March 01, 2012 BY Christopher Bennett
Adding Insult To Injury: Accidents While Traveling To And From Medical Appointments
Sometimes there seems to be no end at what a claimant wants to relate back to his or her work injury once a compensable injury has been established. As a result, employers and insurers are often presented with requests to pay for benefits that do not readily appear to be related to an original work injury. One such scenario involves accidents that occur traveling to and from doctors appointments. In the case of Flores v. Dependable Tire, Co., Inc., the Georgia Court of Appeals recently (and significantly) narrowed what such accidents are considered “related” to an original work injury. 2012 Ga. App. LEXIS 362.
In the Flores case, the Claimant had sustained a compensable on-the-job injury on February 12, 2008. Specifically, had he injured his back while lifting a large tire. Mr. Flores was unable to return to work and, as a result, the Employer and Insurer paid ongoing indemnity benefits and provided necessary medical treatment.
On November 18, 2008, approximately nine months after the date of accident, as Flores was traveling from a doctor's appointment related his February 12, 2008 compensable injury, the vehicle in which he was riding was struck from the rear. The collision caused injuries to the Claimant’s neck, back, chest, abdomen, pelvis and knees. In fact, Flores was ultimately diagnosed as having acute chest, abdomen and pelvic blunt trauma, neck sprain and acute contusions to both knees.
It was the Employer’s position that the intervening auto accident was the cause of the Claimant’s continuing medical problems and disability. Based upon this, it suspended indemnity and medical benefits. In turn, the Claimant filed the request for a hearing after the Employer suspended benefits. Ultimately, a hearing was held at the trial level of the State Board of Workers’ Compensation in order to determine whether Flores had a change in condition based on the intervening accident.
The administrative law judge (“ALJ”) concluded that the accident should be considered work-related and determined that the accident in question was a compensable event resulting in the Claimant's inability to work. As a result, the Employer was directed to pay indemnity benefits and provide medical treatment related to the November accident and provide continued treatment for the initial compensable injury. The Employer appealed to the Appellate Division of the State Board of Workers Compensation which adopted the ALJ's decision.
However, upon the Employer’s appeal, the Superior Court reversed the Board, concluding that the Board misapplied the law with respect to accidents occurring while traveling to and from medical appointments, erred by incorrectly ordering payment for medical expenses associated with the November 18, 2009 automobile accident and erred by finding that there was no change in condition (due to the intervening accident). Ultimately, the Claimant appealed the Superior Court decision to the Georgia Court of Appeals.
Two main issues were addressed by the Court on appeal. First, did the accident serve as an “intervening cause” which would sever the liability of the Employer for all future indemnity and medical treatment? Second, should the accident be considered “work related” since it occurred while the Claimant was returning from a doctor’s appointment which was for the purpose of treatment for his original work related injury?
Regarding the first issue, the Court held that the accident did not act as an intervening cause which would completely sever the Employer’s responsibility for subsequent benefits. The Court’s decision was based on medical evidence which established the Claimant original work related injuries had not resolved before the intervening accident and that these injuries continued after the second accident. However, regarding the second issue, the Court of Appeals held that any new injuries or aggravations sustained by the Claimant due to the second (November 18, 2008) auto accident were not compensable because the accident was not work-related.
Regarding this second issue, the Court reasoned that the question of whether an employee's injuries were sustained while en route to or from a physician's appointment for treatment of a work-related injury turned on whether the trip was voluntary in nature. In its decision, the Court cited Johnson Controls v. McNeil, where it was held that an accident did not arise out of the course and scope of the claimant's employment because the trip to the doctor was voluntary and the treatment was not a prerequisite to returning to work. 211 Ga. App. 783, 440 S.E.2d 528 (1994). In that case, it was found that the employer did not set up the appointment or provide the transportation and the employee was free to use his time for his own affairs. Id. 785-786. However, the Court noted that, in the case of Firestone Tire & Rubber Co. v. Crawford, it was held that injuries sustained in an accident en route to an employer-mandated appointment was related to the work injury and, therefore, compensable. 177 Ga. App. 242, 339 S.E.2d 292 (1985).
In the Flores case, the Employer provided transportation after it was requested by Flores' attorney. The Court indicated that this fact, alone, would render the accident not "work-related". In reaching this conclusion, the Court pointed to the following facts: (1) Flores was not going to or from work when the accident occurred; (2) the appointment was not required by the Employer; and (3) the Employer had no control over Flores' appointments.
In sum, despite the fact that the vehicle in which Flores was traveling was provided by the Employer’s insurance company, the Court nevertheless concluded the travel was not “related” because the transportation was provided at the Claimant’s request and because the appointment was “voluntary”, in that is was not specifically scheduled, required, (or even requested, for that matter) by the Employer in order for the Claimant to maintain benefits.
In light of the Flores decision, it is reasonable to expect travel to and from a doctors appointment, that has been requested by an employer (such as an IME or any other appointment specifically scheduled by the employer), to be considered a trip related to the claimant’s work injury. However, it appears that routine medical appointments that are scheduled by and between the claimant and his or her doctor - and not by the employer - will not be considered “work related”. In the end, the Flores decision should help employers and insurers determine what medical appointments will be considered “voluntary” and which ones will be considered “mandatory” and help them to plan accordingly.
The Journal is a publication for the clients of Drew Eckl & Farnham, LLP. It is written in a general format and is not intended to be legal advice to any specific circumstance. Legal Opinions may vary when based upon subtle factual differences. All rights reserved.
H. Michael Bagley