Independent Medical Examinations in Georgia Workers' Compensation Claims...Understanding Your Rights Under the Act

Often, I am told by my clients that they do not agree with their doctor's opinion regarding their diagnosis and treatment options. I am never surprised to hear this because with workers' compensation, you are usually only allowed to select a physician from a list of 6 doctors the employer and/or insurance company has pre-screened for their practice tendencies and willingness to cooperate with the attorney who represents the interests of the employer or insurer.

In fact, some doctors are reluctant to put injured employees on restrictions or take them out of work because they are afraid of being removed from the insurance company's panel of physicians.

For some doctors, staying on these panels keeps the patients coming in the door and generating cash for their practice. This is notoriously true for occupational medicine clinics. With that said, there are hundreds of good doctors who are on panels that have the courage to stand up for the best interests of their patient - the injured worker - and do what is right.

This issue is important to you because your body and your health are not something that should be taken for granted, especially for unethical reasons. When I find a client's objective medical records are consistent with a serious injury, usually through x-rays, CT scans, or MRI's, and their doctor ignores their subjective complaints of pain, I recommend these clients undergo an independent medical examination or IME. The trick is that O.C.G.A. Sec. 34-9-202 (e) (the applicable law) requires that the case has been accepted as compensable, meaning the employee has received money for their lost time from work, and the injured worker must have received a check within the last 120 days at the time of the appointment.  So, if an injured employee's case has not been accepted as compensable, it is often very difficult to arrange for a second opinion; however, other options are available.

At the IME, the physician will perform a thorough physical examination of the injured worker, take a complete medical history of the injury, and review any x-rays, CT scans, or MRI's the worker has had. In many cases, the doctor will take his own x-rays to confirm the diagnosis. After the doctor has had an opportunity to examine the injured worker and review his or her records, the doctor will issue an opinion. The opinion will usually state whether he or she agrees with the patient's former treatment, diagnosis, work restrictions, and permanent partial disability rating, if applicable. Occasionally, the doctor will recommend further treatment and testing and state whether he or she is willing to take over treatment.

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Facebook, Tweets & Myspace for Injured Workers...Who Is Watching You?

Social networking sites are the newest way we communicate with our family, friends, and co-workers. The craze has caught on and nearly every generation is tweeting or posting status updates to their Facebook and Myspace pages. In fact, Facebook now has 400 million users worldwide.  If it were a country, it would be the 4th largest behind China, India, and the United States. It took radio 38 years to reach 50 million people...Facebook added 100 million users in less than 9 months. So why does that matter to the injured worker? 

It is important to keep in mind that what you say on the internet may come back to haunt you. Insurance defense firms and private investigators are beginning to monitor injured workers' status updates and tweets. Some private investigators are even making up bogus Facebook profiles of attractive men or women to target injured employees with the hope that they will accept their friend request and essentially give them access to the injured workers' daily activities.

I have already seen the seemingly innocent and often funniest status updates from injured workers who did not have privacy control settings in place.  Some real examples included "going to the gym for a strenuous workout," "just got P90-X dude, game on," and by far the worst.... "I've got these doctors all fooled, they think they know me, but they don't." 

Today, defense attorneys are attempting to use these updates and tweets against injured workers in court and in the doctor's office. The term "social website surveillance" has emerged as yet another weapon in the insurance industry's arsenal. In Canada, courts are beginning to order plaintiff's private social website information, including pictures and status updates, to be produced and preserved in civil actions. I imagine the idea of requesting courts to authorize similar information, even when the information is not public, is not that far away for Georgia workers' compensation cases.

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Calculating Your Weekly Benefits Check Under the Georgia Workers' Compensation Act

 In Georgia, determining how much you should receive each week begins with determining your average weekly wage. This is a tricky issue that often requires the assistance of an experienced workers' compensation attorney because a number of factors from uniform allowance to how many hours you worked per week can come into play.

To begin, review your wage records from the thirteen weeks prior to the week of your injury. You should utilize your gross pay (before taxes, insurance, etc. are taken out), not your net pay (what your actual paycheck is.)  Not counting the week of your injury, look to see if you worked the majority of the 13 weeks preceding the date of the injury. If you worked substantially the whole of the 13 weeks, add up your pre-tax weekly wages for those 13 weeks, and divide that number by 13. That is your average weekly wage. To determine how much your weekly benefit should be, divide that number by 1.5. That amount should be how much you are paid each week if you have been taken completely out of work by your doctor. For example, if your average weekly wage is $600, your weekly check should be $400. Note, the current cap on temporary total disability weekly benefits is $500.

If you are working reduced hours or at a lower rate of pay because you were placed on light-duty restrictions by your doctor, you will be receiving temporary partial disability benefits and your check should be equal to two-thirds of the difference between your pre-injury wage during the 13 weeks prior to your injury, and your actual weekly pay while working on light-duty.

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Surveillance of Injured Employees: What You Need to Know About Who is Parked Across the Street

One of the most common questions I am asked by my clients is whether the insurance company will conduct videotaped surveillance of them after they file a claim. The answer is Yes, and often! Just ask Jack "Rocky" Whitten who was taped by The Hartford eating a taco. Rocky lost his disability benefits he had obtained due to a broken neck after paying his premiums for years while working as the Manager of a Wal-Mart. While Mr. Whitten's case involved a long-term disability plan, the same tactics are used in workers' compensation claims.

The insurance companies will use the tapes for many reasons. The surveillance is almost always used to intimidate claimants into settling their case for less than they should.  However, the insurance company will also show the tapes to your doctor to try to persuade their diagnosis and to the judge in order to influence the outcome of the hearing. In the most extreme cases, the insurance company may even try to press charges against you for insurance fraud as was the case with a Quakertown, Pennsylvania woman who lied about a second job she had as an exotic dancer. 

How do you know if you are being watched? The private investigator will usually set up a post outside of your residence in an unmarked car and wait for you to come outside. The P.I. will follow you if you drive anywhere and tape you getting in and out of your car, filling your car up with gas, loading your car with groceries, putting your child in their car seat, or even eating a taco. It is okay to do those things, but make sure you are not moving or lifting in a manner that would seem inconsistent with your injury.  This is true even if you have not hired an attorney or even filed your claim for workers' compensation benefits.

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