Category Archives: Workers’ Compensation Doctors

What shoud I do if sustain an injury at my job in Georgia?

If you have never experienced an on-the-job injury before, you should be aware of what to do before an incident, so that you are able to protect your rights should something occur. I’ve put together a short (but important!) list of things Georgia employees should know:

Take Notes
You should do this quickly, while events are still fresh in your mind. Jot down significant details like the time, the surroundings, the names of any witnesses, any details that led to your accident, and how the accident occurred. If company safety or equipment violations are at play, be sure to note those as well. Alternately –and since we live in a tech-friendly world– you could make a brief video or voice recording of your recollections about the incident (if you choose to do this, however, don’t surrender this to anyone; it should only exist as a point of reference for yourself).

Report It
If your injury is not life-threatening, you need to report it to your immediate supervisor or union representative immediately. There are forms they are required to file, and they will need to take a report about what happened to cause your injury.

If your injuries are life-threatening, go to the closest emergency room right away. When you are doing hospital paperwork, be sure to tell the staff that your injury occurred in the workplace. They have special procedures in place for workers’ compensation injuries.

Seek Treatment
When dealing with a workplace injury, you need to be seen in an E.R. or by a company-approved workers’ comp doctor, depending on the severity of your injury and the immediacy of your need for care.

If your injury is severe, you should report to an emergency room, and notify your supervisor as soon afterward as you are able to do so. If your injury is not severe, your employer will refer you to a workers’ compensation doctor. You must see the provider you are referred to.

Get Documentation
Get a copy of all documents you sign and forms you fill out in relation to your injury. Keep them together in a safe place in case you need them for reference later on. Keep records on-hand of every appointment and prescription.

Follow Instructions
This is one instance where you do not want to be a rebel. You need to follow the doctor’s instructions to the letter. If you are told to stay out of work, stay out of work. If you are told to report to work, report to work. Do not miss scheduled appointments with doctors or therapists. Take any medications prescribed to you according to physician instructions. Do your physical therapy faithfully, and limit activities as directed. This can all be summed up by the phrase– “Be a good patient!”

Say No
If your workers’ compensation doctor requires you to stay out of work or orders that you can only perform light duty tasks on the job, it is against the law for an employer to threaten your employment or potential disability benefits. They cannot legally use your workplace injury to discriminate against you. Refuse anything that goes against doctor’s orders. You have the law on your side, no matter what your employer says.

Get Legal Counsel
Every injured Georgia worker can benefit from a consultation with an experienced workers’ compensation attorney. Atlanta workers’ comp lawyers from Moebes Law, LLC are well-versed in Georgia law and can assist you in determining your best course of action with regard to your disability benefits. They work closely with a team of respected Georgia medical professionals to ensure the highest quality of care for their workers’ compensation clients.

While I hope that you never have to put these tips to use, please bookmark them and review them periodically so that you are prepared.

Does workers’ compensation pay more for medical care than group health insurance?

A recent report by the Workers Compensation Research Institute indicates that workers’ compensation plans have to pay out more on the whole for treatment than employer-sponsored group or private health plans. The independent think tank is based in Cambridge, Massachusetts and looked at sixteen states for this study. In over two-thirds of them, medical payouts on workers’ comp procedures were much higher than the exact same procedures for private plan holders. They sometimes climbed to greater than fifty percent -a startling figure, for sure– more, in fact.

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Research was based on data from medical care given in 2008. Richard Victor, executive director of WCRI, believes these findings will be of interest to insurance and health care professionals, union leaders, workers, and state officials.

“In every state I know of, they are interested in what they can do to increase job creation,” Victor said. “If workers’ compensation costs are unusually high, that puts that state at a disadvantage.”

Workers’ compensation insurance is purchased by employers to provide benefits to employees who become ill or injured while on the job. Coverage includes both medical costs and a partial replacement of an injured worker’s income while they are out of work. The premium employers pay for this insurance is based on the size of their payrolls as well as the volume and degree of severity of injuries and illnesses in their particular industry.

There are two ways that payment to providers can be approached: Regulated and unregulated. In the regulated scenario, amounts paid out on workers’ compensation claims are often regulated by states or are negotiated between insurers and health care providers. In unregulated states there are no set fee schedules for procedures. In three of the four unregulated states -New Jersey, Iowa, and Virginia– costs associated with workers’ comp treatments were extremely high.

