Articles Posted in Georgia Workers’ Compensation

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.

Appeals 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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In a recent decision, a Georgia appeals court considered whether an employee who was injured while traveling from Georgia to Alabama for work was entitled to workers’ compensation benefits. The employee worked for a company repairing railroad tracks in different states. On one Sunday afternoon, the employee left his house in Georgia and drove toward Alabama, where he was supposed to begin work on a railroad track on the following morning. On his way to the motel, the employee was injured in a car accident. The employee filed for Georgia workers’ compensation benefits, claiming he was temporarily disabled. Yet the company argued that the accident did not arise out of and in the course of his employment.

What It Means to Arise Out of and in the Course of Employment

Under O.C.G.A. 34-9-1(4) of Georgia’s Workers’ Compensation Act, in order to be eligible for benefits, an injured employee must prove that their injury was related to their job. Specifically, an employee must show that the accidental injury arose out of and in the course of his or her employment. The requirement that the injury arises out of the employment means that there has to be a causal connection between the employee’s job and the injury. The requirement that the injury occurs in the course of employment considers the time, place, and circumstances of the injury.

Generally, injuries that occur when an employee is commuting to and from work do not arise out of and in the course of employment because courts believe that most jobs require some form of commute, which is not necessarily related to the functions of the job. In this case, the employee was traveling to a motel near the job site when the injury occurred. Accordingly, the court found the employee’s injury was not compensable.

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If an employee is injured on the job in Georgia, the employee is generally entitled to medical, rehabilitation, and financial benefits to help the employee return to work. However, an “injury” compensable under Georgia’s Workers’ Compensation Act has to meet certain requirements. A compensable injury is limited to an injury by accident arising out of and in the course of employment. It may include an aggravation of a preexisting condition that arises out of and in the course of employment.

Generally, a compensable injury does not include diseases. Most workers’ compensation claims involve occupational injuries rather than occupational diseases. However, a disease is compensable when it “results naturally and unavoidably from the accident.” O.C.G.A. § 34-9-1. Distinguishing a disease from an injury is not always clear. If an employee develops a disease from a sudden and unexpected exposure to an injurious risk at work, the injury will typically be an occupational injury. However, if a claimant’s disease arises from an expected, gradual exposure to a risk, the disability will generally be considered an occupational disease. For example, an employee who develops an injury after being exposed to a risk gradually over a long period of time would generally have an occupational disease claim.

If employment contributes to an injury, it is normally considered an accident and is compensable. An accident generally means an event that was not expected or designed. Injuries resulting from haste and inattentiveness are also generally covered under the Workers’ Compensation Act.

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Back in 2015, the Governor signed into law Haleigh’s Hope Act, which established the Georgia Commission on Medical Cannabis to provide recommendations concerning medical marijuana regulations. The Act allowed individuals with certain illnesses to possess up to 20 ounces of cannabis oil, if approved by their physician. The qualifying illnesses were Crohn’s disease, seizure disorders, mitochondrial disease, multiple sclerosis, severe or end-stage ALS, Parkinson’s disease, cancer, and sickle-cell disease.

In May of this year, Governor Nathan Deal signed into law Senate Bill 16, a measure that expands Georgia’s medical marijuana program. According to a recent article, the law makes six more illnesses eligible for medical marijuana treatment:  AIDS, Alzheimer’s disease, epidermolysis bullosa, Tourette’s syndrome, peripheral neuropathy, and autism.

While the law allows doctors to certify patients for the State’s Low THC Oil Registry and authorizes the Georgia Department of Public Health to issue a registry card to qualified individuals, the bill does not authorize doctors to “prescribe” marijuana. The State has explained that a doctor’s certification is merely a certification that there is an established doctor-patient relationship, that the doctor has examined the patient, and that the patient has one of the qualifying medical conditions.

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According to the Occupational Safety and Health Administration (OSHA), falls are a leading cause of workplace deaths. Falls represent 39% of all construction workplace deaths and account for around 350 deaths in construction jobs per year.

OSHA requires employers to set up the workplace to prevent employees from falling and injuring themselves. Employers are required to provide fall protection for overhead platforms, for elevated work stations, and near holes in floors and walls. Fall protection must be provided for elevations of four feet or higher in general industry workplaces, five feet in shipyards, six feet in construction workplaces, and eight feet in long-shoring operations. Employers must also provide fall protection if employees are working over dangerous equipment and machinery, regardless of height.

Georgia Woman Falls to Death in Lowndes County

A 28-year-old woman recently fell to her death as she was working on a billboard in Lowndes County, Georgia. According to one news source, the young woman had been doing routine maintenance on the billboard on Interstate 75 when she fell. An OSHA spokesperson said that her death was still under investigation.

