Court Rejects Claim for Out-of-Pocket Expenses Due to Lack of Explanation in a Workers’ Compensation Case

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.

Evidently, before trial began, the court had issued a pretrial order requiring the parties to file a joint pretrial memorandum. In the memorandum, the parties were required to submit a cover sheet of medical expenses, “setting forth an itemization of each medical expense incurred and unpaid, or for which reimbursement is claimed, by provider, date, and amount.” The cover sheet listed a total of $104,356.87 in medical expenses, but failed to list the dates for each expense. Later, the claimant claimed that he was never reimbursed for out-of-pocket expenses, totaling $12,315.94. After trial, the court asked the claimant’s attorney for more information clarifying the medical expenses twice, but the additional information was not provided.

The court denied the claimant’s request for compensation for any out-of-pocket medical expenses, explaining that the information provided “falls woefully short of what was ordered to be provided by the Pretrial Order, and the Court is unable to meaningfully analyze the information.” The court found there was a discrepancy between the amount of medical expenses claimed and the amount reflected in the invoices that were entered into evidence. The court also noted a discrepancy between the amount of out-of-pocket expenses claimed in the cover sheet ($3,975.41) and those in the exhibits ($12,315.94).

The appellate court affirmed the lower court’s decision. The court reasoned that the trial court asked two times for clarification due to the discrepancies, and because the claimant failed to clarify the expenses when asked, the court was unable to determine a sum for out-of-pocket medical expenses.

The Requirement to Provider Medical Treatment Under Georgia’s Workers’ Compensation Act

Under O.C.G.A. § 34-9-200, an employer is obligated to provide and pay for medical treatment for employees covered under the Workers’ Compensation Act. An employer is required to provide “such medical, surgical, and hospital care and other treatment, items, and services which are prescribed by a licensed physician” that are “reasonably required and appear likely to effect a cure, give relief, or restore the employee to suitable employment.”

Contact a Georgia Workers’ Compensation Attorney

If you have been injured at work, you may be able to file a claim for Georgia workers’ compensation benefits. Filing a successful workers’ compensation claim requires an understanding of workers’ compensation law, as well as the ability to clearly articulate your claim and your expenses. At the Georgia law office of J. Franklin Burns, P.C., we have decades of experience in workers’ compensation claims. Our Georgia law firm offers our clients quality legal representation and responsive client service. For a free consultation, call us at 404-303-7770 or contact us through our online form.

More Blog Entries:

Court Denies Benefits for Specific Surgery, Finding Procedure was Considered “Alternative Medicine”, September 7, 2018, Atlanta Workers’ Compensation Lawyer Blog

Appealing a Georgia Workers’ Compensation Case, September 13, 2018, Atlanta Workers’ Compensation Lawyer Blog