Knee and shoulder injuries are some of the most common injuries in workers’ compensation cases. In reviewing these types of cases, the WCRI found that the average workers’ comp payment for shoulder surgery in New Jersey was $7,323 while group health plans paid only $4,583 on average, making the group plan procedure 37 percent less. Knee surgery via workers’ compensation insurance cost $5,547, 42 percent higher than payments through group health plans, to include the co-payments and deductibles paid by patients themselves.

According to a separate study by Oregon’s department of consumer and business services, New Jersey ranked seventh-highest among all fifty states for workers’ compensation premiums paid by New Jersey employers last year.

In Virginia and Iowa, shoulder surgery was more than twice the group health average cost of $5,279 and fifty percent more for workers’ compensation procedures at $8,586, respectively.

In several states where hospital fees are not regulated, workers’ compensation insurers have less bargaining power in price negotiations with hospitals than private group insurers, which lay claim to a much larger portion of the market than workers’ comp insurers. This is a contributing factor to high costs.

Massachusetts and California, which are both states with fixed payment amounts that hospitals can charge in workers’ comp cases, payments were lower than payments made via group health plans. Shoulder surgery in Massachusetts was an average of $2,636 under workers’ comp, while group health plans for the same surgery paid out an average of $4,592. In California, workers’ compensation payments were an average of 16 percent lower than group plans.

Hopefully, studies such as these can be used to 1) further evaluate and adjust medical costs in workers’ compensation claims and 2) encourage quality physicians to “take on” workers’ compensation claimants as patients!

New WCRI study shows some services underutilized by workers’ comp doctors

According to the just-released results of a study by the Workers’ Compensation Research Institute, nearly one in twelve workers injured on the job and given narcotics are still on them three to six months later. The report released on the study, ‘Longer-Term Use of Opioids,’ asserts that this is a result of few doctors following recommended best-practice guidelines on preventing abuse. These include utilizing services in place -like drug testing and psychiatric evaluation- intended to help prevent overdoses, addiction, and diversion caused opioid misuse and abuse.

The WCRI study examined longer term use of narcotics in 21 states (to include our own Georgia and nearby Southern states Arkansas, Louisiana, North and South Carolina, Tennessee, and Texas) and how often the recommended treatment guidelines for monitoring injured workers with this longer-term use was followed by their physicians.

In most of the 21 states, the compliance rate was pretty low. “This study addressed a very serious issue: how often doctors followed recommended treatment guidelines for monitoring injured workers under their care, who are longer-term users of narcotics,” said Dr. Richard Victor, WCRI executive director.

Among the study’s findings:

  • Drug testing was used less frequently than recommended by medical treatment guidelines. Among claims with longer-term use of narcotics, 18-30 percent got drug testing in most of the states studied, with the whole study median at 24 percent. Over the study period, the percentage of workers with longer-term use of narcotics who received at least one drug test increased from 14 to 24 percent in the median state.
  • Use of psychological evaluation and treatment services continued to be low. Only 4-7 percent of the injured workers with longer-term narcotic use received these services in the median state. Even in the state with the highest prevalence of utilized services, only 1 in 4 injured workers with longer-term narcotic use had psychological evaluation and 1 in 6 received psychological treatment. Little change was seen in the frequency of use of those same services.
  • More frequent and longer-term use of narcotics may lead to addiction and increased disability or work loss. Nearly 1 in 12 injured workers who started narcotics were still using them 3-6 months later.

Dr. Victor said the study should assist public officials, employers, and others balance providing appropriate care to injured workers with reducing unnecessary risks to patients and costs to employers.

The study was based on nearly 300K workers’ comp claims and 1.1 million prescriptions associated with them across the 21 states studied. Claims represented involved injuries occurring between October 1, 2006 and September 30, 2009; some of these had prescriptions filled up until March 31, 2011. Overall, the data reflects an average of 24 months of experiences.

To me this study further underscores the fact that injured workers need caring professionals invested in their long-term well-being and not just their short-term care. As a workers’ compensation attorney who practices throughout Georgia, I have worked closely with my clients to help them acquire care with involved and responsive health care professionals. Please contact our offices if you need the services of someone who values your quality of care.

Are workers’ compensation doctors overprescribing pain meds to injured workers?

It’s no new thing that workplace insurers nationwide are having to pay out billions of dollars in workers compensation benefits and reimbursements every year. The largest of those payouts, naturally, go to employees who are catastrophically injured, losing limbs and function in the process. However, those insurers are now finding themselves addressing another large, fast-growing money vacuum:  payouts to those workers whose injuries have been treated using strong pain medicine(s), some of whom don’t return to work for a good while, if they ever do.

