Common Defenses Insurance Companies Use to Deny Georgia Car Accident Claims
Claim denials are undeniably frustrating, particularly when ample evidence indicates that the policyholder qualifies for compensation. Insurance adjusters use every trick in the book to put a stop to deserved claims — a few of their more disturbing ploys are highlighted below:
Act of God
Adjusters who rely on the “Act of God” defense may claim that a given accident only occurred due to unexpected weather conditions or other uncontrollable circumstances — driver negligence supposedly played no role. In certain cases, this defense may be valid, but often, drivers and their insurers use this excuse to cover for irresponsible behavior behind the wheel.
Playing the Good Guy
Be cautious of overly sympathetic insurance adjusters — they’re rarely on your side! Rather, they demonstrate false compassion in hopes of convincing you to downplay your symptoms or even admit fault. Problematic adjusters may also claim that they’re making every effort to close the case as soon as possible. In reality, they stall in hopes of missing the statute of limitations.
Social Media Stalking
Don’t mention your accident on Twitter or Facebook; you could compromise your case. Increasingly, companies follow accident victims online, as foolish individuals often incriminate themselves while discussing their vehicular mishaps. Insurers are also eager to determine whether your injuries are as severe as you claim. Consider waiting until your case is closed before posting those surfing or acroyoga pictures.
Incentives For Claim Representatives
Insurance companies incentivize employees to deny as many car accident claims as possible. For example, the American Association for Justice highlights a Farmers Insurance executive, who quipped that representatives should wear a fake tooth grin while responding “Sorry, no more” to policy holders in desperate need of compensation.
Mistreated by an insurance company in Georgia? Call Smith, Wallis and Scott, LLP today. You’ll enjoy in-depth counsel and assertive representation from a highly respected team of attorneys.
Why Isn’t There a Simple Formula to Determine How You Should Be Compensated For Georgia Car Accidents?
Statistics rule the insurance industry, and yet, there is no clear formula indicating the claim value for injuries incurred in car accidents. Insurers use carefully calculated averages to determine what a typical driver may receive, but in reality, nobody exactly fits the profile of the “average” person. A vast array of factors play into compensation values, as highlighted below:
Georgia’s Fault-Based System
As in many states, Georgia follows a fault-based system, in which the at-fault individual is responsible for both property damage and personal injury. This approach offers the potential for several resolutions:
- The injured person can file a claim with his or her insurance company, which then obtains remuneration from the other driver’s insurer.
- The victim can go directly to the other party’s insurer for compensation.
- The issue can be settled via a personal injury lawsuit.
Insurance adjusters seek to determine what the injured party would receive in a juried trial. Companies put a lot of effort into compiling personal injury statistics, along with negotiated settlements. Through examining this data, adjusters have developed multipliers, which may be combined with special damage awards to determine the full extent of deserved compensation.
The Role of Comparative Fault
Comparative fault makes an already confusing system that much more complicated. In Georgia, the primary victim of an accident may be found partially at fault for the incident, and therefore not entitled to complete damages. For example, if evidence indicates that one driver was impaired but the other also demonstrated reckless behavior behind the wheel, fault may lie with both parties. The upside? You can still secure remuneration if you somehow contributed to the accident — it’s just tricky to predict how much you’ll receive.
Confused about car accident compensation in Georgia? Look to Smith, Wallis and Scott, LLP for assistance.
What is the Social Security Administration’s “Listing of Impairments”? How Do You Know If Your Problem Qualifies You For Benefits?
The Social Security Administration (SSA) maintains a thorough Listing of Impairments, which highlights conditions deemed severe enough to prevent sufferers from remaining gainfully employed. Typically, impairments featured on this list are either permanent or expected to result in death.
The Listing of Impairments consists of two portions; Part A, which identifies adult conditions, and Part B, targeted at those under the age of 18. Criteria for Part A may be used among children if their condition has a similar impact on adults and minors.