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Workers’ compensation is designed to help injured workers by allowing them a streamlined way to obtain compensation while they recover from their injuries. The Georgia workers’ compensation program is a no-fault program, meaning an employee will not be required to show that someone other than himself was at fault for his injuries. Of course, an injured worker must be able to prove that the injury occurred while on the job or through the performance of job-related activities.

Despite the good intentions behind the workers’ compensation program, sometimes obtaining benefits can be difficult. This may be because an employer contests the claim, arguing that the injury did not occur at work or that the specific injury alleged is not a covered type of injury. In fact, earlier this month, a local Georgia news source issued a report outlining the difficulties that Georgians who are injured on the job have in obtaining workers’ compensation benefits.

According to the recent report, approximately one in five Georgians who missed a week or more of work reported having “big problems” in obtaining their benefits. Making matters worse, in many cases, injured workers rely on these benefits to pay for the medical expenses related to the injury. The troubles injured employees have can range from repeated delays on the part of the insurer to contested claims. Roughly half of those reporting “big problems” explained that their employer or the employer’s insurance carrier did not want to provide the necessary level of care in the wake of their injury.

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Georgia courts see vast numbers of cases filed each year. In an effort to help courts deal with the volume of cases that are filed, the legislature as well as the court system have developed certain procedural rules that must be followed in order for a case to be properly resolved. These rules come into play early in a case, starting with when, where, and how the case is filed.

In Georgia workers’ compensation cases, generally an injured worker will file a claim. If the employer denies the claim, the claim can be submitted to the State Board of Workers’ Compensation for resolution. In some situations, a party that believes the board made an incorrect decision can then appeal the case to a civil court of law. However, Georgia law only allows for a workers’ compensation appeal to be heard when there has been a “final order or judgment” entered in a case. A recent case decided by the Georgia Court of Appeals illustrates how meticulous courts can be when applying procedural rules and laws.

The Facts of the Case

A worker was injured while on the job. The employee filed for medical benefits under the workers’ compensation program, but his employer denied the benefits. Specifically, the employer claimed that the employee’s claim was not filed in a timely manner and that the statute of limitations barred the employee’s claim.

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Earlier this month, a New Jersey man was killed when he was struck by a piece of construction equipment while on a New York job-site. According to one local news report covering the tragic accident, at around 4:20 in the afternoon a load fell off a crane at the construction site and struck the worker. Immediately after the accident, the worker was alert, but shortly after that he started experiencing pain and having difficulty breathing. Within the hour, he was dead.

The construction company that employed the worker has told reporters that it will fully cooperate with any government investigation into what caused the fatal construction accident. In addition, the Occupational Safety and Health Administration opened an investigation. The representative from OSHA told reporters that the investigation may take as long as six months to complete.

Georgia Construction Accidents

The construction industry is one of the most dangerous in Georgia. Whether it be the heavy equipment, the towering heights, or the long hours resulting in worker fatigue, construction workers face many risks every day. According to the most recent numbers, Georgians suffer approximately 4,500 workplace accidents each year. Of these, a significant portion occur in the construction industry.

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The Georgia workers’ compensation program is designed to provide temporary benefits to injured workers while they recover from an on-the-job injury. In theory, the program works well for both employees – who do not have to about proving who was at fault for their injury – and employers – who are able to limit their own costs by purchasing a workers’ compensation insurance policy.

Most Georgia employers who have three or more employees are required to obtain a workers’ compensation policy. However, some employers are able to self-insure if they obtain prior approval. Many school districts across the state have chosen to self-insure rather than obtain coverage from an outside insurance company. Self-insured employers are essentially able to handle workers’ compensation claims as they see fit. A recent news article discusses the benefits and drawbacks to this self-insurance system for Georgia school district employees who are injured on the job.

Weekly Benefits Versus Lump-Sum Disbursement

The article details the account of a 50-year-old employee of DeKalb School District who was injured when a student pushed her down a set of bleachers almost two decades ago. After her accident, the woman suffered a serious injury to her spine and has since required a spinal implant. She still suffers constant back pain and only has the use of her left leg.

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Last year, a 20-year-old woman was killed in an Alabama manufacturing plant when she attempted to fix a machine that had stopped working. According to news reports at the time, the woman was working on a large crane with three other employees. When the crane stopped working properly, the woman called maintenance but received no response.

The woman and three other co-workers tried to get the machine working again. The woman entered the cage that contained the machine, and while she was inside the cage, the machine started running again. She sustained critical injuries and was taken to the hospital, where she died the next morning.

The plant where the accident occurred manufactures car parts for Kia and Hyundai. According to a recent news source, the Occupational Safety and Health Administration conducted a six-month investigation into the accident, concluding that the accident could have been prevented had the appropriate precautions been taken by the employer.

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