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Workplace insurers are spending an estimated $1.4 billion every year on narcotic painkillers, which are also known as opioids. They’re coming to a startling realization: the medications, if used too early in treatment, too frequently, or for too long, can delay an employee’s return to work and, in turn, up disability payouts and medical expenses for the employee.

A 2008 study of claims by the California Workers Compensation Institute found that workers receiving high doses of opioid painkillers to treat their job-related injuries stayed off the job three times longer than employees having similar injuries, but taking lower doses of many of the same meds.

Accident Fund Holdings is an insurer operating in eighteen states, including here in Georgia. In a 2010 analysis by them, it was found that in cases where medical care and disability payments are combined, the cost of a workplace injury is nine times higher when a narcotic like OxyContin is used than when no narcotic is used.

Drugs like OxyContin, Percocet, and Duragesic are all drugs that are used to treat occupational injuries and are part of a broad problem involving their excessive use, according to experts. Workplace injuries are drawing attention, it seems, because narcotics are often prescribed to treat common problems like back pain even though there’s little evidence of their long-term benefit. Not only do they cause drowsiness and lethargy, but high doses of opioids can lead to addiction and other serious side effects, like overdoses.

“What we see is an association between the greater use of opioids and delayed recovery from workplace injuries,” said Alex Swedlow, the head of research at the California Workers Compensation Institute.

Narcotics prescriptions used to treat workplace injuries jumped 63 percent between 2001 and 2008, according to insurance industry data. Along with that jump in numbers is a jump in costs. In an attempt to find means for reversing the trend, some states (New York, Colorado, Texas, and Washington) have issued new pain treatment guidelines; more are expected to do so soon.

It appears that doctors in four states (Louisiana, Massachusetts, New York, and Pennsylvania) are the biggest prescribers of injured workers’ drugs, according to data review of seventeen states by the Workers Compensation Research Institute, which is a group in Cambridge, Massachusetts. Since taxpayers underwrite coverage for public employees like police and fire personnel, costs are hitting them, as well.

Dr. Bernyce M. Peplowski is the medical director of the State Compensation Insurance Fund of California. According to her, insurer’s policies might have “created a monster.” That’s because during the past decade, insurers readily reimbursed doctors prescribing painkillers while eliminating payments for treatments like therapy, which does not rely on drugs.

On a personal note, most of my Georgia workers’ compensation clients are reticent to take narcotic pain medications unless their pain levels are so severe that they have little choice but to take them.  After taking such medications for a while, we’ll often work together to taper such medicating to avoid addiction issues.

Dr. Aria Sabit is a 36-year-old neurosurgeon who had the benefit of a seven-year residency, the final year of which he spent as a chief resident. He also currently has 17 malpractice lawsuits against him; all the suits deal with surgeries Sabit performed in exactly as many months from the middle of 2009 to the end of 2010.

Sabit now practices in eastern Michigan, but the allegations against him originate in Ventura, California, where he started operating in July 2009. Fresh off of his neurosurgery residency at the University of Medicine and Dentistry of New Jersey in Newark, Sabit was partnered with Dr. Moustapha Abou-Samra, a reputable neurosurgeon. According to Sabit, he began to perform some of the most difficult operations at the hospital and earned a reputation as a ‘go-to physician’ as a result. By December 2010, Sabit was fired by Ventura County Neurosurgical Associates Medical Group, according to a lawsuit filed by him against the group. The lawsuit was later withdrawn.

Ventura internist Dr. Jack Padour says, “He was introduced as the next generation of neurosurgery. We thought, ‘Great, we need a guy like that.'” Two of Padour’s patients are among those who filed suit against Sabit. All 17 lawsuits were filed individually by patients after Dr. Sabit stopped practicing in Ventura. They allege that he performed spinal fusions — an operation that utilizes metal rods and screws to anchor the spine in place while bone grafts are used to generate bone growth to fuse vertebra– in which hardware was misplaced, screws pulled out of bone, there was too much hardware used, some surgeries were simply unnecessary, or postoperative infections resulted.

Some patients, such as Olivia Sawyer, experienced extreme pain and had to have procedures redone completely. Sawyer, a 53-year-old resident of Santa Paula, California, had a follow-up surgery to remove improperly-placed and crooked spinal rods. The USC doctor that worked on  her had to remove everything Sabin had previously installed. Sawyer would have been among the number that filed suit, but she was informed that a one-year statute of limitations had already passed.

