Ramos Law Firm Workers' Comp Blog » O.C.G.A § 34-9- http://www.ramoslawblog.com Georgia Workers' Compensation, Medicare Set-Asides and Injury Trust Funds Thu, 15 Jul 2010 03:07:34 +0000 en hourly 1 http://wordpress.org/?v=3.0 Change of Condition For The Worse http://www.ramoslawblog.com/2010/07/14/change-of-condition-for-the-worse/ http://www.ramoslawblog.com/2010/07/14/change-of-condition-for-the-worse/#comments Thu, 15 Jul 2010 02:27:36 +0000 Bryan Ramos http://www.ramoslawblog.com/?p=1189 Generally, a “change in condition for the worse” is defined as a change in the injured employee’s wage earning capacity, physical condition, or status after the original “condition” was established under the law.  (O.C.G.A. § 34-9-104)  The original condition is usually the establishment of the worker’s weekly benefits or medical status.

The injured employee has the burden of demonstrating that change has occurred.  To do this, the injured worker must demonstrate that (1) her condition has changed for the worse; (2) that because of this change, she is unable to continue to work; (3) that because of this inability to work, she has either a total or partial loss of income; and (4) that the inability to work was caused by the original work injury.

A typical “change in condition” situation occurs when the employee hurt-at-work has an accepted and valid occupational injury.  She is provided weekly income benefits (temporary total disability) for a period of time, as well as medical treatment.  At some point in time, she was able to return to work for the employer.  However, after a few months, the injured employee’s physical condition worsened causing her to miss time from her work.

As you can see, the original condition was established when her claim was accepted under workers’ compensation and she was provided income and medical benefits.  After her return to work, her condition changed for the worse.  Because of this change the injured worker became unable to work which caused some loss of income.  For our purposes, we must presume that the claimant’s recent inability to work was caused by the original work accident.  Consequently, the injured employee may be entitled to a recommencement of workers’ compensation income benefits provided that a proper filing was made with the State Board.

For information, please contact Bryan Ramos at 404-355-3431 or email.

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]]> http://www.ramoslawblog.com/2010/07/14/change-of-condition-for-the-worse/feed/ 0 Understanding Your Georgia Workers’ Compensation Claim http://www.ramoslawblog.com/2009/09/02/understanding-your-georgia-workers%e2%80%99-compensation-claim/ http://www.ramoslawblog.com/2009/09/02/understanding-your-georgia-workers%e2%80%99-compensation-claim/#comments Wed, 02 Sep 2009 15:42:11 +0000 Bryan Ramos http://www.ramoslawblog.com/?p=1032 When an employee files a workers’ compensation claim in Georgia, the process may become confusing, frustrating, and costly.  Generally, the injured worker wants immediate medical care and income benefits because he or she got hurt on the job.  The insurance company, on the other hand, wants to delay and investigate the matter to save as much money as possible.  These opposing forces often cause a lot of heartache and anger.

After the workers’ compensation claim is filed, everyone begins speaking a different language.  The insurance company and their lawyers use acronyms such as TTD, PPD, or MMI.   The doctors will often throw terms around like MRI, CT, PT, or FCE.  The judge may even mandate you to treat with something called an “orthopod”. Being on “workers’ compensation” is not easy and the injured employee did not ask to be hurt.

An injured worker should not go at it alone.  The insurance companies have complex programs and systems designed to maximize the law to their benefit.  Also, many insurance companies hire skilled lawyers who devote their entire lives to protecting these corporations.  It is the classic “David v. Goliath” situation.

Who is protecting the injured worker?  At the Ramos Law Firm, our attorneys can level the playing field for you.  Our lawyers use their knowledge of the insurance defense practice to help workers hurt on the job. We have extensive trial experience, and we are ready to put it to work for you.  For a free consultation, please contact us.

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]]> http://www.ramoslawblog.com/2009/09/02/understanding-your-georgia-workers%e2%80%99-compensation-claim/feed/ 0 Recent Court of Appeals Decision on Workers’ Compensation http://www.ramoslawblog.com/2009/08/06/recent-court-of-appeals-decision-on-workers%e2%80%99-compensation/ http://www.ramoslawblog.com/2009/08/06/recent-court-of-appeals-decision-on-workers%e2%80%99-compensation/#comments Thu, 06 Aug 2009 17:34:56 +0000 Bryan Ramos http://www.ramoslawblog.com/?p=967 The Georgia Court of Appeals recently reversed a decision rendered by the Superior Court of Lowndes County on the issue of appellate jurisdiction.  The case at bar was Strickland v. Crossmark, Georgia Court of Appeals, A09A0491 (06/26/09).

