It's no surprise that a large portion of the money spent in a workers' compensation claim goes towards a claimant's medical treatment. It’s no surprise that a large portion of the money spent in a workers’ compensation claim goes towards a claimant’s medical treatment. Therefore, it is critical that an injured worker treats with a reputable physician who provides suitable treatment geared towards getting the employee back to work as fast as possible. Fortunately, the Board Rules give the employer/insurer the opportunity to maintain control over a claimant’s medical care in workers’ compensation claims. Unfortunately, among the cases that make it to litigation, many of ... Continue Reading
Call Off the Dogs: Basic Steps for Analyzing a Dog Owner’s Potential Liability under Georgia’s Dog Bite Statute
Under Georgia law, a dog owner's liability for injuries caused by her dog depends on several factors. Under Georgia law, a dog owner’s liability for injuries caused by her dog depends on several factors. Georgia’s so-called “Dog Bite Statute” provides: A person who owns or keeps a vicious or dangerous animal of any kind and who, by careless management or by allowing the animal to go at liberty, causes injury to another person who does not provoke the injury by his own act may be liable in damages to the person so injured. In proving vicious propensity, it shall be sufficient to show that the animal was required to be at heel or on a leash by an ordinance of a city, county, or ... Continue Reading
Think You Can’t Win on Summary Judgment? Think Again
Motions for summary judgment are critical tools to litigation, if they can be won. Motions for summary judgment are critical tools to litigation, if they can be won. They are useful for narrowing the issues for trial and can potentially end the litigation. In any case, a cost-benefit analysis must be performed to determine the chances of successfully obtaining summary judgment and the expenses to be incurred preparing the motion. However, such analysis can be daunting and particularly problematic in cases of insurance fraud with suspicious evidence being presented in support of a given claim. Fortunately for insurers, the United States District Court for the Northern District of Georgia has ... Continue Reading
Georgia Court of Appeals Defines What Constitutes “Customary Operations” of a Building Owner
Vacancy exclusions found in insurance policies issued to owners of commercial buildings typically provide that a building is vacant unless at least 31% of its total square footage is (i) rented to a lessee or sub-lessee and used b the lessee or sub-lessee to conduct its customary operations; and/or (ii) used by the building owner to conduct its customary operations. Vacancy exclusions found in insurance policies issued to owners of commercial buildings typically provide that a building is vacant unless at least 31% of its total square footage is (i) rented to a lessee or sub-lessee and used b the lessee or sub-lessee to conduct its customary operations; and/or (ii) used by the building ... Continue Reading
BOARD RULE 221(i) AND THE PITFALLS OF UNILATERALLY SUSPENDING BENEFITS VIA WC-2
Both the Workers' Compensation Act and Georgia State Board of Workers' Compensation Board Rules prescribe specific ways in which an employer/insurer can unilaterally suspend a claimant's benefits... Both the Workers’ Compensation Act and Georgia State Board of Workers’ Compensation Board Rules prescribe specific ways in which an employer/insurer can unilaterally suspend a claimant’s benefits. Some of the more common pitfalls, such as failing to provide ten days’ notice prior to suspension, can easily be avoided to prevent additional exposure. The first thing an employer/insurer needs when seeking to suspend a claimant’s benefits unilaterally is a legitimate reason to do so, and the most ... Continue Reading
Can An Insured’s Execution of An Authorization for Release of Information Satisfy A Insured’s Duties Following A Loss?
Under Georgia law, "[a]n insurer is entitled to require its insured to abide by the policy terms, and the insured is required to cooperate with the insurer in investigation and resolution of the claim."... Under Georgia law, “[a]n insurer is entitled to require its insured to abide by the policy terms, and the insured is required to cooperate with the insurer in investigation and resolution of the claim.” Diamonds & Denims, Inc. v. First of Georgia Ins. Co., 203 Ga.App. 681, 683, 417 S.E.2d 440 (1992). To what extent an insured has cooperated, and therefore, fulfilled his duties following a loss has long been debated by the courts in Georgia. The Eleventh Circuit recently held ... Continue Reading
The Georgia Supreme Court Gives Teeth to Statutes of Limitation
A recent Georgia Supreme Court decision, Roseburg Forest Products Company v. Barnes, has far reaching implications for Employers and Insurers when evaluating catastrophic claims... A recent Georgia Supreme Court decision, Roseburg Forest Products Company v. Barnes, has far reaching implications for Employers and Insurers when evaluating catastrophic claims. No. S15G1808, S15G11811 2016 WL 3147567 (Ga. June 6, 2016). The unanimous Court reiterated that the statutes of limitation within the Georgia Workers’ Compensation Act were enacted by the legislature for the purpose of lending finality to claims and should be afforded a plain, unambiguous reading. Under O.C.G.A. § 34-9-104(b), if the ... Continue Reading
O.C.G.A. 34-9-82 and the Potential for Waiver of the Statute of Limitations Defense
As a matter of practice, one of the first things an adjuster or defense counsel should do when receiving a file is to check to see whether a WC-14 notice of claim or hearing request has been filed, and if so, the date of the filing of the form. ... As a matter of practice, one of the first things an adjuster or defense counsel should do when receiving a file is to check to see whether a WC-14 notice of claim or hearing request has been filed, and if so, the date of the filing of the form. Why? Because one of the most fundamental aspects of bringing a workers’ compensation claim in Georgia is that it has to be done in a timely manner. The policy behind this filing deadline being that the ... Continue Reading
Clearing the Smokescreen: Evidence of Medical Bills Where the Underlying Accident was Covered by Workers’ Compensation Insurance
In Georgia, a personal injury plaintiff is entitled to recover all "reasonable and necessary" medical expenses arising from his or her injury. ... In Georgia, a personal injury plaintiff is entitled to recover all “reasonable and necessary” medical expenses arising from his or her injury. MCG Health, Inc. v. Knight, 325 Ga. App. 349 (2013). However, questions often arise when a Plaintiff seeks to use the “retail cost” for services rendered by a physician as evidence of medical expenses, when the amount actually paid for the services is far less than the “retail cost.” It is well settled that a defendant in a personal injury claim cannot introduce evidence that an entity other than ... Continue Reading
Practical Considerations and Pitfalls when Calculating a Claimant’s Average Weekly Wage under O.C.G.A. §34-9-260(1)
Your employee gets hurt on the job. The injury is compensable, and he or she goes out of work completely and receives temporary total disability ("TTD") benefits or is only able to work in a reduced capacity and receives temporary partial disability ("TPD") benefits... Your employee gets hurt on the job. The injury is compensable, and he or she goes out of work completely and receives temporary total disability (“TTD”) benefits or is only able to work in a reduced capacity and receives temporary partial disability (“TPD”) benefits. The employee/claimant is entitled to two-thirds of his or her gross earnings up to $550.00 per work in TTD benefits and $367.00 per week in TPD ... Continue Reading