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
Out-of-Possession; Out of Liability
At the beginning of 2016, the Georgia Court of Appeals reversed two trial court decisions that denied summary judgment over whether an owner was an out-of-possession landlord. At the beginning of 2016, the Georgia Court of Appeals reversed two trial court decisions that denied summary judgment over whether an owner was an out-of-possession landlord. Sidhi Inv. Corp. v. Thrift, No. A15A1678, 2016 WL 906328, at *2 (Ga. Ct. App. Mar. 10, 2016); Cowart v. Schevitz, No. A15A2036, 2016 WL 563114, at *3 (Ga. Ct. App. Feb. 15, 2016). In both cases, the trial court denied summary judgment to the landlord on the basis that the terms of the lease created issues of fact as to whether the ... Continue Reading
Psychological Injuries in Georgia Workers’ Compensation
When you think of a worker's compensation injury the first thing you probably think of is someone sustaining a physical injury, such as a back, knee or wrist injury, while performing some type of job. When you think of a worker’s compensation injury the first thing you probably think of is someone sustaining a physical injury, such as a back, knee or wrist injury, while performing some type of job. The majority of all workers’ compensation claims fall into the category of physical injuries. In 2014 The Bureau of Labor Statistics estimated there were 3.0 million reported workplace injuries in the United States. However, of that number psychological claims represented a tiny percentage ... Continue Reading
Answers in Apportionment
Appellate Court decisions this past year have provided significant guidance in the ever-developing arena of apportionment law in Georgia. Appellate Court decisions this past year have provided significant guidance in the ever-developing arena of apportionment law in Georgia. As you will recall, O.C.G.A. § 51-12-33(c) a subsection of the apportionment statute requires, “…the trier of fact shall consider the fault of all persons or entities who contributed to the alleged injury or damages, regardless of whether the person or entity was, or could have been, named as a party to the suit.” Last year, I prepared an article on apportionment which discussed the Court of Appeals decision in ... Continue Reading
Winning a Panel Fight – Timing is Everything
He who controls the medical controls the claim. In an accepted workers' compensation claim, controlling the medical has a significant impact on the overall claim exposure and on leverage during settlement negotiations. He who controls the medical controls the claim. In an accepted workers’ compensation claim, controlling the medical has a significant impact on the overall claim exposure and on leverage during settlement negotiations. Claimant’s attorneys are looking for any mistake to get a claimant to one of their doctors who will totally disable the claimant and recommend unnecessary medical treatment to drive up the claim value. Keeping a current posted panel of physicians is a critical ... Continue Reading
A Refresher and Overview of Death Claims
One of the most challenging cases that can arise in the workers' compensation arena involves a work-place fatality. One of the most challenging cases that can arise in the workers’ compensation arena involves a work-place fatality. These cases are difficult in terms of balancing of the tragedy surrounding the loss of a life and the devastation of the bereaved with the need to evaluate the claim for compensability, identify potential dependents, and timely commence benefits. In order to be compensable, a work-place fatality must arise out of and in the course of employment. Under Georgia law, if a death arises out of and in the course of employment or occurs during the period of disability, ... Continue Reading
The Paradox of Approaches: They Extend Further Than You Think
Georgia courts have gradually increased what constitutes an approach, and the Georgia Court of Appeals' recent decision in Six Flags Over Georgia II, L.P. v. Martin, 335 Ga. App. 350 (2015) exponentially expanded how far an approach extends. Georgia courts have gradually increased what constitutes an approach, and the Georgia Court of Appeals’ recent decision in Six Flags Over Georgia II, L.P. v. Martin, 335 Ga. App. 350 (2015) exponentially expanded how far an approach extends. While an appeal of the decision is pending before the Georgia Supreme Court, as it stands, the Court of Appeals decision leaves premises owners in a quandary of having to assume that its approaches may ... Continue Reading
Bias During the Appraisal Process: Are Contingency Fee Agreements Grounds for Appraiser Disqualification?
To expedite settlement during the adjustment process, homeowners' insurance policies include an "appraisal clause." This clause provides an avenue for insureds and insurers alike to resolve disagreements over the amount of damages suffered in any given loss. Pursuant to this clause parties each select an appraiser, these appraisers confer, and if they cannot agree, they select an umpire to determine the ultimate settlement amount. Of course, the presumption is that these appraisers are neutral. Otherwise, appraisers cannot be trusted, parties are not removed from their original deadlock and the fighting in the sandbox continues. To expedite settlement during the adjustment process, ... Continue Reading
Rising Roof Claims Causing Courts To Address Numerous Coverage Issues
With the rise of the number of roofing claims being filed with insurance companies over the past two years, the Courts are now issuing opinions addressing various coverage issues raised in these types of claims. Judge Lisa Wood of the Brunswick Division of Georgia's Southern District Court recently considered the validity of the insurance company's denial of interior water damage based, in part, on the exclusion for damages caused by faulty workmanship of roofers who were in the process of installing a new roof and the viability of the insured's claims that the insurer waived its defenses. Mock v. Central Mutual Insurance Company, ___ F.3d ___ (S.D., Ga., Brunswick, 2:14-cv-00113-LGW-RSB, ... Continue Reading