May 22, 2019

New Job Injury Triggers Related Medical Problems – What is Compensable?

North Carolina workers’ compensation lawyer Dan Deuterman recently wrote about one of his cases, Clark vs. WalMart, that ended up in the North Carolina Supreme Court. Although the Clark case arose under North Carolina law, there are implications for Georgia workers’ compensation claimants.

Mrs. Clark, a 64 year old lady, worked as a greeter at WalMart. She injured herself while attempting to move a decorative sled while standing on a 10 foot ladder. Ms. Clark had previously been diagnosed with osteoporosis. After initially accepting the claim, WalMart cut Ms. Clark off, arguing that Ms. Clark was not entitled to presume that her on-going back pain was solely the result of her job injury given the pre-existing osteoporosis.

The North Carolina Supreme Court agreed with WalMart that Ms. Clark, as the injured employee, had the burden of proving that her on-going disability arose from her job injury and remanded the case back to the North Carolina Industrial Commission (which is roughly equivalent to the Georgia State Board of Workers’ Compensation). The Industrial Commission ruled that Ms. Clark was permanently disabled and that WalMart had to pay for her medical care, including spine care associated with osteoporosis.

This case highlights an issue that we often see here in Georgia. Often our client’s work injury is not the only medical problem afflicting him or her. Sometimes, our client has a pre-existing medical problem (one known to the employer) that makes recovery from the new on-the-job injury more time-consuming or complicated. Sometimes an unknown medical problem will arise due to the stress and shock of a sudden work injury.

Employers and their insurers will attempt to limit the medical treatment to the specific work injury and will refuse to pay for medical treatment that is not directly related. As you might imagine this stance creates issues as often the “other” medical problem limits healing or affects treatment. Certainly, in Mrs. Clark’s case, her job injury at WalMart did not cause her osteoporosis, but the osteoporosis most definitely affected her healing and the extent of her recovery.

As is the case in North Carolina, disputes between employers and their insurers about what constitutes compensable care ends up before workers’ compensation judges.

Employer Does Not Want Me to File My Injury Claim Under Workers' Comp. Is This a Good Idea?

I would like some info. I was injured on the job last week. Actually I broke my foot while working in the woods. My employer said to present him a bill and he will pay instead of filing workers comp. Who is that benefiting he or I? I have since worked everyday just limping along. It hurts alot, but I have a family and cannot miss a paycheck. If he doesnt pay the bills what should I do, or should I do something now? Please advice.
–Edgar

Jodi Ginsberg responds: Edgar, the purpose of workers compensation is to allow an injured worker to get the proper care and income benefits when he cannot work at all or at his normal job. However, workers’ comp is not a choice that your employer gets to make – if you are injured on the job, you have the absolute right to file a claim. Your employer is trying to get you to avoid the system so he does not have to put a claim in to his wc carrier.

In my opinion, that approach is not good for you. You need proper medical care; weekly benefits and the time to heal from the injury. You should not play games with your health.

In addition, if you try to submit medical bills from an on-the-job injury to your health insurance company, they will probably reject the claim as workers’ compensation is considered the primary insurer in an on-the-job injury claim.

Finally, in a worst case scenario, if you do not file your claim and a year goes by, you may lose the right to file for workers’ comp. because of the statute of limitations. If your employer should then decide to stop paying for your medical care, you could be out of luck.

I realize that sometimes injured workers do not like to “rock the boat” and therefore may not to press the issue with their employers. Unfortunately, however, it has been my experience that employees who try to “help” their employer usually end up with the raw end of the deal. At the very least, therefore, please call me at 770-351-0801 so we can discuss what is in your best interest.

[tags] workers comp vs. health insurance, not filing on-the-job injury claim under workers compensation, workers compensation and statute of limitation [/tags]

Am I Covered if I am Injured After Work While Walking to the Parking Lot?

As a rule, if you are injured traveling to or from work, you are not covered by Georgia workers’ compensation. However, there is an exception to this rule. These exceptions include:

  • instances when your employer provides transportation
  • when you do doing some function that is permitted or required by your employer
  • when you are walking to or from the parking lot provided by the employer
  • when you are an “on-call” employee and your employer furnishes transportation
  • when your employer provides you with a vehicle, you are covered when you enter the vehicle and stops when finish your job task

As you might imagine, there is a lot of litigation when an employee is injured off the worksite. There are literally hundreds of published cases and our experience has been that every case has to be analyzed on its own merits. Therefore, if you are injured off site, you may have an uphill battle, but do not assume that there is no way that you are covered.

Fact specific situations are ones where experienced legal counsel can be of great help to you.

[tags] workers comp coverage when traveling to or from work, ingress, egress, georgia workers’ compensation [/tags]