Would you be surprised to learn that the insurance adjuster assigned to your Georgia workers’ compensation case may try to convince your doctor to change his reports to benefit the insurance company?
This type of behind the scenes effort goes on frequently and you may never know that it is happening.
Further, privacy laws like HIPAA won’t protect you since under the workers’ compensation law, the insurance company is paying the doctor and your treatment record is freely available for the insurance adjuster to read.
Recently, I represented a client who hurt his back at work and was scheduled for extensive – and expensive – surgery and post-surgery rehabilitation. The posted panel doctor had clearly stated that my client’s injury arose from his work accident.
Suddenly and unexpectedly, the posted panel doctor changed his diagnosis to suggest that my client’s back injury may have arisen from a childhood fall fifty (50) years previously. Obviously this makes no sense so I requested a hearing and deposed the doctor. The doctor admitted in his deposition that the insurance adjuster had called him repeatedly about a small reference in my client’s medical history to the childhood accident, and encouraged the doctor to associate the current injury to the long ago incident.
In this case, the opposing attorney backed down, recognizing the outrageousness of the insurance company’s argument. But the danger to claimants arising from this type of insurance company behavior is clear.
Insurance adjusters, who have no medical training, will try to influence the medical diagnoses and conclusions of workers’ compensation treating physicians. They know that many of the doctors whose names appear on posted panel get most or all of their referrals from insurance companies. Some of these doctors will sacrifice your health and well being for their own financial interests.
And you will never know about these behind the scenes shenanigans unless you know where to look or you have an attorney willing to confront the doctor and the insurance company.
I think it is shameful that an insurance adjuster will try to deny you medical coverage for bogus reasons, and I think that doctors who allow untrained insurance adjusters to influence their medical conclusions are shameless. However, this is the world of Georgia workers’ compensation and this is why you need a forceful advocate.
If you think this type of nonsense is going on in your case and you want to fight back, I invite you to call me.