We get calls nearly every day from people all over North Georgia who have gotten letters saying their workers’ comp benefits have been suddenly stopped. It’s frightening because the language sounds so official and final. You’ll see phrases like…
- “Your doctor released you.”
- “You’re back to baseline.”
- “Your condition is degenerative and pre-existing.”
- “You can work now.”
- “We’re suspending your benefits.”
The insurance company wants you to think the decision is a done deal. But don’t believe it. We are often able to get benefits restarted. It just takes attention to detail and a thorough application of Georgia Workers’ Compensation law. Very often, the insurance company is using reasoning that does not support its actions.
Let’s look at a real-life example of how this scenario can play out.
Example: A Home Health Aide with a Serious Knee Injury
Our client worked as a home health aide caring for an elderly wheelchair-bound patient. Her work was physically demanding and required long hours. While transferring her patient, she twisted her knee and suffered a major injury.
The insurance company initially accepted the claim and started paying weekly workers’ compensation benefits. However, recovery from a serious knee injury can be slow, and our Client was still struggling after several months. Quite abruptly the insurance company ended benefits.
When the Client came to us with the problem, we immediately reviewed the insurance company’s paperwork and found some big red flags.
The Insurance Company’s Evidence Did Not Support Stopping Benefits
To support their decision to stop benefits, the insurer had submitted a questionnaire to the treating doctor. This is a common and perfectly legal tactic. But insurance adjusters often read the results with a bias toward confirming their decision to stop benefits. It was true in this case.
The doctor’s answers actually made the case in favor of continuing benefits, not stopping them! Key statements from the questionnaire said:
• the work injury aggravated a pre-existing condition;
• the condition had not returned to baseline;
• and extensive conservative medical care had failed.
The insurer took one statement out of context and used it as a basis to suspend benefits even though the clear meaning of the doctor’s responses was that the Client still needed medical care. This is a common tactic in workers’ compensation cases.
When the Insurer failed to reinstate benefits after being informed that their reading of the of the questionnaire was patently wrong, we asked for a hearing before the Judge assigned to the claim.
The Insurance Company Delayed Saying They Were “Not Ready” for Court
After aggressively stopping our client’s checks, the insurance company suddenly claimed it was not ready to go to court.
We insisted on a conference call with the Judge. If the insurance company believed their questionnaire was good enough evidence to immediately stop our client’s checks, how could they not be ready to prove it in court? The Judge agreed to postpone the hearing but ordered the insurance company to restart weekly payments pending the final hearing.
We Won at Trial
After trial, the court ruled in our Client’s favor, denying the suspension of benefits. The Judge specifically found:
- the insurance company acted unreasonably in suspending benefits;
- the medical evidence did not support their position;
- and the insurer acted improperly by stopping checks before it was prepared to defend its actions in court.
The judge also ordered the insurance company to pay assessed attorney’s fees because of its own bad behavior.
To read the published copy of this workers’ comp decision, click here.
The Point: Your Case is Not Over Just Because the Insurance Company Decides to Paying
Many injured workers assume the insurance company has the final word. But injured workers have the right to challenge insurers’ actions in court!
Insurance companies sometimes…
- misapply medical evidence;
- overstate what a doctor said;
- misuse questionnaires;
- ignore medical records;
- or attempt to squeeze injured workers financially.
Talk to a Georgia Workers’ Compensation Lawyer About Stopped Checks or Other Benefit Denials
Stow, Garvin & Glenn handles Georgia workers’ compensation cases involving:
- stopped weekly checks;
- denied income benefits;
- wrongful suspensions;
- change-in-condition disputes;
- denied medical treatment;
- surgery denials;
- and disputes involving pre-existing conditions.
If you would like to speak directly with a local workers’ comp attorney about your case, give us a call. You can reach us at (770)534-5265, send us a message using the contact form below, or stop by our office in Gainesville for a free consultation. There is no obligation in calling. And we only get paid when you win.