Articles Posted in Georgia Workers’ Compensation

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In a recent case, an appeals court considered whether a positive drug test could be used against a claimant who was denied Georgia workers’ compensation benefits.

Drug TestThe Facts of the Case

The claimant was employed at a cotton gin company. He was working at the loading dock one day when a truck backed up and hit him from behind. He was crushed between the truck and the loading dock and suffered multiple injuries, including pelvic, chest, and rib fractures.

The company requested a drug test, and a lab technician obtained a urine sample while the claimant was at the hospital. The test came back positive for the presence of cannabinoid metabolites. One of the claimant’s coworkers testified that they had smoked marijuana at work together on the morning of the injury. The claimant testified that he only smoked marijuana when he was not working. The claimant also presented an expert witness who testified that marijuana metabolites can be present in urine for days or even weeks after marijuana is smoked. The employer asserted that the worker was impaired and, as a result, did not hear the truck backing up before he was struck.

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The Georgia’s Workers’ Compensation Act and its State Board of Workers’ Compensation provide parties with specific laws and procedures to follow in Georgia workers’ compensation claims. In a recent Georgia case, an appeals court considered the impact of an employer’s challenge to an employee’s claim on her ability to choose her own treating physician.

Uncovered DoctorIn that case, the claimant had been working as a banquet server at a hotel when she slipped and fell, seriously injuring her elbow. She suffered a right elbow fracture and sought treatment through an approved orthopedic specialist. Her condition improved and the doctor authorized her return to work. After she returned to work, however, she experienced severe pain and she subsequently stopped working. Before she left her job, she sought treatment with two other doctors who were not approved by her employer.

After she left her job, the claimant tried to have her workers’ compensation benefits reinstated, claiming that her condition had worsened. Her employer requested a hearing to determine whether she was still entitled to benefits. After the hearing, the judge found her condition had worsened and awarded her temporary total disability benefits. The judge also found the employer’s request for a hearing constituted a controvert of the claim, which allowed the claimant to choose her own treating physician.

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Like most other cases, Georgia workers’ compensation cases must be filed within a certain amount of time. These timeframes are outlined in statutes of limitations. For example, in general, the statute of limitations in Georgia workers’ compensation cases is one year. This means that if an injured worker waits longer than one year to file their claim, it will likely be barred as a matter of law.

Time's UpIn many cases, determining when a statute of limitations begins to run is very straightforward. However, that is not always the case. In some cases, involving a delayed onset illness that was a result of exposure to a dangerous substance, the date of exposure may be months or even years in the past. In these situations, courts will normally use the time from when the employee was diagnosed with the illness or disease.

While most Georgia workers’ compensation claims are filed by injured workers themselves, the Georgia Workers’ Compensation Act also permits for the payment of benefits to the surviving loved ones of an employee who died while on the job. In these situations, the statute of limitations is one year from the date of the employee’s death. However, the statute of limitations will not be applied to prevent a dependent minor or someone who is “mentally incompetent” from pursuing a claim for compensation.

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In some Georgia workers’ compensation cases, the consequences of the workplace injury are tragic. In the event of the death of a worker, the worker’s family is generally entitled to death benefits under Georgia’s Workers’ Compensation Act to ease the financial burden on the family. These benefits normally include burial expenses, as well as weekly ongoing compensation for the employee’s dependents.

Movie CameraUnder current law, for a compensable work injury, the employer must pay the reasonable expenses of the employee’s burial, up to $7,500. In addition, the worker’s dependents are entitled to weekly compensation of two-thirds of the worker’s weekly income, up to a maximum of $575 per week. Dependents normally include the worker’s spouse, children, and dependent stepchildren.

However, employers often dispute that a claim is compensable to avoid paying death benefits under the Act. The employer may claim that the worker was not an actual employee or that the injury did not take place on the job. A person claiming benefits must show that the 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.

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One accident can result in a number of claims and potential benefits. For example, as as one news source explains, if a person gets into a car accident at work, not only may there be a Georgia workers’ compensation claim, but also the incident may give rise to a negligence claim, a disability claim, an FMLA claim, and a medical malpractice claim, among others.

Construction SiteThe Difference Between Workers’ Compensation Claims and Personal Injury Claims

In a personal injury claim, a plaintiff has to show four elements:  duty, breach, causation, and damages. This means proving that the defendant owed a duty to the plaintiff, failed to meet the duty to act reasonably under the circumstances, and caused the plaintiff damages.

In contrast, in a workers’ compensation claim, a claimant does not need to show that the employer owed the claimant a duty, nor that it breached that duty by failing to act reasonably. In other words, it does not matter who is to blame for the injury. Instead, the claimant must only show that the injury occurred while in the course of employment and that it was related to the employment. The issue then becomes the extent of the claimant’s disability.

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In a recent Georgia workers’ compensation case, the Georgia Supreme Court recently issued a decision clarifying what an employer has to show in resolved work-related injury aggravation cases. The Georgia Supreme Court considered whether an employer has to show suitable employment is available in order to stop paying workers’ compensation benefits if it has already shown that a work-related aggravation of an injury is no longer the cause of the employee’s disability.

