Articles Posted in Workers’ Compensation Case Law

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In a recent case, one state’s supreme court clarified the standard for the termination of rehabilitation benefits, an issue that regularly comes up in Georgia workers’ compensation cases. In that case, the employee injured both her knees and her right elbow at work and was awarded workers’ compensation benefits, including rehabilitation services. She eventually obtained part-time employment with another employer.

Gavel and BooksThe original employer then sought to terminate the employee’s rehabilitation services. At a hearing, the workers’ compensation judge found that the claimant returned to suitable gainful employment and thus could no longer receive rehabilitation services. On the worker’s appeal, the court held that the workers’ compensation judge used the wrong legal standard to grant the employer’s petition to terminate the employee’s rehabilitation services.

The workers’ compensation judge determined that since the employee had obtained “suitable gainful employment,” she could no longer receive rehabilitation benefits. However, the state’s supreme court found that if the individual who is receiving rehabilitation benefits is no longer a “qualified employee,” a judge must apply the good-cause standard before terminating benefits. That is, a rehabilitation plan may be suspended, terminated, or altered upon a showing of “good cause,” such as an employee’s refusal to cooperate with a rehabilitation plan or if the employee is not likely to benefit from further rehabilitation services.

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Georgia workers’ compensation cases are sometimes resolved through an agreement between the claimant and the employer. A recent case demonstrates the importance of obtaining competent representation before entering into a settlement agreement because of the permanent effects an agreement can have in a case.

Signing a ContractIn a recent case, a hair stylist at J.C. Penney claimed she suffered a work-related injury in March 2010 and filed a workers’ compensation claim in February 2011 for pain in her left foot. J.C. Penney accepted the claim as compensable. Under an agreement, the claimant received a payment “in full and final settlement of all claims for any and all benefits, injuries, disease, illnesses, conditions, and/or symptoms and any and all sequelae allegedly sustain as a result of” her workplace injury. It also stated that the agreement was “intended to be a general release of all claims of the employee against the employer and the insurance carrier arising from employee’s agreement with employer.”

About six months after the settlement was approved, the claimant filed a new notice of injury, alleging a March 10, 2015 injury to her foot. The employer denied the claim, stating that the claim was a preexisting condition and unrelated to employment, and it filed a motion for summary judgment. The Commissioner of the Department of Labor denied J.C. Penney’s motion for summary judgment. The Commissioner determined that the 2014 settlement agreement released the employer from claims related to the March 2010 injuries and was enforceable. However, the Commissioner found the remainder of the settlement agreement was void on public policy grounds because it could not bar unrelated claims. J.C. Penney appealed, arguing that the Commissioner lacked the authority to invalidate an approved settlement agreement.

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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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In many Georgia workers’ compensation cases, even when one injury is covered, there is an issue of whether other injuries are related and covered under Georgia’s Workers’ Compensation Act. In a recent case, one state’s supreme court found that although a worker’s groin injury was covered under the workers’ compensation program, his back injury was not.

SpineThe Facts of the Case

The employee was working at an energy services company, delivering and setting up equipment. One day, he was transporting equipment from Wyoming to Nebraska. The equipment included hazardous materials, and he was required to have a sign on the back of his truck warning that hazardous materials were on board. The sign was on the truck when he left, but when he stopped shortly after beginning the journey, he saw that the sign had fallen off. The employee called his supervisor, who met up with him and helped him locate the sign. The employee and his supervisor then put the sign in the back of the supervisor’s truck. The sign weighed about 100 pounds and was in an 8.5-foot metal frame. As the two were lifting the sign into the truck, the employee stood on his toes to lift it into the truck, and he felt a sharp shooting pain down the right side of his groin.

The employee continued to Nebraska, but when he completed his assignment, he returned to his home in Idaho and saw his primary care physician. He was diagnosed with a right inguinal hernia. His employer covered his injury to his right groin.

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Many Georgia workers’ compensation cases involve only minor or temporary injuries. However, some tragic cases result in an employee’s death. In these cases, the worker’s dependents may be entitled to benefits.

Operating RoomIn a recent case, an employee filed a workers’ compensation claim against his employer for a torn thoracic aorta, which was later settled for a lump sum. As part of the settlement agreement, the employee agreed to waive all future claims, including waiving his right to reopen his claim. A year later, the employee died from his work-related injury. Two years after the employee’s death, his wife filed a motion to reopen her husband’s injury claim to assert her own claim for a workers’ compensation death benefit. The wife was not a party to her husband’s settlement. The Administrative Law Judge allowed the wife to reopen the claim and awarded her death benefits. The employer appealed, and the case eventually made its way to that state’s supreme court.

The court considered whether the wife had a separate and viable claim for death benefits, and whether she could assert her claim by reopening her husband’s settled claim. The court determined that the husband’s settlement did not prevent the wife from seeking death benefits. It explained that a state statute provided a surviving spouse with benefits if an employee died from a work-related injury. Those benefits were separate from the benefits awarded to the worker and gave the spouse the right to a separate claim.

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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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Employees who are injured on the job may be able to pursue compensation through a Georgia workers’ compensation claim. However, not every application will be accepted, especially when submitted without the assistance of an attorney. In a recent case, an employee in South Carolina was working at Lowe’s when he slipped and injured his back and neck. He was diagnosed with a herniated disc.

ToolsThe employee underwent surgery but continued to experience pain, and he had difficulty walking and balancing. He then filed a workers’ compensation claim for his medical expenses and for temporary total disability benefits. After filing the claim, the employee slowly improved and was later given an impairment rating of 25% and permitted to return to work with certain restrictions. Lowe’s subsequently requested a hearing before the Workers’ Compensation Commission to decide whether the employee should be given permanent disability benefits.

Under that state’s law, if a worker sustains the loss of his or her back of 50% or more, the worker will be presumed to have suffered a total and permanent disability. At the hearing, the employee argued that he should receive permanent total disability benefits because he lost 50% or more of the use of his back. Lowe’s contended that the 25% impairment rating meant that the employee had not suffered 50% impairment and thus was only entitled to permanent partial disability. The Workers’ Compensation Commission awarded him permanent partial disability, based on a 48% impairment to his back. The employee appealed.

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An issue that comes up in many Georgia workers’ compensation cases is whether an old injury that is aggravated while on the job qualifies for benefits. In a recent workers’ compensation case, one state’s supreme court found that a judge’s decision denying workers’ compensation benefits to an employee was supported by the evidence in a case involving multiple injuries.

PalletThe Facts of the Case

Before the employee began her job at a supermarket, she had broken her ankle. A few years after she began her job at the supermarket, she was diagnosed with post-traumatic arthritis in her ankle and was told to treat her ankle at home with a brace, supports, icing, stretching, and medication. Her job required her to stand for 40 to 45 hours per week. For the next 10 years, she sometimes felt minor pain and swelling in her ankle.

Then, while working, she tripped over a pallet and twisted her right ankle. About two days later, she sought medical treatment, and the doctor found her ankle was only mildly swollen and not bruised, but x-rays showed “degenerative changes.” The doctor determined she sprained her ankle, and she continued to work at the supermarket. The employee testified that her swelling and pain worsened continuously after the injury, but the doctor noted that the employee had decreased swelling and pain at the first follow-up appointment. At the next appointment about six weeks later, she said her ankle was “about the same,” but he recorded that she had improved slightly. The employee was doing physical therapy, but soon afterward, she twisted her ankle again. Her ankle did not get better, and the doctor scheduled her for an ankle-fusion surgery.

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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.

TrainWhat 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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