Georgia Law Blog

As mentioned in previous blogs, Current Procedural Terminology Codes (CPT Codes) are a major part of medical records and billing. Our Douglasville law firm uses these codes when reviewing and summarizing medical records and bills. Basically, this is a coding system used by medical professionals to describe specific procedures, services, etc. It is essential to understand these codes, or have some sort of reference material to help, to properly follow along with a client’s medical treatment.

The AMA first developed and published CPT in 1966. This edition primarily focused on surgical procedures and had limited information available for medicine, radiology, and lab procedures. Later editions developed these sections more thoroughly and also included sections on therapeutic procedures and other specialty sections. My Douglas County workers’ compensation and personal injury law firm currently uses the Millennium Edition of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) book published for 2003. The edition is color-coded and very user-friendly. My staff refers to this publication while reviewing extensive medical records for clients who have had several medical procedures throughout the course of their case. There are steps to use to adequately “read” each coding. These steps can be found in the book or on the AMA’s website.

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The American Medical Association (AMA) is an organization that provides information and guidelines for medical providers during the treatment of a patient through the use of several available resources. For example, a physician may use the AMA’s guidelines to evaluate permanent impairment to determine a patient’s limitations as they relate to an injury sustained on the job or from an automobile accident. The guidelines are called the AMA Guides to the Evaluation of Impairment. The most recent edition is the 6th Edition. However, Georgia workers' compensation law still references the 5th Edition.

We use the AMA Guides often in workers' compensation cases. In order for a claimant to obtain a Permanent Partial Disability rating, the AMA Guides must be used. Often, the disability ratings are expressed in percentages to the whole body or the affected body part. We also use the AMA Guides in personal injury cases to establish a disability rating to present to a jury if the case goes to court. These percentages can prove useful tools in evaluating the severity of an injury.

The AMA additionally offers information for law offices and attorneys to use while reviewing a case. For example, my Douglasville law firm often uses a handbook comprised of Current Procedural Terminology (CPT codes) while reviewing medical records. CPT Codes are a major part of medical records and billing. The term CPT is a registered trademark of AMA. These specific topics will be discussed in greater detail in upcoming blogs.

Further, the AMA is known for its promotion of policies and activities that involve public health issues and preventions, such as geriatric or adolescent health awareness and violence prevention, amongst others. A complete list of ethical standards and a list of issues that the AMA is involved with can be found at the official AMA website: http://www.ama-assn.org

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Medical information is essential for all injury cases. In workers’ compensation, medical information assists attorneys for Claimants in understanding a client’s specific injuries as well as by providing a detailed report on a client’s ongoing treatment and expected outcome. Though the concept of medical treatment in a workers’ compensation claim may seem straightforward, many things must be considered throughout the course of a case from all sides of the case. The Workers’ Compensation Medical Fee Schedule is an example.

The Fee Schedule is generally a guideline used to reimburse medical providers by setting specific maximum fee amounts for services provided to an injured worker. Within the Fee Schedule, there are different sections for types of medical care and procedures, including surgeries, therapy, general medicine, and home care services. A more conclusive list as well as detailed information can be found in the latest publication of Georgia’s Workers’ Compensation Fee Schedule, available as of April 2008.

As an experienced work comp attorney practicing in the Atlanta area, I have referred to the Fee Schedule many times. I find it to be a useful tool when reviewing a workers’ compensation claim, as maintaining a current understanding of workers’ comp law is essential in order to provide professional and attentive representation. If you or a loved one has been hurt at work, feel free to call my Douglas County law office for a free consultation.

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I have blogged in the past about the importance of medical bills and records in workers’ compensation and serious injury cases. When someone is injured at work or hurt in a car accident, the medical records track the progression of the person’s injuries, treatment, and recovery. Similarly, medical narratives are also important in a case. A medical narrative is a written report from a doctor that details the patient’s treatment, typically in a letter format. The narrative may include notes from the doctor regarding the patient’s continued care, expected recovery time-frame, and may also include the patient’s disability rating and/or limits to return to work. If a case is to go to trial, a medical narrative from a reputable doctor can help. There is usually a fee for medical narratives but they can be essential in determining the strength of a car wreck case or a work comp case.

As a Douglasville attorney, I have handled several accident cases that have been presented narratives in court. A medical narrative serves as a synopsis of a client’s medical issues and injuries. The narrative also provides a jury with a prediction of sorts for how the injured person’s future will be after an injury. While a medical narrative is not necessary or requested in all cases, it serves as a useful aid in a serious car accident case or on-the-job injury case.

My Douglas County, Georgia law office specializes in workers’ compensation and personal injury. If you or someone you know has been hurt on the job or in a car or truck wreck, please call my office for a free consultation.

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The American Physical Therapy Association (APTA) has dedicated October as National Physical Therapy Month. This nationally-recognized month began nearly thirty years ago. The goal is to educate individuals about the importance of physical therapy and inform about procedures, terms, and tips for recovery from injuries that are often the result of an untimely auto accident or a work accident.

The APTA recognizes that sometimes patients elect to try conservative forms of treatment rather than have surgery. My Douglasville law firm handles many injury cases and a vast majority of our clients undergo various physical therapy programs to treat their orthopedic injuries. Physical therapists assist patients in exercises and procedures to alleviate pain and attempt to return the patient back to his or her normal life before the injury.