In Sabit’s withdrawn lawsuit against his former medical group, he took issue with the allegations of both his rates of complications and surgeries being high; he also claimed that the group generated untrue criticism against him. Both Community Memorial Hospital and a leader of the Ventura County Neurosurgical Associates Medical Group are targeted in some of the patient lawsuits and say they can’t discuss the cases, though they did defend themselves against accusations that they waited too long to discharge Sabit. In addition, officials at Community Memorial cite the fact that they were the party responsible for initiating action against Dr. Sabit by the California Medical Board. Duke DeHaas, Sabit’s lawyer, says allegations of unnecessary procedures and poor technique are common in malpractice cases.

According to DeHaas, “That’s what they allege in these lawsuits. It doesn’t mean it’s meritorious. You can allege anything you want. That’s why we have trials.” Contact my Atlanta workers compensation law firm.

Can the workers’ comp insurance company’s lawyer talk to my doctor without me?

The Georgia Court of Appeals has, fairly recently, decided that injured workers cannot be forced to sign away medical privacy rights–specifically, the right to refuse consent for the opposing attorney to meet alone with the treating doctor and tell him/her God knows what–in order to continue getting workers’ compensation disability benefits. A brief summary of the McRae v. Arby’sdecision can be found here.

ga state capital.jpgIn McRae, the insurer’s attorney wanted to speak alone with the injured worker’s doctor; the doctor refused the request, so the insurer’s attorney tried to compel the injured worker to allow such a meeting. While the trial judge agreed with the insurance company’s attorney, the Court of Appeals did not.

 

Currently, there are discussions regarding how this ruling’s reach can be altered or expanded upon via legislation, so there may be additional reach to this ruling in the coming months, as Georgia’s state legislature begins its session.  In the meantime, be careful to read any forms given you after your workers’ compensation injury from the insurance adjuster.  While a WC-207 release may be required, any additional forms or language requiring agreeing to the scenario explained above is not required.

Finally, if your medical information and/or health privacy has been violated, you can report and fight such violations by using the steps outlined in this previous blog entry. Contact my Atlanta workers compensation law firm.

If I’m on workers’ compensation disability in Georgia, am I required to see the panel doctor?

If you’re receiving temporary total disability benefits for your Georgia workers’ compensation claim, you need to attend the medical appointments scheduled with the doctor from the panel of physicians, or the agreed-upon authorized treating doctor. Otherwise, the workers’ comp insurance company may request that your disability benefits be suspended for failure to cooperate with medical treatment.

drugs.jpgMore than likely, they will file a motion to compel your attendance at the doctor appointments first, and then they will pursue suspension of TTD benefits. If getting to the doctor is a concern, you can request transportation to and from the treating doctor’s office (or mileage reimbursement if you drive yourself). Please call Moebes Law, Atlanta workers’ compensation attorneys, for more information on medical benefits and Georgia workers’ compensation issues.

My Georgia workers’ compensation doctor sucks. Can I get another opinion?

If you’re hurt at work in Georgia, and your employer has a valid panel of physicians, you likely started your medical care with a doctor from that panel. Since these panels are chosen by workers’ compensation insurance companies, however, the treating doctors’ interests may not align with yours, and you may find that you do not agree with, or even like, your doctor.  Do you have options?

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Certainly.  You’re allowed a change in physician from the panel of doctors in Georgia.  If you’ve been on workers’ comp disability benefits for several months, you may be able to get an independent medical evaluation (IME) at the workers’ comp insurance company’s expense.  Or, your Atlanta workers’ compensation lawyer may set up and finance an IME for you.

Whether the workers’ compensation insurance company agrees to a change in physicians with you or not, there are options for making a change (your attorney can file a motion if need be).  Certainly, if your doctor is suggesting a treatment you’re not comfortable taking, or if your doctor has released you to a job you know you can’t perform, please explore some of these options for getting another opinion.  My Atlanta workers’ comp lawyers are certainly willing to assist if need be.

How does an injured worker in Atlanta choose a doctor?

Injured workers in Georgia should be directed to a panel of physicians immediately after reporting a workplace injury, in accordance with the Georgia Workers’ Compensation Act.  In most instances, the panel must contain six doctors or medical facilities from which an injured employee can choose a treating doctor.

Often the piece of paper containing these six medical providers is pink, making it easy to distinguish from other notices that may be on display.  The panel is frequently found near a timeclock, in a breakroom, or in an otherwise centrally-located room or office.

workerscompdoctors.jpgThe functions of the panel of physicians should be explained to all employees shortly after they are hired, so that in the event of an accident at work, the injured worker will know where to go for medical care.

Please feel free to contact me, an Atlanta workers’ comp attorney, with any questions you may have about medical treatment after an injury at work.