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Can I settle a workers comp case without reaching MMI? And - what if a new doctor that i have say's i can perform light duty?

Cumming, GA |

I have had three back surgeries in the past three years due to a work injury. I had two posterior lumbar fusions and then I had to move out of state wich complicated things but I just had surgery last month (ALIF) which took a year and a half to approve. This new doctor I have is making me nervous - I'm on disability and I know there are people milking the system - but I am not. I can't even sit on my own sofa. If this doctor say's that I can perform light duty, my benefits will cease due to me being out of state. Truth is, I can't do light duty! Can I be forced to do light duty? Can I just close my case and be rid of this workers comp nightmare? My doctors last comment to me was " you may not be able to do physical work but you can use your mind".How?? when im in bed!

Attorney Answers 4

Posted

First, I'm sorry you've had such a rough time. I'm assuming your claim is a Georgia claim, in which case the answer is "Yes" you can settle your GA comp claim without reaching MMI. Georgia is different from some other states. There is nothing magic per se about reaching MMI here. Just because you reach MMI, it does not automatically affect your income benefits in any way.

You employer/insurer can, if they choose to, go through a procedure to require you to attempt a light duty job which has been approved by your doctor within the last 60 days. But, there is a 15 day trial period to see if you can do the job or not. If you can't do the job and cease working within the 15 days, then the insurer has to automatically recommence your WC checks. If they really want to push it, they could ask for a hearing at that point and try to convince a judge that you are capable of doing the light duty job, but they will have to keep paying you in the meantime. With as many surgeries as you have described, I think they will likely have a tough time proving their case.

If your claim is in another state, then this answer may not apply, since in some other states, reaching MMI will affect your benefits. If you have a claim in another state, you need to seek advice from a lawyer who practices in that locale. I only practice in Georgia. If you need to find a lawyer in another state, I can help you do that.

I hope this helps. If you have further questions, please contact me. I'd be happy to help.

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Asker

Posted

Thank you for sharing your knowledge in this matter. This is, however, a Connecticut wc case. I had to move to GA after my 2nd back surgery. With CT if the doctor says I can perform light duty work, and I live out of state - I would have to be able to perform light duty work within CT. I just fear that this doctor is a little more workers comp "friendly" than I was aware of. Im not sure what to do..

Charles C. Hamilton

Charles C. Hamilton

Posted

I was afraid you were going to tell me that. I'd get in touch with a CT lawyer who does WC. Chuck ______________________ Charles C. Hamilton, P.C. (770) 951-5444

Posted

Yes, you may settle your Georgia workers' compensation claim without reaching maximum medical improvement (MMI). Some insurance claims adjusters will demand the issuance of a permanent partial disability (PPD) or permanent impairment rating before they will settle, but that is not necessary either. Experienced attorneys and adjusters can often estimate what the PPD rating will be and avoid the time and expense of obtaining a formal rating from the doctor.

The short answer to your question, which would be a very long answer if all of the various aspects were evaluated, is that your authorized treating physician's (ATP) opinion controls. Thus, if he/she says you are capable of light duty work and the employer offers you light duty work within your work restrictions, you must at least attempt the job or the employer/insurer can suspend your income benefits without obtaining approval from the State Board of Workers' Compensation. If you attempt the light duty job but cannot perform it for 15 days, your income benefits must be recommenced, then the employer/insurer may seek suspension of your benefits from the Administrative Law Judge if they feel your refusal to work is unjustified, but that will require an evidentiary hearing.

If you are uncomfortable with your workers' compensation physician, I would suggest investigating alternatives for either obtaining a second opinion or possibly transferring your medical care to a different physician.

Tracy W. Middlebrooks, III
(404) 250-3292

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Posted

OK. Lots of questions here. I am assuming you are drawing benefits under Georgia's workers comp. If so, you do not ever have to settle your claim. If you want to, you certainly can regardless of whether any doctor puts you at MMI (this is different from many states). And your benefits are not automatically cut off if your doctor says you can work light duty (LD). There is a mechanism for stopping the disability payments when on LD but the insurer has to go through a hearing to prove a change in condition first.

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Posted

In Arizona, if you are on light duty and there is a job available to you within your restrictions, the insurance carrier can refuse to pay you the equivalent of what you can earn in that position. Regarding settling the case before you reach your maximum medical improvement, most insurance carriers in Arizona are not open to doing this. There usually needs to be at least one doctor rendering the opinion that you are medically stationary. Again, I am licensed in Arizona, so that's how it works here. You should consult with an attorney that is licensed in the state where you were injured.

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