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Georgia workers’ compensation claimants may occasionally receive treatment or tests that are not pre-authorized to receive workers’ compensation benefits. In a recent opinion, this issue was discussed at length by a state appellate court.

The Facts of the Case

According to the court’s opinion, the claimant suffered a neck injury while at work, which was covered under workers’ compensation. Although the claimant had preexisting neck injuries, the claimant received workers’ compensation benefits to treat his neck pain.

An orthopedic surgeon evaluated the claimant’s neck and recommended cervical fusion surgery. The claimant filed a claim to have the operation covered under workers’ compensation. The employer then had an independent medical examiner evaluate the case, who found that the work injury was not the major contributing cause of any condition for which the fusion surgery was recommended, and the employer denied the claim.

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Georgia workers’ compensation claimants may run into issues if their employer claims they are an independent contractor, rather than an employee. In a recent case, a state supreme court considered whether a deputy working security part-time at a grocery store was an employee of the store.

The Facts of the Case

According to the court’s opinion, the deputy was employed by both the sheriff’s department and the grocery store. While he was working, he saw a woman he believed was shoplifting, approached her, and found merchandise that she had concealed. The woman was escorted to the manager’s office, and the deputy placed her under arrest. She asked to use the bathroom, and when he uncuffed her, she ran. While he was running after her, he sprained his ankle and was out of work for five weeks. The grocery store argued that it did not have to pay workers’ compensation benefits for the deputy’s injuries because he was an independent contractor, not an employee.

The court explained that it was not important that the deputy was paid by the store, because that is true for both employees and independent contractors. The court reasoned that he was not an employee because he had to obtain permission from the sheriff’s department to provide security at the store, the sheriff’s department required him to wear his uniform and carry his gun and handcuffs, he was not trained by the store, and the store did not interview him for the job. The court found that all of the factors pointed to the conclusion that the deputy was an independent contractor and, thus, was not entitled to workers’ compensation benefits from the store.

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Workers’ compensation claimants in Georgia may be entitled to compensation even if they have a preexisting condition. If you  have questions of this nature, be sure to reach out to a dedicated Georgia workers’ compensation attorney. In a recent workers’ compensation opinion, the court considered a case involving a preexisting condition that was allegedly worsened by a work injury, and determined the extent to which the injury was covered under workers’ compensation.

In that case, a law enforcement officer allegedly took several blows to the left side of his head during a training course at work. He suffered severe headaches and, a month later, suddenly lost most of the vision in his left eye. Two physicians evaluated the officer and believed that the vision loss was not related to the blows he sustained, but was caused by an underlying condition of defective blood circulation to his left eye

A medical examiner also evaluated the officer and opined that if he had not suffered the blows to his head, he “most likely” would have retained most of his vision, but that the officer could still have lost his vision due to the underlying condition. The medical examiner determined that 85% of the claimant’s disability was caused by a preexisting condition, and 15% was caused by his work injury.

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In a Georgia workers’ compensation case, the ability to present a clear explanation of the facts is just as important as the ability to argue the applicable legal issues. If a judge does not have a clear understanding of the facts, the judge cannot reasonably or reliably make a decision. This was precisely the situation in a recent workers’ compensation case.

The Facts

According to the court’s opinion, the claimant worked as a relief operator and injured his right shoulder in a workplace accident. An MRI later showed that the claimant had a moderate partial rotator cuff tear. The claimant received treatment, and later filed for workers’ compensation benefits. After a trial, the court found the injury compensable and awarded the claimant workers’ compensation benefits. However, the claimant appealed the award in part, arguing that the court should have awarded him for his unpaid out-of-pocket medical expenses.

Not every claimant successfully obtains Georgia workers’ compensation benefits on their first try, but some denials can be reversed on appeal. However, employers and insurance companies can also appeal an award of benefits, as in the situation in a recent workers’ compensation case discussed  below. If you have been injured on the job, a Georgia workers’ compensation attorney could be crucial to obtaining the benefits to which you are entitled.

In that case, an employee who was working at a dairy farm injured his knee while delivering milk to a grocery store. He testified that he was carrying a milk crate and stepped off the truck when his knee “popped” and afterward he could not move it. The employee received workers’ compensation benefits which included surgery and physical therapy.

The following year, the employee’s leg gave out when he was standing up at his house and he fell on his side. He immediately experienced pain in his neck and back. The state’s Workers’ Compensation Commission awarded him benefits for his knee as well as his back. The employer appealed, arguing that there was not substantial credible evidence to support the Commission’s decision.

