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We recently obtained a successful award from the State Board of Workers’ Compensation in one of our clients’ cases. Our client, Christian, trusted us with his claim, and after litigation, the judge ruled fully in his favor.
This case was tried by my law partner, Robert Smith, and it highlights several important lessons about workers’ compensation cases — especially when insurance companies deny medical treatment.
The Insurance Company’s Strategy
After Christian hired our firm, we placed the case into litigation. Months later, the insurance company scheduled a defense medical evaluation under OCGA 34-9-202a. This is a common tactic in workers’ comp cases: the insurer sends the injured worker to a doctor they like, who often produces a report minimizing or outright denying an injury.
In this case, the insurance doctor concluded that nothing was wrong with Christian.
Our Response: Independent Medical Evidence
We did what we always do in these situations. We obtained an independent and fair medical evaluation with a physician who carefully reviewed Christian’s condition and prepared a detailed, well-reasoned treatment plan.
That medical opinion carried far more weight with the judge than the insurance company’s hired doctor. Judges are not required to accept defense medical reports at face value — especially when those reports lack substance or credibility.
The Issue of a Prior Injury
The defense also tried to focus on the fact that Christian had a prior back injury. However, that injury occurred years earlier, involved the same employer, and most importantly, Christian was completely honest about it.
He disclosed the prior injury during his deposition and informed all of his medical providers. Prior injuries only become a serious problem when someone hides them or lies about them. That was not the case here, and the judge recognized Christian’s credibility.
The Judge’s Ruling
The workers’ compensation Administrative Law Judge ruled in our client’s favor across the board.
He ordered the insurance company to authorize the medical treatment that had been denied and appointed our independent medical evaluation doctor as the authorized treating physician. This ensures that Christian will now receive proper care from a doctor focused on treatment — not insurance cost control.
In addition, the judge assessed attorney fees against the insurance company. This means the insurer is required to pay our fees for forcing unnecessary litigation instead of handling the claim properly from the start!
Final Outcome
This was a complete victory for a great client. Christian can now get the treatment he needs and move forward with his recovery.
Cases like this show why it’s critical to challenge insurance denials and why medical evidence — not insurance-paid opinions — often makes the difference.
If you’re in a situation like Christian was, call Colonel Moe to get your life back!
