Getting hurt at work is stressful enough. Most injured workers expect workers' compensation to do what it promises, which is to cover their medical care and replace part of their income while they recover.
When the system breaks down, the signs are usually clear. You need a workers' comp lawyer in Georgia when your claim is denied, your weekly checks stop, the insurance company blocks a recommended surgery, or you are pressured to return to work before you have healed.
At Morrison & Hughes, we see these situations come up time and time again. They are the moments when people start to think, “Huh, maybe I need a lawyer.” Here is what each red flag looks like and why it calls for experienced legal help.
Think Something Has Gone Wrong With Your Claim?
If your benefits stopped, your surgery stalled, or you are being pushed back to work too soon, talk to Morrison & Hughes before you make your next move.
Red Flag #1: Your Claim Was Denied
The first and most common red flag is a denied claim. Insurance companies can deny a workers' compensation claim for dozens of reasons, and some of them are legitimate. However, many claims are denied incorrectly, and those are the cases we hear about most often.
Insurance adjusters frequently handle 200 to 300 files across multiple states, and they may not know the details of Georgia law. They know a claim can usually be denied in certain situations, so they deny it without looking closely at whether your facts actually fit. Some adjusters even deny claims simply to see whether they can get away with it. If your claim has been denied, an attorney can review whether that decision holds up under Georgia law.
Red Flag #2: Your Benefits Suddenly Stopped
The second red flag is a weekly check that stops without explanation. Many workers who call us in this situation assume their claim has been denied, but that is usually not what happened. When you are hurt and out of work, the adjuster typically sets up automatic payments based on how long they expect you to be out. If they estimate 10 weeks, the system issues a check each week for 10 weeks.
Once that period ends, the payments stop, even if you still cannot work. By then, the adjuster has moved on to other cases, and your calls go unanswered. We regularly hear from injured workers who have called their adjuster 20 times, cannot get anyone on the phone, and can no longer afford groceries. At that point, it is time to hire a lawyer and get those benefits started again. An attorney can file motions to restart your benefits and to penalize the insurance company for paying late, and those penalties are typically 15% of the late-paid benefits.
Red Flag #3: The Insurance Company Is Blocking Your Surgery
The third red flag appears when your doctor recommends surgery and the insurance company suddenly hits the brakes, often by requesting an independent medical evaluation (IME). Even though the insurer already handpicked the doctor treating you, it may not like what that doctor recommended. When that happens, it can select another doctor and pay somewhere between $1,500 and $3,000 for a second opinion.
That second doctor may agree that you need surgery but attribute it to a pre-existing condition rather than your work accident. The doctor may also conclude that surgery is unnecessary, suggest it could make your condition worse, or emphasize the risks in a way that discourages you from moving forward. We compare this kind of exam to bringing in a mercenary, because the insurance company is paying for a report that supports its position. Once the insurer has that report and refuses to authorize surgery, you are unlikely to get the treatment you need without a lawyer.
Red Flag #4: You Are Being Pushed Back to Work Too Soon
The fourth red flag is a forced return to work. This often happens after surgery, once you have started physical therapy and the doctor decides it is time for you to go back. A nurse case manager may add to that pressure, even if your job requires you to lift 50 to 100 pounds throughout the day and you do not believe your body is ready.
Whether you actually have to return depends on exactly what the doctor has written. An experienced workers' compensation lawyer knows how to work with those restrictions to help keep your income benefits in place while you heal, so you are not sent back too early and injured even more seriously.
Were You Injured at Work in Georgia? Talk to Morrison & Hughes Today.
When a claim runs into trouble, the insurance company has adjusters, doctors, and nurse case managers working on its side, and you deserve experienced attorneys working on yours. If you are still early in your claim, our guide to the 9 workers' compensation mistakes that can cost you benefits explains how to avoid common problems before they start.
Call Morrison & Hughes at 404-LAW-TEAM for a free and confidential consultation, or request a Free Case Review online. We don't back down.