Georgia company doctor quick to state my client’s injury was solely pre-existing, allowing the insurance company to deny the claim
This is a deliberate strategy on the part of insurance doctors, company clinics and employers and insurance companies in Georgia that is used quite often. Labeling an injury as a preexisting condition, not related to a job at all, “takes the legs out from under” the injured workers' claim, and for that matter, the worker's life.
In a recent case I handled, the company clinic doctor stated my client's rotator cuff shoulder injury was, instead, a type III acromion deformity and could not possibly be a job injury. His proof: an X-ray only.
My client was forced to hire an attorney to fight this arbitrary decision. Of course, the workers' compensation insurance company was glad to totally deny the claim. Yet the first lawyer did nothing to pursue the legitimacy of the medical condition. On multiple occasions, the first lawyer told my client she should settle her claim. Finally, getting tired of hearing settle, settle, settle, without the necessary surgery she would need, she terminated her representation with the first lawyer.
I took over and had to hit the ground running. We needed evidence that her surgery, which she used group insurance to pay for (since workers' compensation denied coverage) was the result of job injury. Then we needed to secure all records of any prior treatment from her family doctor that demonstrated she had NO prior treatment for this same shoulder in her past. We accomplished that.
The closer we got to the hearing, the more delay tactics we had to put up with from the insurance lawyer. First it was “we don't have the prior family doctor records.” Then it was, “we need a clarification about the Type III acromium defect because we still think that is the real problem” (even though the MRI showed a clear rotator cuff tear).
The insurance company lawyer pleaded with the judge for 3 different postponements (while I was her lawyer) but finally the judge “put the hammer down” and said, “no more.”
We received 3 different offers of settlement, all low but nevertheless somewhat interesting to a person who has been totally strapped for money for a year. Fortunately, my client had family and friends to prop her up financially as she is still recovering from this serious surgery.
So with the hearing a week away and nowhere to hide, the insurer has agreed to accept this claim, back pay my client to the date of injury, reimburse the group insurance company the medical costs paid out, and to continue to pay my client weekly benefits while she is out of work, recovering from the surgery. The only bad news is that my client through a Court Order of the judge, will be paying me 25% of her benefits as my attorney fees according to my contract.
A couple of take away here:
- Insurance companies and their “drone” doctors will use every effort, every medical “discovery” to deny a claim on any pre-text possible.
- Denial of a claim puts the injured worker on their knees financially, desperate to find a way to survive.
- Once an insurance lawyer enters the picture to “defend” the insurance company's position of denial of a claim, layers and layers of delay follow making it difficult to move the case towards the court and judicial decision.
- My client's first lawyer saw the delays but instead of fighting hard and attempting to “plow through” the junk being thrown at them, all they wanted to do was settle, settle, settle. Fortunately my client saw through this charade and fired the lawyer.
Because the injured worker is required to go to medical care provided by a company doctor to “validate” their claim (and not go to a doctor of their own choosing as most states allow), they can easily become the victim of deliberately mislabeled medical conditions. The panel of doctor requirement of Georgia has been a huge burden placed upon the injured worker and there is no sign of this part of the law changing in the near future.
Practice area(s): Workers Compensation