The list is further divided into the following sections:
- Musculoskeletal System
- Special Senses and Speech
- Respiratory Disorders
- Cardiovascular System
- Digestive System
- Genitourinary Disorders
- Hematological Disorders
- Skin Disorders
- Endocrine Disorders
- Congenital Disorders that Affect Multiple Body Systems
- Neurological Disorders
- Mental Disorders
- Malignant Neoplastic Diseases (Cancer)
- Immune System Disorders
Each section consists of several specific categories. For example, the Mental Disorders section for adults includes categories for psychotic disorders, intellectual disorders, pervasive development disorders, and more.
How Long Should Impairments Last to Qualify For Benefits?
A specific duration may be indicated for certain disabilities, but typically, the SSA mandates that severe conditions result in continuous suffering for at least twelve months.
What If My Issue Is Not On the List of Impairments?
If the SSA does not list your condition, don’t panic; you may still qualify for benefits. Disabilities included in this document merely indicate that adjudicators must automatically move on to the next step in the process. More evidence may be necessary to prove that your problem warrants compensation.
The Listing of Impairments is not the be-all and end-all of Social Security disability, but it can provide excellent insight into your condition and its potential eligibility. Still not sure if you qualify for disability benefits? The experienced Social Security Disability attorneys at Smith, Wallis and Scott, LLP are happy to help.
What Types of Evidence Do You Need to Win a Social Security Disability Case? Part 2
Despite your best efforts to obtain evidence from your primary health care provider, you still risk being turned down for Social Security disability benefits. How can you defeat the odds win your case? Read on to find out.
If initial assessments fail to garner approval for benefits, you may be asked to schedule a supplemental exam. The Social Security Administration mandates use of the treating source, unless that facility lacks appropriate equipment or the claimant otherwise has a good reason for using independent information.
Following the exam, the responsible health care professional will submit a report consisting of the injured party’s top physical or mental problems, the history of those complaints, the believed validity of said grievances, and anything unusual circumstances. The report may also include a statement indicating what the person can reasonably expect to accomplish at work. If the medical professional suspects mental impairment, he or she should indicate the individual’s ability to comprehend instructions and respond appropriately to typical workplace scenarios.
A list of symptoms alone may not be enough to demonstrate that you deserve disability benefits. A variety of other factors may increase your suffering, making a seemingly minor grievance far more difficult to handle, particularly in the workplace. When assessing your current condition, your health care provider should take the following into account:
- Intensity of pain or discomfort
- Side effects of medication or other treatments
- Other methods the claimant uses to relieve pain
- Aggravating factors
Thorough evidence can significantly enhance your likelihood of coming away with the benefits you so desperately need during this difficult time. When in doubt, err on the side of more proof.
Reach out to Smith, Wallis and Scott, LLP today to learn how you can prove your eligibility for Social Security disability.
What Types of Evidence Do You Need to Win a Social Security Disability Case? Part 1
Merely claiming you have a condition worthy of Social Security disability is not good enough; the Social Security Administration (SSA) mandates that you provide ample evidence of your illness or injury. Thankfully, a variety of records and documents can be used to prove your eligibility. Keep reading to learn more:
Acceptable Medical Sources
The SSA highlights a variety of healthcare professionals who can be relied upon for proof of your debilitating condition. These medical experts play a critical role in assessing your impairment and gathering necessary evidence. They include:
- Primary care physicians
- Certified speech-language pathologists
- Licensed optometrists
- Qualified podiatrists
In select cases, non-medical sources may be called upon to confirm the presence of a severe physical or mental impairment. Often, this information is sought from school professionals who work with children suspected of having disabilities. Examples include school nurses, school psychologists, social workers, and caregivers. Alternative health care practitioners may also be called upon for insight into the patient’s condition. Adults seeking compensation occasionally obtain feedback from employers, volunteer coordinators, audiologists, or chiropractors.
Physicians and specialists may be asked to provide thorough reports about a particular patient’s impairments. Typically, these include the individual’s medical history, recent diagnoses, clinical findings, and prescribed treatments. Medical professionals may also be asked to submit detailed statements indicating what the person in question can and cannot accomplish due to the impairment. The focus should be on work-related activities, such as heavy lifting, carrying objects, traveling, speaking, or even sitting still for long periods of time.