In this case, the claimant was an employee at Wal-Mart who was tasked with stocking shelves in a store located in Valdosta, Georgia.  In order to perform this job, she was using a ladder.  The claimant, who had pre-existing back problems, missed a step on the ladder and experienced lower back pain.  This injury allegedly occurred between 11:00 and 11:30 in the morning.  However, the Employer presented evidence that the claimant had not signed in until noon that day.   Moreover, the Employer presented other contradictory evidence to the claimant’s case.  The presiding administrative law judge denied the claimant’s claim for benefits, as well as her claim for attorney’s fees.

Initially, Employer/Insurer voluntarily commenced benefits, but later controverted the claim.  The claimant contested the controvert on the grounds that the Employer/Insurer failed to pay her all compensation due at the time of filing, in violation of O.C.G.A. § 34-9-221.

The claimant successfully appealed the ruling and the Appellate Division vacated the decision and remanded the matter for additional proceedings on the procedural issues surrounding the controvert.  The Employer/Insurer filed an appeal to the Superior Court, who reversed and remanded the case back to the Appellate Division to review only the issues raised before the trial administrative law judge.  As a result, the claimant requested assistance from the Court of Appeals to review the Superior Court’s order and sought a reinstatement of the Appellate Division’s decision.  The claimant argued that the Superior Court did not have jurisdiction and prematurely decided the matter on the merits.

The Court of Appeals agreed with the claimant on the procedural issue as the State Board’s decision was not a “final award” as mandated by law.  The Court held that the decision of the Appellate Division remanding the case to the trial division was “pending.”  Hence, the Superior Court should have declined to review the Employer/Insurer’s appeal as “such an interlocutory appeal is unauthorized under the Workers’ Compensation Act.”

For a copy of this case or for more information, please feel free to contact the Ramos Law Firm.

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]]> http://www.ramoslawblog.com/2009/08/06/recent-court-of-appeals-decision-on-workers%e2%80%99-compensation/feed/ 0 Georgia Court of Appeals Clarifies Workers’ Comp Requirements for Tolling Statute of Limitations in Catastrophic Designation Cases http://www.ramoslawblog.com/2009/08/01/georgia-court-of-appeals-clarifies-workers%e2%80%99-comp-requirements-for-tolling-statute-of-limitations-in-catastrophic-designation-cases/ http://www.ramoslawblog.com/2009/08/01/georgia-court-of-appeals-clarifies-workers%e2%80%99-comp-requirements-for-tolling-statute-of-limitations-in-catastrophic-designation-cases/#comments Sat, 01 Aug 2009 18:24:22 +0000 Bryan Ramos http://www.ramoslawblog.com/?p=965 On July 9, 2009, the Georgia Court of Appeals delivered its opinion in the Kroger Company v. Wilson case (A09A1226).  In this matter, the Court specifically addressed the application of the statute of limitations provision to a change of condition/catastrophic designation case.

Mr. Tommy J. Wilson worked as a truck driver for the Kroger Company when he injured his back in 1994.  He underwent spinal surgery and remained out of work for nearly two years.  He was able to return to wok in a light duty capacity for the next 14 months.  Unfortunately, Mr. Wilson required another surgery in 1998 but was able to return to work in a sedentary “dispatcher” position.  During this time, Mr. Wilson was paid temporary total and partial disability benefits accordingly.

In September 2001, Mr. Wilson reached the statutory caps for indemnity benefits.  While he was able to continue to work until May 2004, he apparently did so without any workers’ compensation income supplements.

In August 2003, Mr. Wilson filed a WC-14 requesting an evidentiary hearing on the issues of temporary total or partial disability from September 2001 forward.  The hearing did not take place as he later withdrew his request.

In April 2006, Mr. Wilson filed an Employee’s Request for Catastrophic Designation with the Board.  However, the administrative law judge (ALJ) issued an order finding that Mr. Wilson’s claim was time-barred under the change of condition limitations found in O.C.G.A. § 34-9-104.  Upon appeal the Appellate Division reversed the ALJ’s decision and the Superior Court of Clayton County affirmed appellate decision.