Knee BraceThe Facts of the Case

In that case, the employee injured his right knee when he was working at a youth detention center. He had three knee surgeries and eventually settled his workers’ compensation claim about a year later. As part of the settlement agreement, the employee admitted that he was partially disabled, his condition would not improve, and he would not be able to perform the same type of gainful employment on a regular basis in the future. He was given a 20 percent permanent impairment rating and was out of work for about four years.

The employee then applied for a job as a meter reader. When he applied, the employee did not disclose information that would have demonstrated that he was not physically capable of performing the job. Instead, the employee stated that he was physically capable of performing the job functions, including standing and walking. The employee got the job, and while he was working about two years later, he stepped in a hole and re-injured his knee.

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Car accidents often involve complex issues of liability involving different insurance policies. When one or more injured individuals is working at the time of a car accident, workers’ compensation laws may also come into play and could limit an individual’s recovery through other policies, as was the situation in a recent Georgia workers’ compensation case.

Car AccidentIn that case, the plaintiff was in a car accident and suffered substantial injuries. Two cars were involved in the accident, and the plaintiff filed a lawsuit against the other vehicle’s driver. The other driver was underinsured, and the other driver’s insurance paid him only $25,000 in a settlement. The plaintiff was working at the time of the accident and also received workers’ compensation benefits of $197,966.55 for his injuries. Yet the plaintiff’s workers’ compensation provided him with a weekly amount that was less than his weekly income at the time of the accident, and he therefore accumulated $183,022.38 in lost wages. The plaintiff also did not receive compensation for pain and suffering or for future medical expenses.

However, the plaintiff’s insurance provided uninsured motorist (UM) insurance coverage to the plaintiff, and he sought additional compensation through his UM coverage. His policy provided a total limit of $100,000 in UM benefits. The policy also had a provision that stated that the limit would be reduced by any money paid under the workers’ compensation law.

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Although most Georgia workers’ compensation claims result from a physical injury at work, some workers also suffer a mental health injury at work. In a recent case, one court considered whether a worker’s psychological injury was compensable under that state’s law.

Judge's GavelThe Applicable Law

The case was brought in Florida, and under Florida law, there is a requirement that there be an “accompanying physical injury requiring medical treatment” before benefits for mental or nervous injuries can be paid. In order for a mental or nervous injury to be compensable, there must be clear and convincing medical evidence from a licensed psychiatrist, and the physical injury has to be the major contributing cause of the mental or nervous condition. Additionally, there has to be a connection between the mental or nervous injury and an underlying permanent, compensable physical injury. There is also a state statute that provides that an employee cannot be paid temporary benefits for a “mental or nervous injury” for “more than 6 months after the date of maximum medical improvement for the injured employee’s physical injury or injuries.”

The Facts of the Case

In this case, the court had to consider whether the six-month period mentioned in the statute can begin at any time after the worker reaches physical maximum medical improvement, or whether the time period expires six months after the worker reaches physical maximum medical improvement.

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In many Georgia workers’ compensation cases, there is a question of whether the employee’s own actions played a role in causing the injury. In a recent case, Georgia’s Supreme Court explained the meaning of “willful misconduct,” which can bar compensation in some cases.

Cell TowerIn that case, an employee was attempting a controlled descent from a cell phone tower and was seriously injured when he fell to the ground. The employer had instructed technicians not to attempt a controlled descent from cell phone towers but instead to climb down from towers. The administrative law judge found that the employee was barred from receiving workers’ compensation benefits because he engaged in “willful misconduct.” The employee appealed, and a Georgia court of appeals reversed the decision, finding the employee’s actions did not constitute “willful misconduct.”

However, Georgia’s Supreme Court reversed, determining that the court of appeals improperly made its own findings. The Court explained that a mere violation of instructions or engaging in an obviously hazardous act does not mean it was willful misconduct. Yet an intentional violation of rules can constitute willful misconduct if it involves knowingly engaging in a hazardous act in which the danger is obvious. In these cases, the fact finder must determine whether the intentional act was done with knowledge that it was likely to result in a serious injury or with a wanton and reckless disregard of its likely consequences. In this case, the Workers’ Compensation Board failed to make findings, and the court of appeals improperly made its own findings. Therefore, the case was sent back to the Board for further proceedings.

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Often, when a Georgia workers’ compensation case is denied, the employee chooses to appeal their case to a higher court. In many cases, there can be multiple rounds of appeals, resulting in ongoing uncertainty. However, ultimately the goal of filing an appeal is to reverse a negative decision, so it is important to carefully present a case and follow the procedural requirements at each step of the way.

CalendarAppeals in Workers’ Compensation Cases

In Georgia workers’ compensation cases, the initial determination of whether benefits are appropriate is made by an administrative law judge. Either party can appeal an administrative law judge’s decision to the appellate division of the State Board of Workers’ Compensation. The Board will then review the evidence and issue a decision.

If the Board finds the administrative law judge’s findings are supported by a preponderance of competent and credible evidence, the Board will accept the administrative law judge’s findings of fact. The Board generally does not hear additional testimony or receive additional evidence, but it can remand the case to an administrative law judge to take additional testimony or receive additional evidence. However, the Board may reject the administrative law judge’s findings, or it may accept the findings but come to a different legal conclusion. This may result in the approval of a claim that was initially denied.

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