A thorough understanding of required materials can greatly improve your chances of obtaining benefits. Contact Smith, Wallis and Scott, LLP today for assistance with finding and presenting the evidence needed to win your Social Security disability case
Critical Deadlines for Employers and Employees in Georgia Workers’ Compensation Cases
In the aftermath of a workplace injury, you enjoy some element of flexibility in filing for workers’ compensation. Official deadlines do not require you to file right away. If you fail to adhere to the proper timeline, however, you may forfeit your right to remuneration.
Giving Notice of the Disability
Recently injured on the job? The Georgia State Board of Workers’ Compensation mandates that you provide notice within thirty days of the incident, or thirty days after you discover the symptoms of a work-related injury.
Filing a Claim
If you fail to file a claim for workers’ compensation within a year, you’ll forfeit your right to remuneration. There are, however, a few exceptions:
- If the employer paid weekly benefits due to the injury, the claim can be filed within two years.
- When employers offer remedial care, filing must occur no more than one year after the final treatment.
- Claim timelines may be extended in select cases involving mental incapacity, injury to minors, or employer fraud.
What If My Condition Changes?
If your disability becomes worse, you must file a claim within two to four years of receiving your final benefit payment, depending on the type of remuneration you intend to seek. If you fail to adhere to the two-year deadline, you may be barred from receiving future temporary disability or temporary partial benefits. You’ll become ineligible for permanent disability if you file after four years of receiving your last payment.
It’s not easy to determine the appropriate timing for filing your workers’ compensation claim. File too early, and the full extent of your injury may not yet be evident, leaving you with reduced benefits. Wait too long, and you’ll lose eligibility for compensation.
Struggling to keep track of important workers’ compensation deadlines? Smith, Wallis and Scott, LLP can give you a hand, so get in touch today.
What if You Need Surgery, an MRI, or a CT Scan Following Your Injury?
Workplace injuries often lead to severe health problems that must be assessed via magnetic resonance imaging (MRI) or computed tomography (CT) scans, and eventually, resolved through surgery. The added expenses of these treatments leave employers reluctant to provide necessary coverage. The Georgia State Board of Workers’ Compensation offers much-needed guidance for both employers and employees, as outlined below:
There is no legal mandate requiring advance communication between medical professionals, workers’ compensation administrators, and employees, but employers typically prefer to be notified before workers schedule major operations. Administrators can then work directly with injured workers and physicians to ensure that proper arrangements are made.
In emergency situations, employees should seek prompt care from the closest medical facility. Once out of immediate harm, they can visit a healthcare professional from the Posted Panel of Physicians. Employers are not responsible for any unauthorized treatments that occur following the emergency.
MRIs and CT Scans
Precertification is not required prior to scheduling an MRI or CT scan. However, contact the claims administrator first. If inappropriate delays occur prior to the test, the employer may be penalized.
Covering the Cost of Travel
Sometimes, workers must travel out of their way to visit approved providers for surgery or necessary scans. This mileage may be covered, along with parking expenses and some meals. Requests for reimbursement should highlight when and where the employee drove. This detailed information must be submitted within a year of the trip. If reimbursement is not provided within thirty days, the employer may incur a significant penalty.
By following instructions and timelines provided by the Georgia State Board of Workers’ Compensation, you can increase your chances of obtaining full compensation. Look to Smith, Wallis and Scott, LLP for counsel as you deal with surgery and other complications of workplace injuries.
Important Georgia Workers’ Compensation Terms Defined
To the uninitiated, workers’ compensation proceedings feel a bit like conversing in a foreign language. Struggling to make sense of the many confusing terms involved in your claim? A few essentials are outlined below:
- Occupational Injury refers to any damaging condition that arose due to typical duties on the job, or as the result of a workplace accident.
- Catastrophic Injuries render employees unable to perform previous duties that did not cause them suffering prior to a workplace accident. Examples include leg, arm, foot, or hand amputation; total blindness; traumatic brain injury; second or third-degree burns covering a significant portion of the body; or severe paralysis.
- A Change in Condition indicates that the workers’ compensation beneficiary’s wage-earning capacity has changed, often because a previous injury has become more or less severe since the employee’s status was last established.
