Workers Comp Blog
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In a recent rulling, the Court of Appeals held that the Five-day time lmit for insurers to respond to a WC 205 request from the treating physician cannot be enforced if the insurer defends on the basis that the requested treatment in not related to the on-the-job injury. This unfortunate ruling for employees could result in even longer delays for employees to get much-needed treatment. Under Board rules, A physicain authorized to provide treatment to the employee could send a form called a WC 205 to the insurer requesting authorization to provide certain treatment. The insurer had 5 days to respond, either approving the request or denying it. If the insurer failed to respond, the procedure was considered approved and the insurer was required to pay the doctor for it. Doctors are oftentimes reluctant to proceed with certain treatment, such as surgery or other expensive treatment, without prior approval from the insurer for fear they may not get paid for it. The delays caused by insurers who are slow to respond to the requests for approval, or who fail to respond at all, are one of the biggest difficulties an employee is faced with who is receiving medical treatment for a work injury. Thus, Board Rule 205 was enacted to give the employee and his doctor a better chance to get a faster response when the treatment requested was of a more urgent nature. In the case at bar, the insurer did not reply to the doctor and when the employee requested a hearing, it defended on the basis while it may not have responded within the 5 days, that the procedure requested was not related to the injury so it did not have to. The employee argued that the insurer waived its right to argue in this manner because it had not responded within 5 days to the WC 205. The Court sided with the insurer, essentially ruling that the 5-day requirement did not apply when the insurer did not believe the procedure was related to the injury. The obvious problem this ruling creates for employees is that as long as the insurer makes the argument, whether valid or not, that the procedure is not related to the injury, it will not have to comply with the Rule. It is unknown whether the employee in this case will appeal to the Georgia Supreme Court, but I hope that he will do so.
On another note, be sure to visit my new website, www.romeworkerscomp.com, a site dedicated to my claimants side workers comp practice. If you have questions about your workers comp claim, please contact me. Thanks, and have a great day. BGS
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In a recent deccision, the Court of Appeals reversed an order awarding benefits to an employee by a Superior Court, which had reversed a decision of the State Board of Workers Compensation denying benefits to the employee for an injury he received. The employee injured his knee while at work on two occasions. On each occasion, he got minimal medical treatment and returned to work. On the last occassion, he reinjured the same knee while riding a four-wheeler on his personal time. He claimed that the last injury was the result of wear and tear from hs job duties and further argued that one part of his injury was essentilally from one of the previous work injuries. The employer argued that the last injury was the reason he needed medical treatment, and was clearly not related to his work. Apparently, there was at least some medical eveidence to support the arguments for each side. Ultimately, the employer won the case and benefits were denied. There were a number of interesting legal issues in this case, but the moral of the story that lay persons can take from this opninon is that even if you have medical evidence to support your argument as to why you should receive benefits, the Judge can put as much or as little weight on your evidence as he/she chooses, and rule based on whichever side's evidence seems the most compelling. The judgement willl not be reversed on appeal, because the appellate judges cannot substitute their judgement for the Board's and determine that the other side's medical evidence makes a more compelling argument. If there is some evidence to support the judge's findings, the award will be affirmed. If you have questions about your workers comp claim, please contact me. Thanks, and have a great day. BGS
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Under Georgia law, when a workers compensation insurance carrier pays benefits for a work-related injury caused by the negilgence of a third party, the carrier has a lien against any settlement or judgement rendered for damages paid to the employee due to the third party's negilgence. This is known as subrogation. It allows the carrier to recover for its loss by allowing it to collect reimbursement for benefits it had to pay when the person suffered the injury at the hands of another. The way this usually arises is when an employee is injured in a car wreck caused by another person while on-the-job. The employee then sues the person who caused the accident resulting in his injuries. The workers comp carrier asserts its lien because it has a claim for any benefits it paid for medical treatment and wage loss suffered by the employee against the settlementy or judgement the employee obtains. There are some prerequisites to the carriers' ability to collect, and the statute which allows subrogation is worded in such a way that it can be difficult for the carrier to successfully assert the lien. However, most insurance companies will not settle with the employee for the third party claim unless there is also an agreement in place regarding how much the workers comp carrier will get from the settlement to resolve its lien. Thus, most subrogation liens are usually resolved by negotiation, rather than by going to court. If you were hurt on the job and are pursuing a claim against the third party who caused your injuries, and because the injury occurred while you were at work, and you received workers comp benefits, you will have to address the lien in order to collect damages. If you need assistance with this, or if you have any questions regarding your workers compensation claim, please contact me. Thanks, and have a great day. BGS
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I take calls every month from people injured on the job who work for an employer that does not carry workers compensation insurance. Under Georgia law, any employer who regularly employs 3 or more persons is required to have workers compensation insurance. Unfortunately, many smaller businesses do not comply with this requirement. Workers compensation insurance can be expensive, and some business owners simply "hold their breath" and exist without it, hoping they will not have a claim filed against them. Some employers even believe that if they do not carry workers comp insurance that they will not have to pay claims. However, just because an employer who is supposed to have workers comp insurance does not, the employer is still liable for payment of benefits in the event of a work injury, just as if there was insurance. In other words, it is not a defense to a workers comp claim that the employer does not have workers comp insurance. On the other hand, few uninsured employers can afford to pay benefits without workers comp insurance, especaiily medical benefits for serious injuries which require expensive medical treatment. As a result, lawyers are reluctant to take cases against uninsured employers, because the likelihood of obtaining relief for the injured worker is small, and sometimes, impossible. If you are employed by an employer that does not carry workers compensation insurance, you are taking a very serious risk, especially if you are in a line of work that is dangerous, or where you work with power tools, or engage in manual labor. You would be wise to make sure you have another source of health insurance, or a way to pay for medical treatment in the event your suffer an injury, because it is very unlikely your employer can or will do anything meaningful to assist you. If you have questions about your workers compensation claim, or have been hurt on the job, please contact me. Thanks, and have a great day. BGS
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Under Georgia law, an injured worker is required to give notice of his/her injury to the employer within 30 days of the work injury. While the legal requirement is that the notice should be given in writing, as a practical matter, it ofttentimes is only given verbally. Failure by the employee to give proper notice can result in the claim being barred. On the defense side, is it often said that if all you have is a notice defense, you have no defense. While this is true, I have seen many claims end up needlessly in litigation simply because the employee either did not report the injury, or when they did report it, the neglected to report it as a work-related injury, and instead reported it as an old medical problem that had simply reoccurred without cause. I am currently involved in several cases where the employer has questioned the existence of a work injury because the employee did not report the injury as work-related. In one case, the employee told me she feared losing her job if she reported it as a work injury. Once the employer found out she was hurt, can you guess what happened to her? If you guessed she was fired, you guessed correctly. She lost her job, anyway. The injured employee should always truthfully report the circumstances of a work injury. Even if the employer terminates the employee for it, there are remedies for the employee and consequences for the employer for doing so which often work out to the employee's benefit. If you have questions about workers compensation law, or if you have been hurt on the job, please contact me. Thanks, and have a great day. BGS
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