The Court of Appeals granted discretionary review and first examined what limitation period applies to catastrophic designation cases.  The Court determined that requests for catastrophic designation constitutes a change in status or condition contemplated in O.C.G.A. § 34-9-104. Consequently, the two year statute of limitations applies from the last date of income benefits.

As that statute of limitations applies, the next question the Court addressed was whether Mr. Wilson’s filing was sufficient.  The Court found it was not.  The Court noted that the 2003 filing did not include a request for catastrophic designation.  Moreover, Mr. Wilson was working at the time and the Employer could not have adequate notice that the 2003 request was for life-time benefits.  Furthermore, the State Board Rules require that the employee file an official “Employee’s Request for Catastrophic Designation.” Mr. Wilson did not file this request in 2006.

Therefore, the claim for catastrophic designation was invalid as a matter of law.

These issues raise many questions as to the form, process and due process rights of the parties involved in a workers’ compensation claim.  For information regarding this case or about your workers’ compensation issues, please contact Bryan Ramos.

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]]> http://www.ramoslawblog.com/2009/08/01/georgia-court-of-appeals-clarifies-workers%e2%80%99-comp-requirements-for-tolling-statute-of-limitations-in-catastrophic-designation-cases/feed/ 0 Georgia Workers’ Compensation Changes in 2009 http://www.ramoslawblog.com/2009/07/14/938/ http://www.ramoslawblog.com/2009/07/14/938/#comments Tue, 14 Jul 2009 10:36:41 +0000 admin http://www.ramoslawblog.com/?p=938 Earlier this year we wrote about the proposed changes to the Georgia Workers’ Compensation Act.  These changes have now taken effect.

Following are some of the changes:

Allowing the ICMS email system to serve as the “notice” and “service” vehicle for ALJ Awards.  The bill also contemplates the “issuance” of awards  via email will be recognized as notice and service to the parties for appellate matters.

The medical release language has been broadened and it’s possible that an employee’s psych recods may be produced.  Click here to see a full copy of original post outlining some of the changes with examples.

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]]> http://www.ramoslawblog.com/2009/07/14/938/feed/ 0 Reporting the workers’ compensation injury http://www.ramoslawblog.com/2009/07/06/reporting-the-workers-compensation-injury/ http://www.ramoslawblog.com/2009/07/06/reporting-the-workers-compensation-injury/#comments Mon, 06 Jul 2009 11:40:22 +0000 Bryan Ramos http://www.ramoslawblog.com/?p=877 Being injured on the job can be embarrassing and some workers fail to report their injuries until the condition is much worse.  While this is understandable, the workers’ compensation law provides that the injured worker must report their accident to his or her supervisor as soon as possible and within 30 days after the accident.  There is no magic form in reporting the injury.  A simple phone call or conversation will suffice. In a recent case, the worker fell and injured his knee in front of his supervisor.  The supervisor helped the worker to a chair and called the ambulance.  While the injured worker did not actually make an official report, the supervisor had actual knowledge of the industrial accident.  As a result the employer was prevented from claiming it did not have notice.

From a practical standpoint, it is always good to report all injuries immediately.  By doing this, the employer has an opportunity to investigate and the employee’s credibility should remain intact.  In another case, an employee was lifting crates of cola and stacking them at a convenient store.  The employee felt some pain in his back but thought it would go away.  The next morning the worker required immediate medical attention as his back “froze up.”  The employee called into work “sick” and saw his own doctor.  The physician diagnosed him with a back strain, and the employee relayed the information to the supervisor.  The employee’s reporting the injury to his supervisor should be enough.  It would be better if the employee provided some background as to “how” the back pain started.  In turn, the supervisor should investigate the facts surrounding the injury. Additionally, the employee should request for a “panel of physicians” or list of doctors he can treat without cost to the employee.  The worker has the right to choose any of those doctors.

If you have any questions about reporting your injuries, please contact the attorneys at the Ramos Law Firm.

