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The intent of workers’ compensation law is to ensure costs resulting from industrial accidents and conditions are borne largely by industry. By ensuring workers receive definite and speedy payments for medical expenses and lost wages incurred for on-the-job injuries and illnesses, they forfeit the right to pursue further litigation.
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This is true across the country, and it’s referred to as “exclusive remedy.” It means workers’ compensation is the exclusive remedy through which workers can be compensated for occupational ailments or injuries. Companies are otherwise immune from civil litigation on these matters.

But, as with all areas of law, there are exceptions. There is the third-party litigation that can be brought against parties who are not considered employers. Beyond that, there is the realm of “intentional tort” by employers.

This has been very narrowly interpreted by most courts. In some states, it’s all but impossible to bring such a claim. The definition generally holds anything less than outright, specific intention on the employer’s part is insufficient to permit exception to the exclusivity rule. This typically is not going to extend to situations in which employer acts with indifference or even creates an exceptionally or unlawfully hazardous work environment. It instead means the actual intent to cause harm to the worker.
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Two reports. One by NPR and ProPublica. The other by the Occupational Safety and Health Administration. Released at the same time. Both on the issue of cuts to workers’ compensation nationwide. worker2.jpg

Same conclusions: Workers are quickly losing the aspects that made the bargain of workers’ compensation worthwhile to employees. Due to legislative action in the last decade, benefits are not easily obtained and the monthly payouts are often far less than they should be. When the exclusive remedy of workers’ compensation was established, workers traded the right to sue employers for negligence related to on-the-job injuries in exchange for assurance that their company would subsidize their basic needs while they recovered.

There is now a wide-ranging disparity of these benefits among states, and if action isn’t taken soon, we will see this trend continue.
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In Georgia, companies cannot legally terminate an injured worker as retaliation for filing a workers’ compensation claim.
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However, there is no law preventing an employer from terminating an injured worker who is receiving workers’ compensation – so long as that worker isn’t being punished for filing the claim. Unfortunately, it’s not unheard of for employers to invent reasons for firing unrelated to injury. Because Georgia recognizes employment at-will, this means without a written employment contract, a company can fire a worker at any time for most any reason.

This puts injured Georgia workers in a tough spot, and may actually discourage some from reporting their work-related injury in the first place.
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When it comes to workers’ compensation law, states have varying applications with regard to disputed issues. In general, though, what must be proven is the injury or illness was caused or compounded by work-related duties or functions, and that the individual seeking to collect has legal standing to do so.
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A recent case before the South Carolina Court of Appeals posed some interesting issues with regard to these elements, but the claimant still prevailed.

In Thomas v. 5 Star Transportation, claimant was the widow of a worker who died in a traffic accident while driving a tour bus for his employer. But the case was complicated by two central facts:

  • The worker had suffered a brain aneurysm around the time of his death, though it could not definitively be proven it happened before the crash.
  • The woman who sought spousal benefits was not in fact married to decedent, as his divorce to his previous was not final at the time of their wedding – a fact she didn’t learn until after he died.

Yet, claimant was able to succeed in securing workers’ compensation death benefits, but it didn’t come without a vigorous fight by the employer.
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In most cases, injuries that happen at home or are attributed to an internal, personal condition will not be compensated through workers’ compensation insurance. That’s because injuries must arise out of and in the course of one’s employment.
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However, the recent case of Sullwold v. Salvation Army, before the Maine Supreme Judicial Court, proves there are always exceptions.

The case involved a high-level executive for a non-profit organization who died of a heart attack while walking on the treadmill at home. Three factors made this case different than most others we might see in similar circumstances. The first is that plaintiff was given permission to work from home on some occasions, and this was one of those. The second is that although he was on a treadmill when he suffered the heart attack, he was working from his smartphone as he walked. And finally, his widow was able to produce evidence indicating the heart attack was caused in large part due to work-related stress.
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A woman who became ill as a result of exposure to toxic heavy metals while working to restore furniture for a large chain store was recently awarded compensation for necessary treatments at her doctor’s office.
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In Moore v. K-Mart Corp., the West Virginia Supreme Court took the unusual step of declaring a law invalid for its direct contravention to the underlying purpose of state workers’ compensation benefits law.

The primary issue was not whether the illness was work-related. No one disputed it. The issue was not the extent of injury. All agreed it was severe. In fact, no one even argued the treatment she was receiving wasn’t medically necessary or reasonable. The core of the dispute was the place in which she was receiving this particular type of treatment.
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In a decision aligned with that of the Florida Supreme Court, the 11th Circuit Court of Appeals – the same one that oversees the review of Georgia cases – backed the exclusive remedy provision of workers’ compensation law as the sole source of compensation for a deceased worker’s family.
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The exclusive remedy provision – which is woven into workers’ compensation laws in all 50 states – strips workers of the right to sue employers, even when the incident leading to injury or death was the result of negligence. Rare exceptions are made in certain states when it can be shown an employer displayed wanton or reckless disregard for the safety of workers. However, in most cases, workers and their families will be limited to workers’ compensation benefits from an employer.

Some situations may be ripe for civil litigation against a third-party wrongdoer, but that will depend heavily on the underlying circumstances.
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In workers’ compensation law, the concept of maximum medical improvement can be an especially thorny one. That’s because this determination spurs important questions about the continuation and amount of benefits.
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Maximum medical improvement is considered the point at which a worker’s medical condition has stabilized to the point that any further improvement isn’t likely, even in spite of ongoing treatment or rehabilitation. Essentially, it’s a plateau, meaning the worker is “as good as he/she is going to get.”

This can indicate full recovery, but it also can simply mean the patient is not going to get any better. It is from this point a determination can be made regarding permanent partial impairment.
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When a worker suffers an on-the-job injury, state law holds workers’ compensation benefits are the sole source of compensation a worker can receive, with few exceptions. These benefits are considered the “exclusive remedy” a worker can pursue against an employer.
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Other third parties may still be vulnerable to a negligence lawsuit, but plaintiffs should bear in mind that some are still statutorily protected under workers’ compensation law in some cases.

For example, a negligent third-party driver could be held liable, as could potentially the property owner of a construction site. However, there are some exceptions. Co-workers, for example, are usually protected. (A 2012 Georgia Supreme Court decision in Smith v. Ellis held co-workers could potentially be held liable for injuries caused if their negligent actions occurred outside the course and scope of their employment.)
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In order for a workplace injury to be compensable, it has to arise out of and in the course of employment. This means there has to be some connection between the conditions under which employee was working the injury that resulted. feetwalking.jpg

Usually, if an injury is deemed idiopathic, or due to some internal weakness or breakdown, it’s not considered compensable by workers’ compensation because though it may arise in the course of employment, it does not arise out of employment.

An example might be a heart attack or seizure that occurs at work, but had nothing to do with work.
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