggerating your injuries or trying to avoid going back to work.

    To illustrate the cost-savings effect nurse case managers have for insurers, consider that a 2011 report from Boston-based Liberty Mutual Insurance Company found that nurse case managers reduced medical costs associated with workers' compensation claims by $6,100—producing a return on investment of eight-to-one.

    Never forget that a “good” outcome will be defined differently by you and by your nurse case manager. Your nurse case manager’s priority is getting you back to work as soon as possible. Your priority is making sure you’ve recovered fully from your injuries and aren’t placing yourself at further risk. A nurse case manager's actions could also ultimately result in you receiving a smaller settlement on your claim than if you had not consented to that person's involvement in your case.

    Consenting to Use Nurse Case Manager’s Services

    Contrary to popular belief, in most cases, you’re not legally required to have a nurse case manager work on your claim. According to the State Board of Workers' Compensation, key points to remember regarding consent to use a nurse case manager include:

    • Consent of either you or your attorney is required for a nurse case manager to work with you on your claim.
       
    • Written consent is required for a nurse case manager to attend your medical appointments.
       
    • Your consent is not required for the nurse case manager to contact your physician for the purpose of assessing, planning, implementing, and evaluating options and services required for your treatment.
       
    • You have the right to withdraw previously given consent at any given time.

    If you have questions about the nurse case manager’s role, or feel that your nurse case manager is damaging your workers’ compensation case, Rechtman & Spevak can help. Our attorneys are committed to helping Georgia residents receive fair and timely workers’ compensation settlements. Please contact us to schedule a free, no-obligation consultation.