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]]> http://www.ramoslawblog.com/2009/07/06/reporting-the-workers-compensation-injury/feed/ 0 How Will I Receive Medical Treatment if My Workers’ Comp Claim is Controverted? http://www.ramoslawblog.com/2009/06/25/how-will-i-receive-medical-treatment-if-my-workers%e2%80%99-comp-claim-is-controverted/ http://www.ramoslawblog.com/2009/06/25/how-will-i-receive-medical-treatment-if-my-workers%e2%80%99-comp-claim-is-controverted/#comments Thu, 25 Jun 2009 14:27:24 +0000 Adriana Sola Capifali http://www.ramoslawblog.com/?p=860

When the Employer/Insurer “controverts” or determines a workers’ compensation claim is not compensable, the Employer/Insurer will not pay for the injured Employee’s medical treatment. Consequently, the injured Employee will be responsible for finding a physician to treat with and for payment of his or her medical bills.  This determination does not necessarily mean the injured workers’ claim has ended.  It is merely the position the Employer/Insurer has taken.  It will be the claimant’s burden to prove that the Employer/Insurer is wrong. From a practical perspective, the Employee has the daunting task of locating a qualified physician to continue treatment.

When a claim is controverted, the Employee may choose to treat with a physician of his or her choice, pursuant to Board Rule 201(b).  This Board Rule  states that “the Employer/Insurer cannot restrict treatment of the Employee to the panel of physicians, conformed panel of physicians, or WC/MCO when the claim has been controverted.” Therefore, the Employee is free to choose his or her authorized treating physician.

Although an injured Employee has greater control of his or her medical treatment when a claim is controverted, the Employee is still left with the challenge of paying for medical treatment.  Since the cost for medical treatment will escalate within a short period of time, an Employee must consider alternatives to paying for medical treatment either out of pocket or through another insurance carrier.  An attractive alternative for Employees is to identify a physician who will provide medical treatment on a ”lien basis”.  Treating on a lien basis means the Employee will not pay for medical treatment or services at the time the treatment is rendered, but will pay for the treatment at the time his or her claim settles.

A physician or medical facility which offers medical treatment on a lien basis to workers’ compensation patients will protect their interests by requiring that the Employee and his or her attorney sign a ”letter of protection.”  A letter of protection is a contract between the patient, attorney and medical provider, which ensures the attorney will pay all medical bills for treatment rendered on a lien basis from the Employee’s settlement funds.

Seeking treatment on a lien basis is not the ideal for most Employees and attorneys, but it is a workable alternative for the injured Employee who cannot afford the immediate out-of-pocket cost.

If your workers’ compensation claim is controverted, please contact the Ramos Law Firm to discuss seeking treatment for your work injuries.

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]]> http://www.ramoslawblog.com/2009/06/25/how-will-i-receive-medical-treatment-if-my-workers%e2%80%99-comp-claim-is-controverted/feed/ 0 What Role Does Medical History Play in Workers’ Compensation Claims? http://www.ramoslawblog.com/2009/06/24/what-role-does-medical-history-play-in-workers%e2%80%99-compensation-claims/ http://www.ramoslawblog.com/2009/06/24/what-role-does-medical-history-play-in-workers%e2%80%99-compensation-claims/#comments Wed, 24 Jun 2009 14:07:57 +0000 Adriana Sola Capifali http://www.ramoslawblog.com/?p=858 Most individuals enjoy a certain level of privacy regarding their medical history.  Most employees are weary about sharing intimate details about their medical history with the employer/insurer; however, pursuant to O.C.G.A. 34-9-207, the employer/insurer may be entitled to this information.

In a Georgia workers’ compensation claim, an employee’s personal health information can be used by the employer/insurer to assess the compensability of a claim.   Medical records are of interest to the employer/insurer because these records reveal whether an injured worker has previous injuries to the body part injured in the work accident at issue or pre-existing conditions (such as diabetes or high blood pressure).  It is critical to investigate previous injuries because the employer/insurer may not be liable for payment of medical treatment for an injury which occurred before the accident at issue and/or did not occur in the course and scope of the employee’s employment.  Additionally, if an injured worker is a diabetic or suffers from high blood pressure, these pre-existing conditions can slow down an injured worker’s recuperation or cause complications in healing.

For example, if an injured worker sustains a broken ankle and is also suffering from type 2 diabetes, but is non-compliant with her diabetes treatment plan, he or she may experience delays in her recuperation due to poor circulation or possible nerve damage in the lower extremities.  In the aforementioned example, the repercussion of non-compliance with her diabetes treatment plan can lead to serious complications, which may prevent the employee from returning to work and may sever the employer/insurer’s liability for continued medical treatment for the broken ankle.  The employer/insurer will point to this fact to deny future benefits.  Obviously, this will be a medical question for the administrative law judge.

