I regularly advise my clients that they should be cooperative, yet guarded in their interactions with posted panel or employer provided independent medical examinations. 1 Often the physicians used by employers and their insurance companies get most or all of their business from insurance companies and they frequently minimize your symptoms, hold off on ordering tests, and are quick to return seriously injured claimants back to full duty work.
Most of us are brought up to think that a doctor is a doctor and that there must be some law or rule which says that your doctor’s first priority is your health and well being. In the reality of the workers’ compensation system, many of the doctors you will encounter assume that all injured claimants are most likely exaggerating or even faking their symptoms and will base their treatment decisions on this often false assumption.
I recently attended a continuing legal education seminar where one of the speakers related a story about an insurance company IME that illustrates what many claimants face. In this case, a long time employee of a company injured his right knee when he fell off a loading dock. The employer/insurer picked up the claim and paid benefits. Medically, however, his condition did not improve with rest, physical therapy or injections. [Read More...]
Often, disputes will arise in your workers’ compensation claim that require a decision by a judge. The types of disputes that might require such a decision include such things as:
- disagreement about which doctor should be authorized as a treating physician
- whether the insurance company’s termination of benefits is appropriate
- delays by the insurance company in sending out checks and penalties that may be appropriate
In the past, if I found myself in disagreement with the insurance adjuster or defense counsel, my only recourse was to request a hearing. The problem with this option has to do with timing – the State Board dockets are full and it may take weeks or even months to get a hearing scheduled. Further, my hearing request would likely trigger depositions, motions to produce and other costly and time consuming procedures.
Fortunately, State Board judges are increasingly open to helping the parties resolve these disputes in brief conference calls that can be scheduled in a few days or weeks rather than full blown hearings. Conference calls are not appropriate for every type of dispute but I have found them to be indispensable when I need to “encourage” the insurance company to speed up their payment processes, or to approve an emergency medical procedure. In this video I discuss how these conference calls work and when I use them.
Speeding Up the Process with a Conference Call to the Judge on my Vimeo law channel.
Many of the problems that you may face in your workers comp. claim will arise from the medical care you receive from the posted panel physician. While it would not be accurate to question the motivation and integrity of every doctor who appears on a posted panel, I counsel my clients to always keep in mind that panel docs get paid by insurance companies and get on-going business from insurance companies.
Over the years I have reviewed thousands of pages of treatment records and been involved in several thousand cases and I can tell you that medical care relies to a great extent on the judgment of the treating physician. If you experience a severe back injury, for example, physician A may prescribe 6 weeks of physical therapy, followed by a series of 3 epidural injections, followed by minimally invasive diskectomy to trim protruding disc material. Physician B may order epidural blocks right away, followed up by a much more extensive fusion surgery. Physician C may make the determination that you are not a surgical candidate at all and refer you to long term pain management.
Each of these options involves both a short term and a long term cost and risk to the insurance company. As your attorney, I am focused on which treatment option will give you the best chance at long term health – both freedom from pain and maximum return to physical capacity. I am your advocate and the cost of treatment is not my concern.
The insurance company is focused on keeping its costs in check.
The physician who relies on the insurance company for business has an ethical and professional obligation to help his patient but will feel pressure to choose treatment options that may not be entirely focused on your heath. [Read More...]
I want to call your attention to an issue that may seem like a minor part of your workers compensation case but, in fact, could significantly increase your bargaining power. This issue has to do with the validity of your employer’s posted panel of physicians.
As I have discussed extensively on my web site, employers subject to the jurisdiction of the Georgia State Board of Workers Compensation are required to post a list of physicians at an accessible place on the work site, and they are required to explain to workers how to report injuries and obtain medical care from a panel doctor.
Georgia law at Code Section 34-9-201 sets out very specific requirements for what constitutes a valid panel of physicians. With limited exception, a valid posted panel must include at least 6 unaffiliated physicians, at least one of whom must be an orthopedist, and no more than 2 of which may be industrial clinics.
If the panel is not valid, the injured employee may choose any physician to serve as the authorized treating physician and the employer must pay for medical care provided unless and until the State Board orders otherwise.
Given the adversarial nature of the workers’ compensation system in Georgia and the anti-claimant biases displayed by many panel physicians, a failed panel can serve the interests of you, the injured claimant, by giving you control of your medical care.
Often, my clients advise me that when they are hurt, their human resources supervisor shoves a panel in their face and tells them to “choose a doctor.” What I am finding, however, is that many of these posted panels are not valid because the physicians listed on the panels have moved, changed phone numbers, retired, or joined the practice of another panel physician.