Georgia Workers' Compensation
Attorney Blog

In a recent case before a Georgia appellate court, the court considered whether an employee who was injured while leaving for a lunch break was entitled to workers’ compensation benefits. According to the court’s opinion, the employee was working as a seamstress. One day, the employee took a lunch break and as she was walking out to her car, she tripped on the sidewalk and was injured. She sought workers’ compensation benefits under Georgia’s Workers’ Compensation Act.

A judge decided that she was entitled to benefits under the “ingress and egress rule” and because she was on a scheduled lunch break. The employer appealed, and the State Board of Workers’ Compensation reversed the decision, finding the employee was not entitled to benefits because the injury occurred while she was on a scheduled break. The employee appealed, and after an affirmance from the superior court, the employee appealed again to the Georgia Court of Appeals.

Injuries Covered by the Workers’ Compensation Act

To be entitled to benefits under the Workers’ Compensation Act, a worker’s injury must arise “out of and in the course of employment.” This means generally that injuries must occur at work and while performing the duties of the job. Georgia courts have created exceptions to this general rule, including the ingress and egress rule and a scheduled-break exception. The ingress and egress rule allows claimants to recover benefits if an employee is injured while going to or coming from work, as long as the employee is still on the employer’s premises. The scheduled break exception allows claimants to recover benefits if an employee is injured during a regularly scheduled break.

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Georgia workers’ compensation claimants may have to go through multiple appeals to obtain the benefits they deserve. Such was the situation in a recent case involving a coal miner who was attempting to obtain benefits under the Black Lung Benefits Act.

The Facts of the Case

According to the court’s opinion, the claimant worked as a coal miner for about 30 years, during which he suffered two heart attacks. Despite having difficulty breathing, the claimant continued to work. Evidently, he smoked cigarettes for many years but quit smoking after his first heart attack. The claimant’s breathing problems became severe about six years after he had stopped working as a coal miner. He used an oxygen monitor and supplemental oxygen when his oxygen levels got too low. After his breathing problems worsened, the claimant sought benefits under the Black Lung Benefits Act. His claim was first denied, but he successfully appealed. The claimant’s employer appealed to the state’s high court.

Benefits Under the Black Lung Benefits Act

The Black Lung Benefits Act was passed to provide compensation and medical benefits to coal miners to treat their lung injuries. The Act is meant to apply to coal miners who develop pneumoconiosis, a lung disease that is caused by inhaling dust. The Act also provides benefits to family members of coal miners whose deaths are attributable to the disease. The Division of Coal Mine Workers’ Compensation, also known as the Black Lung Program, administers claims filed under the Black Lung Benefits Act. The Division provides monthly compensation and medical coverage for treating covered lung diseases.

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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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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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