The medical records are also a tool the employer/insurer can utilize to gather information about injured worker’s conversations with his or her medical providers.  Ordinarily, a patient’s conversation with his or her physician is confidential, however, when an injured worker files a workers’ compensation claim and seeks medical treatment for work-related injuries, the patient-physician conversations are no longer considered confidential.

Pursuant to O.C.G.A § 34-9-207, when an employee files a workers’ compensation claim, the employee waives

“…any privilege or confidentiality concerning any communications related to the claim or history or treatment of injury arising from the incident that the employee has had with any physician… .”

Employees should not be discouraged from filing a claim due to privacy concerns. The release of workers’ compensation information to non-parties is generally prohibited under the workers’ compensation code.  Employees must keep in mind that in order to receive the best medical care, the doctors must have access to his or her medical history to create an effective treatment plan.  The mutual goal of all parties is to return the injured worker back to normal duty if possible.  However, it is important to realize that this may never happen depending on the severity of the injury.  If the goal of “normal duty work status” is not reachable, then the injured worker should still strive to reach maximum medical improvement.

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]]> http://www.ramoslawblog.com/2009/06/24/what-role-does-medical-history-play-in-workers%e2%80%99-compensation-claims/feed/ 0 How long do I have to…file my claim, notify my supervisor, etc. http://www.ramoslawblog.com/2009/06/03/how-long-do-i-have-tofile-my-claim-notify-my-supervisor-etc/ http://www.ramoslawblog.com/2009/06/03/how-long-do-i-have-tofile-my-claim-notify-my-supervisor-etc/#comments Thu, 04 Jun 2009 01:59:04 +0000 Bryan Ramos http://www.ramoslawblog.com/?p=848

If you are injured at work in Georgia there are several deadlines you should be aware of in order to preserve any potential workers’ compensation claim you may have.  First, you must give the employer notice of the injury within 30 days of the injury date.  (O.C.G.A. § 34-9-80).  You then have one (1) year from the date of injury or last remedial medical treatment to file your notice of claim with the State Board. ( O.C.G.A. §34-9-81).  Notice must be provided by filing a WC-14 with the State Board.

Those are the first two statutes  to be on the lookout for, however, there are several other important deadlines that will arise during the course of your claim.

For instance, one scenario you may run into is that if your benefits are suspended and you then have a change in condition for the worse, you must file a request for recommencement within two (2) years from the date of last payment of income benefits.  (O.C.G.A. § 34-9-104).

Also, claims for permanent partial disability benefits must be filed within four (4) years from date of last payment of income benefits.

These deadlines are vital to your case.  The attorneys at the Ramos Law Firm will track these statutes for you and make sure the appropriate action is taken on time.  Contact an attorney for a free consultation.

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]]> http://www.ramoslawblog.com/2009/06/03/how-long-do-i-have-tofile-my-claim-notify-my-supervisor-etc/feed/ 0 Can I receive disability benefits and workers compensation benefits at the same time? http://www.ramoslawblog.com/2009/06/01/can-i-receive-disability-benefits-and-workers-compensation-benefits-at-the-same-time/ http://www.ramoslawblog.com/2009/06/01/can-i-receive-disability-benefits-and-workers-compensation-benefits-at-the-same-time/#comments Mon, 01 Jun 2009 18:00:48 +0000 Julia Lindsey http://www.ramoslawblog.com/?p=796 No, pursuant to Board Rule 200 (c), “an injured employee who receives regular wages during disability shall not be entitled to weekly benefits for the same period.”

Assuming that an employee has a wage-continuation plan or sick leave policy, the employer should offer the employee the choice to receive either the sick leave OR the workers’ compensation benefits after the employee is injured.  In most cases, the wage-continuation plan/sick leave will be equal to the employee’s salary which is usually more than temporary total disability benefits (TTD).   Therefore, most employees will elect to receive the wage-continuation benefits over the workers’ compensation benefits (TTD).

It is important for the employee to understand that when the employer offers the employee both types of benefits, the employee must select one in lieu of the other.  In other words, they cannot select one now and use the other later.  If the employee elects to receive benefits under the wage-continuation plan, the employee will not receive the workers’ compensation benefits and the employer can request a credit for the workers’ compensation benefits.  Under the law, employees are offered 400 weeks of workers compensation benefits.  When an employee chooses his wage-continuation plan, the employer can obtain a credit pursuant to O.C.G.A. § 34-9-243 which starts the clock ticking for the 400 weeks of workers’ compensation benefits.

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