If you or somebody you know has been injured in a car wreck, truck accident or on-the-job, please call my workers’ compensation and serious injury law office for a free consultation. We are conveniently located outside Atlanta, Georgia and serve several counties, including Douglas County, Cobb County, and Carroll County.

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A piece of information that may not be considered when someone has been injured in a car accident is the necessity in filing one’s medical bills with the health insurance company as soon as possible. Also, medical bills should be submitted to the automobile insurance company, if medical payments coverage is applicable. Insurance companies often have set deadlines for submission of medical bills under their respective policies. Furthermore, in the case of medical payments coverage, the auto insurer needs to be notified promptly and expenses must be incurred within 3 years from the date of the accident under O.C.G.A. 33-34-2(1).

The financial shocks resulting from a car wreck can be frustrating and devastating, especially in our current economic state. It is good piece of mind to know that your health insurer is doing its part to pay for medical bills, even if they will have to be re-paid due to their subrogation interest.

Actually, in any situation, this is very important. When a person has health insurance, whether it be an individual plan or one offered through the workplace, bills should be submitted for payment in order to avoid credit agencies from hounding you and harming your credit. . When the time comes for a case to be settled, my Atlanta area office thoroughly investigates the file and corresponds with medical providers to confirm all outstanding medical bills, as referenced in an earlier blog. Often, my clients have requested that all outstanding amounts be paid from the settlement so that nothing goes unpaid and shows up later. To provide an accurate breakdown of fees in a settlement, we must have an accurate list of what bills have already been paid by health insurance. Many health insurance companies are relatively easy to work with to see that bills are paid for an injured person.

Please contact my Douglasville law office if you or a loved one has been injured in a car accident, truck wreck, or workers' compensation accident.

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My last blog entry discussed the importance of medical records. This post discusses medical bills which can be equally challenging to obtain, understand, and redact for trial, if necessary. My Douglas County, GA law firm is here to help organize these bills for our clients to help obtain a good result and provide professional representation.

Similar to the importance of an organized set of medical records, the accompanying medical bills are essential in a serious injury case. While medical records provide a detailed description by the doctor about a patient’s treatment, the medical bills provide an ongoing tally of charges for office visits, necessary tests and procedures, surgeries, physical therapy, medical equipment, prescriptions, etc. When people visit the doctor or go to the emergency room, they often do not realize the extensiveness of charges for each provider. For example, a typical emergency room visit following a car accident or truck accident will involve the hospital bill, the emergency room physician bill, a radiology bill, and even an anesthesiology bill, if applicable. If the injured person was transported to the emergency room by ambulance, that is another charge. Each bill plays a part in the breakdown of a case, and, when settlement or trial approaches, they are also essential to have along with sets of medical records.

For a free consultation concerning your car accident or on-the-job injury, contact my office. We will work hard in moving towards a settlement in your workers’ compensation or personal injury case.

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A large part of the workers’ compensation and car accident cases that my Douglasville law firm handles involve the extensive medical records process. For example, when a new file is opened, my office staff reviews which medical providers the new client has seen for his or her serious injury and requests medical records, if needed. Once these records, called “Official Sets,” are received from the hospitals, orthopedic doctors, and primary physicians that our clients have treated with, my office staff summarizes each set. We try to use an organized system for reviewing, summarizing, and understanding the treatment process for each injured worker or auto accident victim. My staff is also experienced at recognizing commonly-used medical terms and procedures and they use this knowledge when reviewing a case. When a case approaches settlement, these medical records play a large role in the overall decision. It is vitally important that we be made aware of each client’s medical providers that they treated with following their automobile accident or on-the-job injury.

If you or a loved one has been injured on-the-job or in an automobile accident, call my office for a free consultation. We will take your serious injuries seriously.

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    The subject of liens causes concern in most lawyers handling injury cases.  When I say the term lien in auto accident and personal injury cases, I refer to the interest a third-party has in recouping money it paid for medical services.  This usually happens when a health insurance company or governmental entity pays medical bills.  Liens can also arise when medical providers perform medical services and are not paid by the patient/client or their insurance.  The term "lien" can also include terms such as subrogation and workers' compensation reimbursement.  Admittedly, this is a complicated subject that could be the subject of a full treatise. 
    I have a simple rule of thumb: it is better to address liens and subrogation interests head-on instead of ignoring the issue.  In years past many lawyers, many very good lawyers in fact, routinely ignored repayment issues.  Recently, however, the legal landscape has changed significantly.  Here is a short list of some of different types of liens and subrogation interests that lawyers handing personal injury claims are likely to encounter:

Continue reading "Dealing With Medical Bills And Health Insurance After A Car Accident: Stand Up Straight & Stop "Liening"" »

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I am often asked what is the most important aspect of an automobile accident or personal injury case.  While there are many important factors, one of the most important aspects in any case is documenting, understanding, and proving injuries.

The first basic task in any case involves gathering medical records and medical bills.  While this may seem simple to many, it is very labor intensive.  Medical bills can especially be difficult to obtain and piece together.  I define the term medical provider to mean any person or entity that provides medical-related services or products.  The term can encompass physicians, nurses, hospitals, physical therapists, chiropractors, laboratories, x-ray / imaging companies, prosthetic companies, psychologists / psychologist, and specialized workers such as speech therapists, occupational therapists, and rehabilitation therapists.  Although cumbersome, the best way I have found to list, on a spreadsheet, each date of service (DOS) with the corresponding medical provider and amount. 

Continue reading "Medical Issues After A Car Accident or On-The-Job Injury" »

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