23 Presumptive Medical Conditions

In order for an employer/insured to be eligible for reimbursement from the Subsequent Injury Trust Fund, the employee’s subsequent injury must be directly caused by the prior impairment. The employer must show that this prior impairment was permanent and likely to be a hindrance to employment. Any pre-existing, permanent condition qualifies. The condition may be derived from an automobile accident, personal injury, or an acquired or congenital disease. For some medical conditions, the Fund has defined them as presumptive conditions. In other words, the employer/insured need not provide documentation to prove that these medical conditions are permanent and a hindrance to employment. Pursuant to Section 34-9-361 of the Official Code of Georgia, the presumptive medical conditions are defined as permanent and a hindrance to employment. The 23 presumptive medical conditions in O.C.G.A. § 34-9-361 are: 1. Epilepsy 2. Diabetes 3. Arthritis which is an obstacle or hindrance to employment or reemployment 4. Amputated foot, leg, arm or hand 5. Loss of sight of one or both eyes or a partial loss of uncorrected vision of more than 75 percent bilaterally 6. Residual disability from poliomyelitis 7. Cerebral palsy 8. Multiple sclerosis 9. Parkinson’s disease 10. Cardiovascular disorders 11. Tuberculosis 12. Mental retardation, provided the employee’s intelligence quotient (IQ) is such that he or she falls within the lowest two percent of the general population; provided, however, that it shall not be necessary for the employer to know the employee’s actual IQ or actual relative ranking in relation to the IQ of the general population. 13. Psychoneurotic disability following confinement for treatment in a recognized medical or mental institution for...

What Benefits May the Employee Receive?

Employees are potentially entitled to the Five Pillars of Workers’ Compensation: (i) Temporary Total Disability; (ii) Temporary Partial Disability; (iii) Permanent Partial Disability; (iv) Medical care / treatment; and (v) Rehabilitation care and counseling. Assuming the claim is compensable, the Employee may receive two-thirds of his average weekly wage, but not more than $500.00 for an accident which occurred on or after July 1, 2007. Employees are entitled to weekly income benefits if they are unable to work for more than 7 days. The first check should be mailed within 21 days after the first day of missed work. If the Employee misses more than 21 consecutive days, then he will be paid for the first week. In terms of medical treatment, the Employer or workers’ compensation insurance carrier will pay for the authorized medical treatment if the treatment was for an on-the-job injury. These expenses generally include hospital bills, physical therapy, prescriptions, and necessary travel expenses if the injury or illness was caused by an accident on the job. These medical benefits last until the injury has resolved or in some cases for the Employee’s life. If the Employee is able to return to work at the regular pay, then the income benefits should be suspended. However, if the Employee returns to work at a lesser rate of pay, then he may be entitled to receive a reduced benefit based upon his earnings. This benefit will not exceed $334.00 if his accident occurred on or after July 1, 2007. These income benefits may last up to 400 weeks, or 350 weeks if the Employee has been reduced to...

What are the Employer’s Rights and Duties?

Along with the shield against tort claims that arise out of and in the course of employment, Employers have the unique right of controlling who the injured Employee treats with after the accident. The Employer is required to post a list of physicians who the Employer has confidence will treat its Employee’s fairly. This list of often referred to as the “Panel of Physicians.” Employer may maintain a traditional panel of physicians that shall consist of at least six (6) non-associated physicians. Employers are allowed to have more than six physicians on this panel as well. The minimum panel shall include an orthopedic physician, and no more than two physicians shall be from industrial clinics. This panel shall include a minority physician, where feasible. Employers may maintain a list of physicians that shall be known as the conformed panel of physicians, which shall include a minimum of 10 physicians or professional associations. The physicians and groups listed on the panel shall be counted as a separate choice from the others listed only if they are not associated with other physicians or groups on the panel. This panel includes the same physicians required in the traditional panel, plus a chiropractor and a general surgeon. Finally, Employers may contract with a Workers’ Compensation Managed Care Organization (WCMCO) certified by the Board. A “WCMCO” provides for the delivery and management of treatment to injured employees with a complex network of physicians. The WCMCO sets its own rules and regulations for treating the Employees. As a matter of course, Employers must post the panel in prominent places around the work area or in...

RLF Attorneys Attend Advanced WC Institute In St. Simons

Bryan Ramos, James Timmons, Adriana Sola Capifali and Julia Lindsey participated in the annual Advanced Workers’ Compensation Institute in St. Simons Island, Georgia. The Institute’s meetings were held from October 2 through October 4. During this time, one topic discussed was the use and implementation of the Integrated Claims Management System (ICMS) at the State Board. Essentially, this computer based system is the State Board’s “online” or electronic filing system. The State Board is attempting to become “paperless” and produce “real time” results. Other topics covered included Professionalism, Recent Appellate Division Decisions, Chronic Pain Management, Legislative Changes, Discovery, and the Future of Workers’ Compensation in Georgia. “The topics discussed are very timely and useful to the everyday practice of workers’ compensation,” said J.J. Timmons. The Ramos Law Firm attorneys annually attend the Institute. According to Bryan Ramos, “[t]he Committee did a fine job at organizing the seminars and I understand that the Institute raised a substantial amount of money for the Kids’ Chance Foundation, which benefits the children of catastrophically injured...

What is Considered a Workers’ Comp Injury?

The law provides that an “injury by accident arising out of and in the course of employment” shall be considered a workers’ compensation injury. O.C.G.A. § 34-9-1(4). Hence, the Employee must show that she suffered an (i) injury by accident; that (ii) arose out of employment; AND was (iii) in the course of employment. To be successful, the Employee must meet all three prongs. The term “injury by accident” is very broad. Essentially, the Employee must have suffered an initial physical injury that was not intentionally inflicted. The term “arising out of employment” has been interpreted to refer to the causal relationship between the work and the resulting injury. Moreover, the term “in the course of employment” refers to time, place, and circumstances under which the accident took place. These terms are not interchangeable. Lee v. Middleton Logging Co., 198 Ga. App. 585 (1991). Given our global economy, litigation has arose as to the parameters where employment ends and the Employee’s personal life begins. The doctrine of “continuous employment” has been an evolving area of the workers’ compensation landscape. Most recently, the Georgia Supreme Court has ruled on this issue in Ray Bell Construction v. King, S06G0891 (March 26, 2007). I have attached the opinion to this paper for your reference. Since it was a divided opinion and one definitely worth reading, I will not cover it here and invite you to read it yourself. A frequent question is whether a psychological injury is covered under the system. The quick answer is yes, provided that it stems from an acceptable physical injury and the treating physicians relate the need...