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Georgia workers’ compensation claimants can encounter problems when requesting certain treatments. In a recent case before one state’s supreme court, the court had to consider whether a worker’s back surgery she had performed in Germany was compensable.

The worker suffered a back injury while working as a driller for a coal company. She underwent surgery and other treatments here in the U.S., but continued to experience pain. One doctor recommended a laminectomy, and the worker went to obtain a second opinion. The second doctor recommended a foraminotomy and transforaminal lumbar interbody fusions. The worker continued to investigate her options online and found an orthopedic surgeon in Germany. The German surgeon recommended two fusions and an implantation of an artificial disc. However, while the artificial disc was approved for use in Europe and several other countries, it was not approved in the U.S. by the Food and Drug Administration.

The worker flew to Germany and had the surgery performed, which appeared to be a success. The worker went back to work and was able to perform her previous duties. She even stopped taking pain medication. Yet, the state’s Workers’ Compensation Division denied compensation for the surgery. The Division found it was “alternative medicine” and was not reasonable and necessary medical treatment.

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In the tragic event of a family member’s death while they are at work, Georgia families may be entitled to death benefits under the Georgia’s Workers’ Compensation Act. These death benefits, which are meant to ease the financial burden on the worker’s family, may be contested by employers.

Employers may dispute the compensability of a claim to avoid paying benefits to a worker’s family by claiming that the worker’s death is not covered under the Workers’ Compensation Act. To receive benefits, a person must show that the worker’s death resulted instantly from an accident arising out of and in the course of employment, or that during a period of disability caused by an accident, the worker died as a result.

The Workers’ Compensation Act currently provides benefits for burial expenses of up to $7,500, and weekly compensation of two-thirds the worker’s income for the worker’s dependents up to $575 per week.

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Workers’ compensation claimants are not required to show that their employers were at fault in order to succeed in a Georgia workers’ compensation claim. In a recent state appellate decision, the court reversed the decision of a workers’ compensation judge, reiterating that the employee was not required to show that the employer was at fault for the injury.

In that case, the employee was walking down a set of stairs as she was leaving work when she fell and broke her ankle. She was carrying a plant from her desk and was not using the stairs’ handrails. She later testified that her shoe stuck to the tread of the stairs.

The employee filed for workers’ compensation benefits, but her employer argued that the injury did not “arise out of” her employment so the employee was not entitled to benefits. The workers’ compensation judge found that the injury did not arise out of the employee’s employment because she did not show that the stairs were more hazardous than normal stairs or that her work increased her risk of falling on them.

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In a recent case, a Georgia appeals court reinstated a teacher’s claim for Georgia workers’ compensation benefits after it was appealed for the third time. The teacher brought the claim for benefits after she injured herself at work. The teacher was instructing fifth grade at an elementary school and allegedly fell while walking from her desk to the front of the classroom, injuring her knee.Her employer argued the injury did not arise out of her employment. An administrative law judge for the State Board of Workers’ Compensation first granted the claimant’s claim for benefits, finding that she sustained an injury that arose out of and in the course of her employment. The board’s appellate division then reversed the lower court’s decision, denying her benefits. The appellate division found that the claimant’s injury was not compensable because it was not due to the configuration of the classroom, and the act of turning and walking was not unique to her employment. The court found that it was a risk to which she would have been equally exposed outside her employment, and it found it was caused by an idiopathic fall.

The claimant appealed, and the Superior Court then reversed the Board’s decision, reinstating the award. Finally, the employer appealed to the Georgia Court of Appeals.

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Georgia workers’ compensation claimants must be cognizant of the state’s procedural rules and requirements in order to bring a successful claim. In a recent workers’ compensation case, a claim for benefits was denied on appeal after the claimant raised an issue for the first time on appeal.The claimant was employed at Walmart as an overnight support manager. One night during his shift, he felt lightheaded and exhausted, and he told coworkers he was going to leave early that night. Soon afterward, he fell in an aisle and had a seizure that lasted for at least 30 seconds. The claimant suffered sinus fractures, a facial laceration, and a potential traumatic brain injury. The claimant requested workers’ compensation benefits, claiming that his injury was a result of his tripping over a pallet at work.

Evidence showed that when he was 12 years old, the claimant became sick with a virus and had several surgeries to remove a cyst and implant a shunt. He was prescribed anti-seizure medicine after experiencing a seizure during a surgery, but he stopped taking the seizure medication after high school, and he did not have any seizures until the fall at work, when he was 44 years old.

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