- The Statute of Limitations defines when claims must be filed in order for employees to retain eligibility for benefits. In Georgia, the statute of limitation for workers’ compensation cases is one year after the date of injury, or after the responsible employer has covered the final medical treatment. Employees who fail to abide by this timeline risk forfeiting their right to remuneration.
- A Controvert notice lets the State Board know that a claim for indemnity has been denied. To avoid penalties, this must be filed 21 days after the employer learns of the injury.
- Subrogation allows employers to collect expenses from third parties responsible for workers’ injuries.
The more you understand basic terminology, the more capable you’ll be of meeting essential deadlines and remaining compliant with workers’ compensation law.
Let Smith, Wallis and Scott, LLP ease your workers’ compensation confusion — reach out today to schedule a consultation.
What are Some Reasons Why Your Social Security Disability Payments Might Stop (and What Can You Do About It)?
Social Security disability insurance (SSDI) benefits are never guaranteed; your compensation could stop after years, even decades of reliable payments. If benefits suddenly cease, one of two common culprits may be to blame: excessive income or improved medical condition.
You Earn Too Much Money
The Social Security Administration (SSA) can stop providing benefits if it deems your income substantial. As of 2016, this threshold was $1,130 per month for most disabled individuals, but $1,820 for blind SSDI recipients.
You Aren’t Ill Or Injured Enough
SSDI benefits only last as long as your medical condition. A swift recovery may result in a prompt halt to your disability payments. Unfortunately, only the SSA can determine whether you are truly healthy enough to no longer receive compensation.
What to Do if Benefits Stop
You have the right to appeal SSA decisions if you believe they were made in error. Request a reversal within sixty days of receiving notice of your halted benefits. If you fail to seek an appeal within that time frame, you must let the SSA know why you missed the deadline. If your request is made within ten days of receiving notice, you may continue to obtain payments as your case is re-examined.
Should you lose your appeal, you still have the opportunity to prove your eligibility for disability benefits. Following an initial reconsideration, your case may be presented in a formal hearing or even in federal court. Whether you appear in court or meet with a disability hearing officer, you will have the opportunity to submit evidence indicating that you are still disabled or that your income is not high enough to warrant a ceasing of benefits.
If you no longer receive Social Security disability, and you believe you should, contact Smith, Wallis and Scott, LLP to learn more about your options.
5 Books to Read to Help You Fill Your Time Constructively When Injured/Sick And on SSDI
Chronic illness and injury sufferers complain nearly as much about boredom as they do about the physical symptoms of their maladies. Social Security Disability Insurance (SSDI) benefits may be appreciated, but it’s tough to replace that sense of purpose that accompanies a regular workday. Instead of sitting at home and feeling sorry for yourself, tackle this reading list:
- David and Goliath: Underdogs, Misfits, and the Art of Battling Giants — Malcolm Gladwell
Whenever you feel defeated, grab this inspiring ode to the underdog, which reexamines stereotypes about advantage and disadvantage.
- Not Broken: Making the Transition to Living With Physical Disability — Andrea M. Orsini
Don’t let disability define you. “Not Broken” features valuable strategies for handling the mental, emotional, and social challenges associated with physical impairments. This valuable read will help you reclaim your personal power and momentum.
- At Home: A Short History of Private Life — Bill Bryson
Sitting at home isn’t so bad, as you’ll discover while paging through one of Bill Bryson’s most underrated works. You’ll learn more about the common household items you take for granted.
- Gilead — Marilynne Robinson
The deserved recipient of a Pulitzer Prize, “Gilead” tells the somber tale of Reverend John Ames, a small-town pastor with a devastating heart condition. The book demonstrates why faith is an integral component of daily life, even (or especially) for those dealing with terminal illness.
- Life Without Limits: Inspiration for a Ridiculously Good Life — Nick Vujicic
You won’t feel bad about your malady after reading “Life Without Limits.” Written by a man who lacks limbs, the book shows how anybody can lead an extraordinary life, regardless of disability.
Look to Smith, Wallis and Scott, LLP for assistance with the legal aspects of your Social Security disability benefits case.